Should you take tadalafil daily?

In this article:

• Tadalafil daily
• Who benefits from daily use?
• Considerations for daily use
• Daily vs. as-needed tadalafil
• The bottom line

In this article

• Tadalafil daily
• Who benefits from daily use?
• Considerations for daily use
• Daily vs. as-needed tadalafil
• The bottom line

Erectile dysfunction (ED) is a lot more common than most people think, affecting an estimated 30 million men in the United States alone, according to the NIH. Although it might not be the easiest topic to discuss, treatment options have improved, offering more flexibility. 

One of the most well-known options is tadalafil, a medication that is FDA approved for the treatment of erectile dysfunction and the symptoms of benign prostatic hyperplasia (enlarged prostate). It is also known by the brand name Cialis and belongs to a class of medications called phosphodiesterase-5 (PDE5) inhibitors, which work by relaxing blood vessels and increasing blood flow where it counts. 

Many people still think of ED medications as something you take right before intimacy. But tadalafil has quietly expanded the playbook. In addition to on-demand use, it can also be taken as a low-dose daily medication. So, can you take tadalafil daily? Yes, and for some people, it may actually be the better fit.

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Can you take tadalafil daily? 

Most of the time, tadalafil is taken on an as-needed basis, before engaging in sexual activity. But that’s not the only dosing option.

“ED medications like tadalafil, along with similar ED treatments like Viagra (sildenafil) and Levitra (vardenafil), were originally thought of as something you take when you need them,” says Bilal Chughtai, MD, chief of urology, Plainview Hospital and Syosset Hospital. “But daily dosing has changed that conversation.” Daily dosing of tadalafil allows a person’s treatment to blend into their daily routine, Dr. Chughtai says.

According to Anurag Das, MD, chair of urology at Northwell’s Staten Island University Hospital, other daily tadalafil benefits include:

• Spontaneity and less need to plan your life around taking a pill.
• More stable drug levels in your body, which can translate to more predictable responses as compared with on‑demand use.
• Better symptom control for benign prostatic hyperplasia (enlarged prostate), which may include a reduced need to wake at night to urinate and decreased urinary urgency.
• Potentially fewer peak‑dose side effects for some patients.

When taken on an as-needed basis, the starting dose is 10 mg, which can be increased to a higher dose of 20 mg if needed. A typical tadalafil daily dose is 2.5-5 mg, taken once daily. 

How to know if daily tadalafil is right for you? “I would recommend any patient experiencing ED symptoms work closely with their provider to see if tadalafil may be a good fit for their medication regimen based on their current medications and lifestyle considerations,” says Kari M. Ford, Pharm.D., director of pharmacy at Saint Anthony Hospital’s SAH Pharmacy. 

Who benefits most from daily tadalafil?

There are several different groups of people who benefit from daily tadalafil, including:

• Men who prefer spontaneity: Males who have ED and don’t like the interruption of on-demand tadalafil may benefit from daily tadalafil. “Daily tadalafil is most beneficial for patients experiencing ED who prefer spontaneity in their sexual activity rather than timed intercourse,” Dr. Ford says. 
• Men who’ve had prostate cancer treatment: Some men experience ED after prostate cancer treatment, and tadalafil can help. “We often prescribe daily Cialis [tadalafil] for men after treatment for prostate cancer in order to maintain adequate blood flow to help with erections,” says Jairam Eswara, MD, chair of urology at Tufts Medical Center. 
• Men with both ED and benign prostatic hyperplasia (BPH): Taking tadalafil daily is particularly helpful for men “who are experiencing both ED and benign prostatic hyperplasia [enlarged prostate], as daily tadalafil administration can address both of these symptoms,” Dr. Ford notes. 

Considerations and potential drawbacks of daily use 

While most people who take tadalafil daily don’t have major issues, daily dosing of tadalafil is not for everyone.

First of all, not everyone wants to have to take a medication like tadalafil on a daily basis. “The trade-off is that you’re committing to a daily medication,” Dr. Chughtai says. “For some people, that’s a worthwhile exchange for consistency, while others prefer a more as-needed approach.”

Another issue is health insurance coverage. “Insurance may not cover daily dosing for ED; out‑of‑pocket costs can add up, though generics are inexpensive at many pharmacies,” Dr. Das says. Since insurance companies differ, call your provider if you have questions about tadalafil coverage.

People often worry about the effects of long-term tadalafil use. Thankfully, there isn’t much to be concerned with here. “Overall, tadalafil has a strong long‑term safety record in clinical trials and post‑marketing surveillance, including studies with daily 5 mg for many months to years,” Dr. Das assures.

Additionally, there are sometimes instances where taking tadalafil isn’t compatible with other medications you are taking. In particular, “tadalafil is contraindicated in patients taking nitrate medications due to the risk for severe low blood pressure,” Dr. Ford says. As such, if you are prescribed a nitrate medication (such as nitroglycerin for chest pain associated with heart disease), you must avoid tadalafil for 48 hours. Additionally, use caution with alpha blockers, such as tamsulosin or doxazosin, because this combination can lower blood pressure as well. This is not a complete list. Be sure to share all prescription and over-the-counter medications you take with your prescribing provider to avoid a drug interaction.

Comparing daily vs. as-needed tadalafil use

If you’re unsure which is better for you—daily use of tadalafil or “on demand” use—talk it over with your healthcare provider. Plus, the following are some considerations to keep in mind.

Effectiveness

There isn’t strong evidence to find that daily tadalafil is more or less effective than “on demand” dosing. Both seem to be effective for ED. But for some people, having tadalafil in their system at a steadier pace may make it more effective. “Taking low-dose Cialis [tadalafil] may provide improved blood flow compared to taking it as needed, almost like ‘priming the pump’ so to speak,” Dr. Eswara says, thereby improving erectile function. 

Side effects

Everyone reacts differently to tadalafil. Some people experience no side effects, while others may have more noticeable side effects. The good news is that serious side effects are uncommon. “Most side effects are mild, like headache, some nasal congestion, or back pain, and often improve as the body adjusts,” Dr. Chughtai notes.

If you do experience side effects, the disadvantage to daily use of tadalafil is that you’ll experience these side effects more persistently, whereas “on demand” use minimizes side effect exposure. If daily tadalafil is a priority for you, “dose reduction (5 mg to 2.5 mg) or switching to on‑demand use or a different phosphodiesterase type 5 can help,” Dr. Das says. 

Lifestyle integration

The main pro of daily tadalafil is that it can be taken without consideration of sexual function.

“This gives the patient the freedom to take the medication at a time convenient for them and is shown to be useful in patients desiring more spontaneous sexual intercourse or those who have concomitant BPH symptoms,” Dr. Ford says. 

But for other men, as-needed tadalafil works well, and they’d rather not have a routine that involves daily ED pills. “The choice really comes down to lifestyle, urinary symptoms, and frequency of sexual activity,” Dr. Chughtai says.

The bottom line

Like with any medication, taking tadalafil on a daily basis isn’t the best choice for everyone. “Some men prefer not to take a daily pill, and others may experience side effects like headache or nasal congestion,” Dr. Chughtai says. “There is no one-size-fits-all approach.”

Dr. Chughtai urges patients to seek medical advice from their provider, discussing their symptoms, preferences, and quality-of-life goals. “Ultimately, daily tadalafil is about improving quality of life, both in terms of sexual health and urinary function,” he concludes.