Can Cialis treat your BPH symptoms? Here’s the breakdown

In this article:

• Understanding BPH
• Cialis for BPH
• Efficacy
• Usage instructions
• Side effects and precautions
• Contraindications
• Cialis vs. other BPH treatments
• Is Cialis right for you?
• Expert takeaway

In this article

• Understanding BPH
• Cialis for BPH
• Efficacy
• Usage instructions
• Side effects and precautions
• Contraindications
• Cialis vs. other BPH treatments
• Is Cialis right for you?
• Expert takeaway

Cialis (tadalafil) is widely known for treating erectile dysfunction (ED), but it is also approved to treat an enlarged prostate, known as benign prostatic hyperplasia (BPH). This condition can cause urinary symptoms such as frequent urination and difficulty emptying the bladder. While there are several treatments for BPH, Cialis may help relieve symptoms for some people. 

Understanding BPH

Benign prostatic hyperplasia is a non-cancerous enlargement of the prostate caused by hormonal changes. It becomes more common with age, particularly in men older than 50. According to Harvard Health, around half of all men will have BPH by age 60, and up to 90% of men will have it by age 85. Not all men who have BPH will experience symptoms.

The prostate is a gland that sits below the bladder and surrounds the urethra. As it enlarges, it can press on the urethra, affecting urine flow. Common symptoms of BPH include:

• Frequent urination
• Waking up to urinate
• Difficulty beginning urination
• A weak or slow urine stream
• Dribbling after urination
• Incontinence
• Pain during urination or ejaculation
• Unusual urine color or odor

In some cases, it can lead to more serious symptoms from secondary urinary retention and infection that require immediate medical attention, including:

• Inability to urinate at all
• Blood in urine
• Fever and chills with urgent and painful urination
• Lower abdomen or urinary tract pain

How does Cialis work for BPH?

The active ingredient in Cialis is tadalafil, which is a phosphodiesterase 5 (PDE5) inhibitor. It works by blocking the PDE5 enzyme that breaks down cGMP, a messenger molecule within numerous cells of our body, including smooth muscle cells. As cGMP levels increase, it signals the smooth muscles in our blood vessels, prostate, and bladder to relax. This reduces pressure on the urethra, improves blood flow to the area, and helps relieve BPH symptoms. 

How effective is Cialis for BPH symptoms?

Research has shown that Cialis is an effective treatment for BPH. For example, clinical trials that examined patients at 54 different urology centers found that once-daily Cialis improved symptoms of both BPH and erectile dysfunction. Other studies reported similar findings, showing that men taking tadalafil experienced greater improvement in lower urinary tract symptoms compared to those taking a placebo.

Still, Cialis is not the best choice for all BPH cases. “In my experience, it is not the most effective treatment when urinary obstruction is the main problem,” says David Shusterman, MD, urologist and founder of Modern Urologist. “It may improve symptoms, but it tends to be less effective in larger prostates, especially above about 40 grams.”

In some cases, Cialis may offer advantages over other treatments. “Where it really stands out is in men who also have erectile dysfunction, which is incredibly common in this population. Being able to address both issues with one medication is a big win,” says Jason B. Carter, MD, urologist and medical adviser at Aeroflow Urology. “That said, I usually frame the benefit as meaningful but modest. It’s not a ‘night and day’ drug for most of my patients, but for the right person, it can noticeably improve quality of life.”

How to use Cialis for BPH

Cialis comes in doses up to 20 mg for ED when taken as-needed, but the typical daily dose for BPH is 5 mg. Research has shown that this dose can significantly improve the BPH symptoms. People with kidney disease may require a lower dose, such as 2.5 mg, depending on the severity of their condition.

Cialis can be taken with or without food, but it should be taken consistently to maintain steady levels in the body. 

“The biggest point I emphasize is that this is a daily medication, not something you take as needed. The standard dose is 5 mg once a day, and consistency matters,” Dr. Carter says. “This is about symptom management, not a cure, and it works best when patients stick with it, and we reassess over time. And practically speaking, I remind my patients to take it at the same time each day.”

Always follow your healthcare provider’s instructions when taking Cialis, as dosing and use may vary based on your individual condition. 

Side effects and precautions

Like most prescription drugs, Cialis has some potential side effects. Common side effects of Cialis may include:

• Headache
• Indigestion or upset stomach
• Back pain
• Muscle pain
• Stuffy nose
• Flushing
• Limb pain

These side effects are typically mild and temporary. However, more serious side effects can occur and require immediate medical attention, including:

• Prolonged erections
• Loss of vision
• Trouble hearing
• Cardiovascular events
• Low blood pressure (hypotension)
• Allergic reactions

Who should not take Cialis for BPH?

According to the drug’s label, Cialis is contraindicated for people who are allergic to tadalafil or any other ingredients, as well as those who take nitrates or guanylate cyclase stimulators. In these cases, a healthcare provider will recommend an alternative treatment. It’s also not recommended for people who have severe kidney or liver disease.

Before taking Cialis, you should let your healthcare provider know if you have any of the following pre-existing conditions:

• Mild-to-moderate kidney disease
• Mild-to-moderate liver disease
• High/low blood pressure
• Heart disease
• Pulmonary hypertension
• Diabetes
• High cholesterol
• Stomach ulcers
• Bleeding problems
• Penile deformities
• Blood cell conditions
• Eye conditions
• Stroke

In addition to these medical considerations, Cialis may not be effective for everyone, particularly in more advanced cases of BPH.

“In my experience, if a patient has a very large prostate or clear obstructive issues, high residuals, retention, that kind of picture, Cialis alone is usually not going to move the needle enough,” Dr. Carter says. “In those cases, relying on it can delay more effective treatment, which is something I try to avoid.”

Cialis is not approved for use in women. There’s limited research on tadalafil in pregnancy or breastfeeding, but women should avoid it regardless.

Drug interactions

Cialis can interact with certain medications, so it may not be appropriate if you’re already taking others. In addition to nitrates and guanylate cyclase stimulators, possible Cialis interactions include:

• Alpha blockers
• Certain anti-infective medications
• Other PDE5 inhibitors
• Antihypertensives

People taking one of these drugs should consult their healthcare provider before using Cialis.

People taking Cialis should avoid or minimize alcohol consumption, as both alcohol and tadalafil can lower your blood pressure.

Additionally, certain foods or supplements may also interact with Cialis. For example, grapefruit or grapefruit juice can slow how the body breaks down the drug, while St. John’s Wort may affect its metabolism. 

Cialis vs. other BPH treatments

Several different medications can help relieve the symptoms of BPH, including alpha blockers, 5- alpha reductase inhibitors (5-ARIs), and phosphodiesterase type 5 (PDE5) inhibitors like Cialis. Based on current evidence, the American Urological Association strongly recommends combination therapy with alpha blockers and 5-ARIs for certain patients.

“If the patient has mild symptoms and erectile dysfunction, Cialis can be reasonable. If I am treating BPH more directly, an alpha blocker such as Flomax is usually a better medication choice,” Dr. Shusterman says. 

Cialis may offer a unique advantage for people with both BPH and erectile dysfunction. A study from 2020 comparing tadalafil and tamsulosin (Flomax) found that both drugs performed similarly in treating BPH symptoms, but tadalafil was superior for men who also had erectile dysfunction.

However, medication alone may not be enough for everyone. “Many men, especially those with larger prostates, do not get enough benefit from medication alone,” Dr. Shusterman says. “In those patients, I often recommend PAE, a very minimally invasive procedure that can provide better relief with fewer side effects than many long-term medication strategies.” 

Other surgical procedures for BPH may use scopes, lasers, or water jets to remove prostate tissue and relieve pressure on the urethra.

Is Cialis right for you?

If you have symptoms of BPH, you have several treatment options to choose from, each with its own pros and cons. Choosing the right one depends on factors like your overall health, the medications you’re taking, and the severity of your symptoms. For people with BPH and erectile dysfunction, Cialis might be a helpful option.

 “BPH treatment isn’t one-size-fits-all.” Dr. Carter says. “Cialis is a great tool. It’s one piece of a larger, very individualized strategy.” A healthcare provider can evaluate your symptoms, circumstances, and overall health, and offer personalized advice on which BPH treatment is best for you.

Expert takeaway

“Men are often pleasantly surprised to learn that Cialis can be used to treat both their BPH and ED symptoms, but that enthusiasm should be tempered with an understanding about commonly encountered interactions with blood pressure meds, heart disease treatments, and alpha blockers for BPH,” cautions Chad Shaffer, MD, member of the SingleCare Medical Board.