Cialis side effects and how to avoid them

In this article:

• Common side effects
• Serious side effects
• How long do they last?
• Long-term side effects
• Contraindications & warnings
• Interactions
• How to avoid side effects

In this article

• Common side effects
• Serious side effects
• How long do they last?
• Long-term side effects
• Contraindications & warnings
• Interactions
• How to avoid side effects

Cialis (tadalafil) is a brand-name prescription medication that treats erectile dysfunction, as well as the signs and symptoms of an enlarged prostate (benign prostatic hyperplasia or BPH). Classified as a phosphodiesterase type 5 (PDE5) inhibitor, tadalafil relaxes penile smooth muscles and arteries and increases blood flow to the penis. 

As can be expected, medicines that affect blood vessels may have unwanted side effects and potentially risky drug interactions. People considering Cialis should be aware of the potential side effects, potential interactions, and any medical conditions that may make the medicine unsuitable.

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Common side effects of Cialis

The most common side effects of Cialis are:

• Headache
• Indigestion or upset stomach
• Back pain
• Muscle pain
• Nasal congestion (stuffy nose)
• Flushing
• Pain in the limbs 

Serious side effects of Cialis

Cialis can cause serious side effects such as:

• Prolonged erections: Though rare, some people have reported prolonged erections (erections lasting longer than four hours) or priapism (painful erections lasting longer than six hours) with this class of prescription drugs, which includes Cialis, Viagra (sildenafil), vardenafil, and Stendra (avanafil). Both prolonged erections and priapism should receive emergency medical treatment. Priapism may damage erectile tissues if it is not treated right away.
• Sudden loss of vision: Non-arteritic anterior ischemic optic neuropathy or NAION has been reported—rarely—in people taking drugs like tadalafil. NAION can cause a sudden decrease or complete loss of vision in one or both eyes. Immediately stop the drug and get emergency medical help if you notice changes in vision.
• Sudden loss of or decrease in hearing: Hearing loss has been reported with Cialis and may be accompanied by dizziness or ringing in the ears. Immediately stop the drug and get emergency medical help if you notice a change in or loss of hearing.
• Cardiovascular events such as fainting, chest pain, heart attack, or stroke: Many people who have had severe cardiovascular events while taking Cialis had pre-existing risk factors.
• Low blood pressure (hypotension): Tadalafil lowers blood pressure, so low blood pressure is a possible side effect.
• Severe allergic reactions: Rare but severe (and potentially life-threatening) hypersensitivity reactions due to Cialis include hives, Stevens-Johnson syndrome, and exfoliative dermatitis. Get emergency medical help if you have symptoms of a reaction, such as hives, trouble breathing, swelling, skin pain, blistering or peeling skin, fever, or burning eyes.

How Cialis affects blood pressure

Cialis relaxes the arteries, which can cause a drop in blood pressure. For most healthy users, this effect is mild and temporary. However, those taking antihypertensive drugs (drugs to treat high blood pressure) or alpha blockers should exercise caution. People who take nitrates or guanylate cyclase stimulators should never take a PDE5 inhibitor like Cialis. 

Clinical studies show that in healthy males, combining Cialis with blood pressure medications slightly increases the risk of hypotension but rarely causes severe outcomes.

How does Cialis affect the heart?

Cialis relaxes blood vessels, which can lower blood pressure. This blood pressure-lowering effect is typically mild in most healthy individuals. However, Cialis should not be used with certain medicines, such as nitrates, because it could result in dangerously low blood pressure. Serious cardiovascular events (heart attack, stroke, chest pain, palpitations, fast heart rate, and sudden cardiac death) have been reported in association with Cialis use, although many patients had preexisting heart conditions. Be sure to inform your healthcare professional of your full medical history, including any existing heart problems, before taking Cialis. 

How long do Cialis side effects last?

Many common side effects of Cialis are temporary and will subside or disappear as your body adjusts to the medication.

Other side effects, such as severe allergic reactions, prolonged erections, priapism, hearing loss, and cardiovascular events, require immediate medical attention and may require long-term attention. Severe but rare possible adverse events such as damage to erectile tissues due to priapism, hearing loss, heart attack, or stroke may have lifelong consequences. Vision loss due to NAION can be permanent.

Does dose affect the prevalence of side effects?

In many cases, certain side effects of tadalafil may be slightly more prevalent at higher doses. For example, 11% of people who took 5 mg or 10 mg doses reported headache, compared to 15% of those who took 20 mg. And 4% of people taking 5 mg doses reported indigestion, compared to 8% of those who took 10 mg doses and 10% of users taking 20 mg doses. If you tolerate a lower dose well and notice side effects at higher doses, your healthcare provider may suggest going back to a lower dose. 

What are the long-term side effects of Cialis?

A study of long-term use of Cialis (taken as needed for ED) over an 18- to 24-month period found the medicine to be safe and well-tolerated. The most common side effects in people who took Cialis for this period of time were headache, common cold symptoms, and back pain. In this study, about 6% of users stopped taking Cialis due to side effects. Although 8.6% of patients had serious side effects, the researchers did not find a cause-and-effect relationship. However, there are many factors that can influence whether you will have long-term side effects of Cialis, so it’s best to discuss your medical history with your healthcare provider to determine the best—and safest—treatment for you. 

Cialis contraindications & warnings

Cialis may not be the right drug for all men, particularly because of its effects on the cardiovascular system. Cialis is contraindicated (should never be used) in men:

• With an allergy to tadalafil or any ingredient in the medicine
• Who take nitrates or guanylate cyclase stimulators

For some people, the healthcare provider will weigh the risks and benefits to ensure the drug is safe for you. Be sure to tell your healthcare provider about any medical conditions you have, including:

• Mild to moderate kidney disease (Cialis is not recommended for people with severe kidney problems or who are on dialysis)
• Mild to moderate liver disease (Cialis is not recommended for people with severe liver problems)
• High or low blood pressure
• Cardiovascular (heart) problems, or a previous heart attack or stroke
• Pulmonary hypertension (high blood pressure in the arteries of the lungs) 
• Diabetes
• High cholesterol (hyperlipidemia)
• Stomach ulcers
• Bleeding problems
• A history of NAION or any other vision or eye problems, including retinitis pigmentosa
• Penile deformities such as Peyronie’s disease, cavernosal fibrosis, or angulation
• A history of an erection lasting more than four hours
• A blood cell condition such as sickle cell anemia, leukemia, or multiple myeloma

According to the prescribing information, patients with cardiovascular conditions such as myocardial infarction, angina (chest pain), hypotension, stroke, or uncontrolled arrhythmias at present, or in the recent past, should not take Cialis because no clinical studies have been conducted to evaluate safety and efficacy.

Who Should Not Take Cialis

• Children: Cialis is not approved for anyone under the age of 18 years.
• Women: Cialis is not FDA-approved for use in women, nor is it recommended during pregnancy or breastfeeding.
• Older adults: No dosage adjustment is required based on age alone, but older adults should be closely monitored for cardiovascular risks or other issues.

Abuse and dependency

Cialis is not a controlled substance and does not cause physical addiction or withdrawal, but misuse (especially for recreational use) may lead to psychological dependence.

Recreational use increases risks of side effects, unsafe sexual behavior, and dangerous drug interactions, particularly when mixed with stimulants or “poppers.”

Cialis interactions

Before taking Cialis, inform your healthcare provider about all the medications you are taking, including prescription and over-the-counter drugs, vitamins, and supplements. Avoid these combinations:

• Nitrates (e.g., nitroglycerin, isosorbide dinitrate): Dangerous drops in blood pressure. Nitrates are contraindicated with PDE5 inhibitors like Cialis. 
• Guanylate cyclase stimulators (e.g., Adempas, Verquvo): Contraindicated.
• Other ED medications (e.g., Viagra, Levitra): Increased risk of hypotension.
• Strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): May increase tadalafil levels and side effects.
• CYP3A4 inducers (e.g., rifampin): May reduce Cialis effectiveness.

Additionally, grapefruit and juices that contain grapefruit can interact with Cialis. Check with your healthcare provider before combining grapefruit with Cialis. 

Drinking too much alcohol can increase your risk of certain side effects like headache, dizziness, fast heart rate, and low blood pressure. If you drink alcohol, check with your healthcare provider for medical advice on how much alcohol is safe for you during Cialis treatment. 

How to avoid Cialis side effects

Follow these 8 key tips to reduce your risk of side effects and get the best results from Cialis:

1. Use Cialis only under medical supervision. Get a prescription from a licensed healthcare provider after a full medical evaluation.
2. Buy from a licensed pharmacy. Avoid counterfeit or online “cheap” versions — they may contain unsafe ingredients.
3. Take Cialis exactly as prescribed. Do not increase or decrease the dose without consulting your doctor.
4. Be transparent about your health. Inform your provider about all medical conditions and medications.
5. Take only one dose per day. Cialis stays active up to 36 hours; overdosing increases side effect risk.
6. Avoid grapefruit and excessive alcohol. Both can heighten side effects and reduce safety.
7. Monitor blood pressure regularly. Especially if you’re taking antihypertensives or have heart disease.
8. Practice safe sex. Cialis does not protect against sexually transmitted diseases — use condoms and safe practices.