Tadalafil (Cialis): daily mini-dose or on demand?

Tadalafil, known under the trade name Cialis, is after sildenafil one of the most important active ingredients against erectile dysfunction. Its special feature is the unusually long duration of effect, which has earned it the nickname weekend pill. But tadalafil can do more than that: it can be taken either specifically on demand or as a daily mini-dose, and in a low dose it additionally helps with an enlarged prostate. This guide explains neutrally and factually how the two intake strategies work, what the dual benefit is about and how tadalafil differs from sildenafil. It does not replace medical advice but helps you ask the question that fits you.

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At a glance

  • Tadalafil (Cialis) is a PDE-5 inhibitor that improves the blood flow in the penis but only works with sexual arousal.
  • With up to 36 hours it has the longest duration of effect of its substance class and is therefore often called the weekend pill.
  • There are two strategies: the on-demand intake of a higher dose or the daily low continuous therapy.
  • In a low daily dose, tadalafil is also approved for benign prostate enlargement, a dual benefit.
  • The combination with nitrates or poppers is absolutely forbidden. Tadalafil is prescription only.

What is tadalafil and how does it work?

Tadalafil belongs, like sildenafil and vardenafil, to the group of PDE-5 inhibitors, named after the enzyme phosphodiesterase 5, which the active ingredient blocks. It was brought to the market in 2003 under the name Cialis; since the expiry of the patent protection in 2017, there are also cheaper generics. Tadalafil is used above all with erectile dysfunction, alongside with benign prostate enlargement and in certain cases with a form of pulmonary hypertension.

The principle of action is the same as with the other PDE-5 inhibitors. With sexual arousal a messenger called cGMP is formed in the penis, which relaxes the blood vessels so that more blood can flow in and an erection arises. The enzyme phosphodiesterase 5 breaks this messenger down again. Tadalafil inhibits this enzyme, so that the messenger can work longer and the blood flow is improved. Very important here: tadalafil only works erection-enhancing, not erection-producing. Without sexual arousal nothing happens, and the sexual desire is also not increased. What sets tadalafil apart from the other active ingredients is its long half-life of about 17.5 hours, from which the duration of effect of up to 36 hours results. This long half-life is also the reason why tadalafil is the only active ingredient of its class suitable for daily continuous use.

Not a desire agent but a circulation aid

A common misunderstanding is that tadalafil is an aphrodisiac that creates desire or triggers an erection by itself. That is wrong. The active ingredient neither increases the sexual desire nor works without arousal. It only improves the physical reaction when a sexual stimulation is present. This also applies during the long duration of effect: the 36 hours do not mean a permanent state but a time window in which the natural reaction to arousal is facilitated.

Daily mini-dose or intake on demand?

The probably most important practical difference with tadalafil are the two possible intake strategies, which do not exist in this form with most other erectile agents. With on-demand intake one takes a higher single dose specifically before the planned sexual activity, usually about half an hour to two hours beforehand. Thanks to the long duration of effect, the time window afterwards remains large, so that the intake does not have to be planned to the minute. This variant is suitable for people who are sexually active rather occasionally and plannably. It has the advantage that the active ingredient is only taken when it is actually needed, which keeps the total amount in the body low and is intuitively obvious for many.

The second strategy is the daily continuous therapy with a low mini-dose. With it one takes a small amount every day at the same time of day if possible, independently of whether sex is planned. Because the active ingredient accumulates in the body and builds up a constant level, a facilitated erection with arousal is possible over the whole time, entirely without forward planning. Because of the long half-life, the exact time of intake does not play a big role; only the regularity is important. This variant is suitable above all for people who are regularly sexually active and want maximum spontaneity. Some also find it relieving that the thought of the single tablet before sex falls away and the pressure of planning decreases. Which strategy fits better is not a question of right or wrong but depends on the personal lifestyle and should be discussed medically.

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The dual benefit with an enlarged prostate

A real special feature of tadalafil is its dual benefit. Since 2012 the active ingredient has been approved in Europe in a low daily dose not only for erectile dysfunction but also for the treatment of complaints with urination as a result of a benign prostate enlargement. Tadalafil is thereby the only agent of its class that can tackle both problems at the same time. For men who suffer from both, this can be practical because two complaints can be treated with a single daily tablet.

The exact mechanism of action with the prostate is not yet fully clarified. It is assumed that the PDE-5 inhibition leads to a relaxation of the smooth muscles in the prostate, bladder neck and bladder, which can improve the bladder emptying and ease the complaints. Important, however, is a restriction: with pure prostate complaints without a simultaneous erectile disorder, tadalafil is not reimbursed by the statutory health insurance in Germany. For the sole treatment of the prostate enlargement, the established and reimbursable agents such as alpha blockers or 5-alpha-reductase inhibitors therefore remain the standard. The dual benefit is worthwhile above all when an erectile disorder is to be co-treated anyway. In this case, with a single daily tablet, two birds can so to speak be struck with one stone, which can simplify the treatment routine. If, on the other hand, only one of the two complaints is present, a therapy specifically tailored to it is mostly the better and often also cheaper choice.

Two birds with one stone, but not for everyone

The dual benefit sounds tempting but is not the best choice for everyone. Anyone who suffers exclusively from prostate complaints is mostly better off with the agents established and reimbursable for this. Anyone who, on the other hand, has both an erectile disorder and prostate complaints, for them the daily tadalafil therapy can be a sensible joint option. Whether this applies to your situation, you best clarify together with your urological or general medical practice.

Tadalafil or sildenafil: a fair comparison

Tadalafil and sildenafil are the two best-known PDE-5 inhibitors, and the question of the better agent is frequent. The honest answer is: there is no generally better agent, only a better-fitting one. Both work according to the same principle and are well effective with erectile dysfunction. The decisive difference lies in the pharmacokinetics, that is in how fast and how long they work. Sildenafil sets in after about 30 to 60 minutes and works around four to six hours. It is well suited for the targeted, plannable use.

Tadalafil works clearly longer with up to around 36 hours and thereby allows more spontaneity. In addition there are the daily continuous option and the additional benefit with prostate complaints, which sildenafil does not offer. On the other hand, with tadalafil, side effects can also last longer because of the long duration of effect. Which active ingredient fits better therefore depends on the lifestyle: anyone who plans sex rather specifically gets along well with sildenafil; anyone who wants maximum spontaneity or additionally has prostate complaints benefits rather from tadalafil. The individual tolerability also plays a role. This weighing-up is best made together with the medical practice. Some people try out both active ingredients with medical accompaniment to find out which fits better in everyday life and in terms of the side effect profile. A switch is also possible later, in case the life circumstances or the needs change. Important is only that every changeover is medically accompanied and does not happen on a solo basis.

Aspect Tadalafil (Cialis) Sildenafil (Viagra)
Duration of effect up to around 36 hours about 4 to 6 hours
Onset of effect about 15 to 30 minutes about 30 to 60 minutes
Daily continuous option yes, as continuous therapy as a rule no
Additional prostate benefit yes, approved for prostate enlargement no

Side effects and the most important safety rule

Like every effective medicine, tadalafil too has side effects that mostly follow directly from the vessel-widening effect. Common are headache, a facial flushing, a blocked nose and digestive complaints. Typical for tadalafil are also back and muscle pains that can be connected with the long duration of effect. Less often dizziness or temporary visual disturbances occur. Because tadalafil stays in the body so long, the side effects too can last correspondingly longer than with shorter-acting agents. A rare but serious emergency is a painful prolonged erection that lasts longer than four hours, technically called priapism, and must be treated medically immediately.

The by far most important safety rule concerns the nitrates. Like all PDE-5 inhibitors, tadalafil must never be taken together with nitrates. Nitrates are used with heart diseases such as angina pectoris, for example as a spray or tablet under the tongue. Both nitrates and tadalafil lower the blood pressure via the same pathway and strengthen each other, which can lead to a life-threatening drop in blood pressure with circulatory failure, heart attack or stroke. Because of the particularly long duration of effect of tadalafil, this risk exists over a longer period than with shorter-acting agents, which makes the medical clarification all the more important. Anyone who has taken tadalafil should without fail inform the treatment team of this in an emergency so that a nitrate is not accidentally administered, for example with sudden heart complaints.

Never combine tadalafil with nitrates or poppers

Never take tadalafil together with nitrates, not even with an emergency nitro spray for heart complaints. The same applies to so-called poppers, that is party drugs that contain nitrites. Both combinations can lead to a fatal drop in blood pressure, and because of the long duration of effect of tadalafil, this danger applies over many hours, partly more than a day. If you have been prescribed nitrates or use poppers, tell your medical practice this without fail before tadalafil even comes into question.

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In sum, tadalafil is a versatile and well-researched medicine that helps many people with erectile dysfunction and offers, with its long duration of effect and the two intake strategies, a lot of flexibility. The dual benefit with the prostate is a sensible option when both problems exist but is not worthwhile with pure prostate complaints. Serious use means knowing the basic rules: tadalafil only works with arousal and must never be combined with nitrates or poppers. With an erectile dysfunction or a prostate enlargement, tadalafil can be an effective building block. Anyone seeking a comparison with sildenafil should weigh lifestyle, spontaneity and tolerability together with the practice. Anyone who has an erectile disorder should also have the cause clarified, because behind it can be treatable diseases such as diabetes or high blood pressure, and an erectile disorder can even be an early warning signal for cardiovascular problems.

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Frequently asked questions about tadalafil (Cialis)

Tadalafil, known as Cialis, belongs to the PDE-5 inhibitors and is used above all with erectile dysfunction. It inhibits an enzyme that breaks down a messenger for the erection, so that the vessels in the penis relax and the blood flow improves, but only with sexual arousal. It does not increase desire. Special is the long duration of effect of up to 36 hours. Tadalafil is prescription only.
With on-demand intake one takes a higher dose specifically before the activity, mostly half an hour to two hours beforehand. With the continuous therapy one takes a low dose daily at the same time of day, independently of planned sex. As a result a constant active ingredient level and maximum spontaneity arise. Which variant fits depends on frequency and plannability and should be discussed medically.
The nickname comes from the long duration of effect. While sildenafil works about four to six hours, tadalafil can be active for up to around 36 hours, thanks to a half-life of about 17.5 hours. In this time window an erection is more easily possible with arousal, without exact planning. The term is, however, somewhat misleading, because here too the agent only works with arousal.
Yes. In a low daily dose, tadalafil has been approved since 2012 in Europe also for complaints with urination as a result of a benign prostate enlargement and is thereby the only agent of its class with this dual benefit. Important: with pure prostate complaints without an erectile disorder, it is not reimbursed by the statutory health insurance in Germany; here other agents remain standard.
There is no generally better agent. Sildenafil works faster and shorter, about four to six hours, and is suitable for targeted use. Tadalafil works up to around 36 hours, offers a daily continuous option and the additional benefit with prostate complaints. Which agent fits depends on lifestyle, spontaneity and tolerability and should be decided medically.
Common are headache, facial flushing, blocked nose and digestive complaints. Typical are also back and muscle pains. Less often dizziness or visual disturbances occur. A rare emergency is a painful prolonged erection over four hours that must be treated immediately. Because of the long duration of effect, side effects can last longer with tadalafil.
Tadalafil, like all PDE-5 inhibitors, must never be taken with nitrates. Nitrates are used with angina pectoris, for example as a spray. Both lower the blood pressure via the same pathway and can strengthen each other dangerously, up to a life-threatening drop in blood pressure. Because of the long duration of effect, the risk applies especially long. The same applies to poppers. This combination is absolutely forbidden.
This must be clarified medically. With well-controlled high blood pressure, tadalafil is often possible, but because it itself lowers the blood pressure, caution is required, especially with several blood pressure agents or alpha blockers. The physical exertion during sex can also be a risk with heart diseases. A medical examination beforehand is important.
This is strongly advised against. Tadalafil is prescription only because it has serious interactions and risks. Erectile agents offered over the counter are frequently counterfeit and can contain wrong or harmful substances. Obtain tadalafil only through a prescription and an approved pharmacy. The medical examination protects you from exactly these dangers.

Related topics

Sources

  • Gelbe Liste: tadalafil, use, effect, side effects
  • Pharmazeutische Zeitung: tadalafil, more than an erectile agent (BPH approval)
  • Fernarzt: tadalafil, effect and duration of effect
  • apomeds: Cialis vs. Viagra, comparison of the PDE-5 inhibitors
  • DoktorABC: tadalafil, dosage and intake
  • kup.at: continuous therapy with tadalafil 5 mg daily

This guide serves general information and does not replace medical advice, diagnosis or treatment. It contains no dosage recommendation. Tadalafil is prescription only. Use it only on medical prescription and examination, obtain it exclusively through approved pharmacies and never combine it with nitrates or poppers. With questions, turn to your medical practice or pharmacy.