Selective phosphodiesterase-5 (PDE-5) inhibitor
ATC code: G04BE08 (Tadalafil)
A selective phosphodiesterase-5 (PDE-5) inhibitor – the enzyme degrading cGMP in smooth muscle cells. cGMP accumulation enhances nitric oxide action, relaxing penile cavernous body smooth muscle (erectile function) and prostatic smooth muscle (LUTS improvement in BPH). Compared with sildenafil and vardenafil, 17.5-hour half-life is much longer – effect lasts up to 36 hours (the «weekend pill»). CYP3A4-metabolized.
Second line
Used in symptomatic benign prostatic hyperplasia in patients with concomitant erectile dysfunction per EAU 2024. Dose 5 mg once daily. Effect on IPSS and Qmax is comparable to tamsulosin, with less retrograde ejaculation. Dual benefit in coexisting conditions makes tadalafil a preferred choice in this group.
First line
First-line for erectile dysfunction per EAU 2024 and AUA 2018 alongside other PDE-5 inhibitors (sildenafil, vardenafil, avanafil). Taken 30 minutes before intercourse at 10–20 mg or daily at low dose 2.5–5 mg. Efficacy around 70% in psychogenic and vascular erectile dysfunction. Lower (40–50%) in diabetes or post-prostatectomy. Do not combine with nitrates.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Tadalafil is a long-acting phosphodiesterase-5 (PDE5) inhibitor. It is prescribed for erectile dysfunction, benign prostatic hyperplasia, and pulmonary arterial hypertension (AEMPS Ficha Técnica). In sports circles, tadalafil is promoted to improve pulmonary gas exchange and physical endurance in healthy athletes. Clinical studies in healthy athletes are small and conflicting. The drug has specific risks: headache, facial flushing, nasal congestion, dyspepsia, muscle pain, visual disturbances (bluish tint), rarely non-arteritic anterior ischemic optic neuropathy (vision loss risk), and sudden hearing loss. It is dangerous combined with nitrates (sharp blood pressure drop). If tadalafil is used for training, consider seeking a second opinion.
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Not used in women for erectile dysfunction (male indication). In pulmonary arterial hypertension in pregnant patients, use is possible for life-saving indications with pulmonology consultation.
Not used in women (male indication).
Tadalafil is evaluated for the following indications with varying evidence strength: Benign prostatic hyperplasia (evidence tier A), Erectile dysfunction (evidence tier A), Athletic endurance (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Tadalafil (≥ 1 in 100): Headache, Facial flushing, Nasal congestion, Dyspepsia, Back pain and myalgia, Dizziness. See the Safety section for uncommon and serious reactions.
FDA category B. Not used in women for erectile dysfunction (male indication). In pulmonary arterial hypertension in pregnant patients, use is possible for life-saving indications with pulmonology consultation.
Not used in women (male indication).
Tadalafil is contraindicated in: Tadalafil hypersensitivity; Concomitant organic nitrates in any form; Concomitant riociguat; Severe heart failure; Stroke or MI in the last 6 months. Full list in the Safety section.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.