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Tadalafil oral tablet side effects: A detailed guide

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Tadalafil oral tablets are prescribed for erectile dysfunction, enlarged prostate, and a specific type of high blood pressure. It may cause mild or serious side effects, including heart-related side effects, such as blood pressure changes.
Medically reviewed by Rosanna Sutherby, PharmD
Updated on February 9, 2023

Specifically, the Food and Drug Administration (FDA) has approved tadalafil oral tablets to treat:

This article describes possible side effects of tadalafil oral tablets. You’ll also find information on cost savings and coupon options for tadalafil.

Tadalafil oral tablets are a generic version of the brand-name drugs Cialis and Adcirca.

You can explore this overview article to learn more about tadalafil oral tablets, including the drug’s uses, dosage, ways to save on cost, and more.

* Sex and gender exist on spectrums. In this article, we use the term “male” to refer to a person’s sex assigned at birth.

More common side effects of tadalafil

Tadalafil oral tablets may cause mild or serious side effects. Below are some of the more common side effects of this medication.

Commonly reported side effects of tadalafil oral tablets for erectile dysfunction, enlarged prostate, and pulmonary arterial hypertension include:

  • upset stomach
  • muscle pain
  • back, arm, or leg pain
  • stuffy nose
  • flushing (temporary warmth, redness, or deepening of skin color)
  • headache*

* To learn more about this side effect, see the “Side effects of tadalafil in detail” section below.

Mild side effects of tadalafil

Tadalafil may cause certain mild side effects. Usually, mild side effects are temporary and can be easily managed. Tell your doctor or pharmacist if you have side effects that don’t go away or become bothersome.

Mild side effects of tadalafil oral tablets that occurred in studies for erectile dysfunction (ED), enlarged prostate, and pulmonary arterial hypertension (PAH) include:

  • upset stomach
  • diarrhea
  • nausea
  • back, arm, or leg pain
  • muscle pain
  • stuffy nose
  • flushing (temporary warmth, redness, or deepening of skin color)
  • headache*
  • mild allergic reaction*†

* To learn more about this side effect, see the “Side effects of tadalafil in detail” section below.
† An allergic reaction is possible with tadalafil oral tablets. But it’s unclear whether it occurred in the drug’s studies for ED, enlarged prostate, and PAH.

Tadalafil oral tablets may cause more mild side effects than those listed above. For details, see the drug’s prescribing information for ED, enlarged prostate, and PAH.

Serious side effects of tadalafil

Tadalafil oral tablets may cause certain serious side effects. If you have any serious side effects from tadalafil, call your doctor right away. But if you think you’re having a medical emergency or your side effects feel life threatening, take immediate action. Call 911, or a local emergency number, or go to the nearest emergency room.

After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Visit MedWatch’s website if you’d like to notify the FDA about a side effect you’ve had with tadalafil oral tablets.

Serious side effects of tadalafil oral tablets that occurred in studies for erectile dysfunction (ED), enlarged prostate, and pulmonary arterial hypertension (PAH) include:

  • priapism (an erection that lasts for more than 6 hours without sexual stimulation)
  • hearing loss
  • heart-related side effects, such as low or high blood pressure*
  • eye-related side effects, such as vision loss or vision changes*
  • severe allergic reaction*†

* To learn more about this side effect, see the “Side effects of tadalafil in detail” section below.
† An allergic reaction is possible with tadalafil oral tablets. But it’s unclear whether it occurred in the drug’s studies for ED, enlarged prostate, and PAH.

Common questions about side effects of tadalafil

Here are answers to some common questions about side effects of tadalafil oral tablets. If you have other questions, talk with your doctor or pharmacist.

How do the side effects of tadalafil 20 mg compare with those of tadalafil 5 mg?

In studies,* certain side effects of tadalafil were more common at higher doses compared with lower doses.†

For example, side effects such as upset stomach, back pain, and muscle pain were more often reported with 20-milligram (mg) doses compared with 5-mg doses.

Note, if you have pulmonary arterial hypertension (PAH), your doctor will likely prescribe a higher dose of tadalafil to treat this condition. In studies of tadalafil for PAH, the risk of side effects increased with a higher dose of the drug. So you may have an increased risk of side effects if you take tadalafil for PAH.

If you’re concerned about side effects at different dosages of tadalafil, talk with your doctor.

* These studies of tadalafil were done in people with erectile dysfunction or enlarged prostate. For more information, see the drug’s prescribing information.
† For details about tadalafil’s dosages, see this article.

Does tadalafil cause long-term side effects?

Not usually. Mild side effects of tadalafil oral tablets are usually short term, going away as the drug wears off. Studies report that long-term side effects from tadalafil use over 6 months are rare.

However, certain rare, but serious side effects of the drug can have long-term complications. This includes priapism* (an erection that lasts for more than 6 hours without sexual stimulation). Priapism may cause damage to your penis and lead to permanent erectile dysfunction.

Non-arteritic anterior ischemic optic neuropathy (NAION) is another serious side effect of tadalafil that can lead to permanent vision loss in one or both eyes.† With NAION, there isn’t enough blood flow to the optic nerve. (Your optic nerve connects your eye to your brain.) This can lead to permanent damage to the optic nerve.

Call your doctor right away if you have an erection that lasts for more than 4 hours or if you have vision changes during your tadalafil treatment.

* To learn more about priapism, see the “Warnings for tadalafil” section below.
† For details about this side effect, see the “Side effects of tadalafil in detail” section below.

Can tadalafil cause liver-related side effects?

No, tadalafil oral tablets aren’t known to cause liver-related side effects.

However, if you have liver problems, your risk of side effects from tadalafil can increase. Your liver breaks down tadalafil and other drugs. So if your liver isn’t working correctly, more of the drug may stay in your body for a longer amount of time. This may increase the risk of side effects.

If you have liver problems, your doctor may recommend a lower starting dosage* of tadalafil. Or they may lower your dosage during your treatment if they detect changes in your liver function.

Also, your liver processes certain other drugs. So taking other drugs with tadalafil can affect your liver or increase your risk of side effects. Be sure to talk with your doctor about the other medications you take before starting tadalafil treatment.

If you have concerns about liver problems while taking tadalafil, talk with your doctor.

* For details about tadalafil’s dosages, see this article.

Coupon for tadalafil

Visit this page to access Optum Perks coupons and get price estimates for tadalafil when you use the coupons. These coupons can provide significant savings on your prescription costs.

Note: Optum Perks coupons cannot be used with any insurance copays or benefits.

Side effects of tadalafil in detail

Below you’ll find details on some of the side effects of tadalafil oral tablets.

Eye-related side effects

Tadalafil oral tablets can cause eye-related side effects, such as vision loss and changes in color vision.

Vision loss was rarely reported in studies* of tadalafil. With vision loss, some people may experience a sudden loss or decrease of vision in one or both eyes. This can be a sign of a serious condition called non-arteritic anterior ischemic optic neuropathy (NAION).

With NAION, your optic nerve doesn’t receive as much blood flow as usual. (Your optic nerve connects your eye to your brain.) Decreased blood flow to the optic nerve can cause damage to the nerve, which may result in vision loss.

With changes in vision color, you may have trouble telling if an object is blue or green. This side effect was rare in studies* and didn’t usually last long. But it occurred more often with higher doses of tadalafil.†

Ways to manage

Talk with your doctor right away if you have changes in your vision that don’t improve quickly. Loss of vision or a decrease in vision may be signs of a serious condition.

If you experience eye-related side effects from tadalafil, dimming or turning off bright lights may help temporarily. But if you keep having problems with your vision, talk with your doctor.

Before you begin tadalafil treatment, talk with your doctor about the possible eye-related side effects that tadalafil can cause.

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* To learn more about tadalafil’s studies, see its prescribing information for erectile dysfunction (ED), enlarged prostate, and pulmonary arterial hypertension (PAH).
† For details about tadalafil’s dosages, see this article.

Heart-related side effects, such as low or high blood pressure

Tadalafil oral tablets can cause heart-related side effects, such as low or high blood pressure. This is because the drug works to open blood vessels, which makes it easier for blood to flow through the body. This can cause low blood pressure. Heart-related side effects were rare in studies* of the drug.

Symptoms of low blood pressure may include:

  • lightheadedness
  • dizziness
  • fainting
  • confusion
  • weakness
  • nausea

In some cases, tadalafil can cause a sudden drop in blood pressure, especially if you take certain drugs along with tadalafil. These drugs include riociguat (Adempas), nitrates, or alpha-blockers. Very low blood pressure could even lead to a heart attack or stroke.

* To learn more about tadalafil’s studies, see its prescribing information for ED, enlarged prostate, and PAH.

Ways to manage

Talk with your doctor if you have symptoms of low blood pressure. But if you have chest pain, call 911 or your local emergency number right away.

If you have a heart condition, you may have an increased risk of heart-related problems while taking tadalafil. Talk with your doctor to see if tadalafil is safe for you.

If you feel dizzy, faint, or lightheaded, sit or lie down until you feel better. To help prevent falls, be sure to move slowly when switching positions, such as from sitting to standing.

Dehydration can also contribute to low blood pressure. So your doctor may recommend that you drink plenty of fluids while you’re taking tadalafil.

Headache

Headache is a common side effect of tadalafil oral tablets. In studies,* headache occurred more often as the dose† was increased.

Headache pain may be sharp or dull, or irregular or constant. This is usually a mild side effect that goes away after a few hours or days. But if they don’t go away, talk with your doctor.

Ways to manage

If you have a bothersome headache after taking tadalafil, your doctor may recommend taking over-the-counter (OTC) pain relievers. These include acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Your doctor or pharmacist can help determine if OTC drugs are safe for you.

If you experience headaches while taking tadalafil, your doctor may recommend that you keep track of them, by recording:

  • what type of pain you have
  • how often they occur
  • if they don’t go away over time during your treatment

You can help prevent headaches by getting a good night’s sleep and avoiding skipping meals. You can also help prevent them by reducing stress with relaxation techniques such as yoga.

* To learn more about tadalafil’s studies, see its prescribing information for ED, enlarged prostate, and PAH.
† For details about tadalafil’s dosages, see this article.

Allergic reaction

For some people, tadalafil oral tablets can cause an allergic reaction. But it’s not clear whether this side effect occurred in the drug’s studies.* Allergic reaction occurred once the drug became available for use.

Symptoms can be mild or serious, and they may include:

  • itchiness
  • skin rash
  • swelling under the skin, usually affecting eyelids, lips, hands, or feet
  • swelling of the mouth, tongue, or throat, which can make it hard to breathe
  • flushing (temporary warmth, redness, or deepening of skin color)

Ways to manage

For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know if you should keep taking the medication.

For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to tadalafil oral tablets, your doctor may recommend taking a different medication instead.

* To learn more about tadalafil’s studies, see its prescribing information for ED, enlarged prostate, and PAH.

Warnings for tadalafil

Below are some factors you may want to discuss with your doctor before taking tadalafil oral tablets.

Warnings

It may not be safe for you to take tadalafil oral tablets if you have specific health conditions. These are sometimes called drug-condition interactions. Other things may also affect whether tadalafil oral tablets are a safe treatment option for you.

Before taking tadalafil oral tablets, tell your doctor about your health and medications you take. Things to consider include those listed below.

Eye problems. Tadalafil may affect your vision or cause a sudden loss of vision in one or both eyes.* Vision loss may be a sign of a serious eye condition called non-arteritic anterior ischemic optic neuropathy (NAION). Talk with your doctor right away if you have vision changes that don’t go away or vision loss.

Allergic reaction. If you’ve had an allergic reaction* to tadalafil or any of its ingredients, your doctor will likely not prescribe this medication. Ask them about other treatment options that may be better for you.

Problems with penis shape. If you take tadalafil and have Peyronie’s disease or problems with the shape of your penis, you may have an increased risk of priapism. Priapism is a serious condition that needs immediate medical treatment. If you have an erection longer than 4 hours, go to a hospital or call 911 or your local emergency number.

The risk of priapism increases with certain conditions, such as sickle cell anemia, leukemia, and multiple myeloma. Tadalafil may further increase this risk. Talk with your doctor if you have any of these conditions.

Kidney disease. If you have kidney problems, you may have an increased risk of side effects from tadalafil. In this case, your doctor may prescribe a lower starting dose.† If your kidney problems are severe, they may not recommend you take tadalafil.

Liver problems. If you have liver problems, tadalafil can increase the risk of side effects. Your doctor may start your treatment with a lower dose† of tadalafil if you have problems with your liver. If you have severe liver problems, your doctor may recommend a different treatment option for you.

Bleeding disorders or peptic ulcers. Tadalafil may cause or worsen ulcers or bleeding. You may or may not experience symptoms. If you have a peptic ulcer or bleeding condition, your doctor may monitor you more closely during treatment.

Heart problems. If you have certain heart conditions or take certain medications during tadalafil treatment, your risk of heart-related problems* may increase. Be sure to tell your doctor if you’ve ever had a stroke or heart attack. Also tell them if you have angina, a heart rhythm problem, low or high blood pressure, or take certain medications for heart conditions. Your doctor can help determine if tadalafil is right for you.

* To learn more about this side effect, see the “Side effects of tadalafil in detail” section above.
† For details about tadalafil’s dosages, see this article.

Tadalafil and pregnancy

It’s not known if it’s safe to take tadalafil oral tablets during pregnancy. If you are pregnant or plan to become pregnant, talk with your doctor about the risks and benefits of taking tadalafil during pregnancy.

Tadalafil and breastfeeding

It’s unknown if tadalafil passes into breast milk. Your doctor won’t likely recommend breastfeeding while taking tadalafil.

If you’re taking tadalafil for pulmonary arterial hypertension, talk with your doctor about safe ways to feed your child during tadalafil treatment.

Tadalafil and alcohol

Both tadalafil oral tablets and alcohol can dilate (widen) your blood vessels. This can lead to a drop in blood pressure if you take alcohol and tadalafil together. To learn more about this side effect, see the “Side effects of tadalafil in detail” section above.

If you drink alcohol, talk with your doctor about whether any amount is safe to consume during your treatment with tadalafil.

What to ask your doctor

This article describes common and serious side effects of tadalafil oral tablets. If your doctor prescribes this medication, they can discuss possible side effects with you. Let your doctor know if you have concerns or questions about treatment with this medication.

Here’s a list of some possible questions you may want to ask your doctor:

  • How do the side effects of tadalafil and sildenafil compare?
  • How common are serious side effects from tadalafil such as priapism?
  • Will drinking grapefruit juice along with tadalafil cause any side effects?

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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