What if a single tablet could help improve sexual performance, ease urinary symptoms and blood flow-related health conditions? That’s exactly what Tadalafil has become a cornerstone medication in men's health. Tadalafil is part of a group called PDE5 inhibitors, which increase the amount of blood to particular tissues. Though it is most often thought of for ED, it is also prescribed for prostate enlargement, as well as an advanced lung disease. However, because it acts on blood vessels all over the body, it is equally important to know its three indications, dosages, and side effects.
What are the Uses for Tadalafil?
The initial approval for Tadalafil was in 2003. It has since been approved for three distinct indications, each with a specific way of determining its dosage.
Condition | What it means | How tadalafil helps |
Erectile Dysfunction (ED) | Difficulty getting or keeping an erection firm enough for sex | Improves blood flow to the penis during sexual stimulation |
Benign Prostatic Hyperplasia (BPH) | Non-cancerous prostate enlargement causing urinary symptoms | Relaxes smooth muscle in the prostate and bladder neck, easing urine flow |
ED + BPH combined | Many men experience both conditions together | A single daily dose can manage both sets of symptoms at once |
Pulmonary Arterial Hypertension (PAH) | High blood pressure in the arteries of the lungs | Sold as Adcirca; relaxes pulmonary vessels to ease strain on the heart |
How Common are These Conditions in Australia?
Statistic | Figure |
Australian men with some degree of ED | Around 1 in 4 (25%) |
Men aged 60–69 affected by ED | Approximately 70% |
Australian men over 40 affected by ED | Around 1 in 5 |
ED is common with increasing age, but it's not necessarily part of aging. Underlying conditions (cardiovascular disease, diabetes, hypogonadism, anxiety and certain drugs) are often to blame and this is why a thorough evaluation should be conducted before any medication is initiated.
How does Tadalafil work?
Tadalafil belongs to a class of drugs called PDE5 inhibitors. In simple terms, tadalafil works as follows:
- The body produces nitric oxide when it becomes sexually aroused, and a substance called cGMP is then generated within the penis smooth muscle.
- The smooth muscle then relaxes, and it becomes easier for blood to fill up the penis and to become erect.
- An enzyme, called PDE5, is available, which normally breaks down cGMP and shortens the duration of an erection.
- Tadalafil inhibits PDE5 and enables the cGMP to continue to function for a longer duration, allowing for an easier erection to be achieved.
Tadalafil dosage
Condition | Typical dose | How it's taken | Notes |
ED (on demand) | 10 mg (range 5–20 mg) | At least 30 min before activity; max once daily | Not affected by food |
ED (daily) | 2.5–5 mg (dm Steady plan) | Once daily, regardless of timing of sex | Best for men sexually active more than twice a week |
BPH | 5 mg | Once daily | May be combined with finasteride in some cases |
ED + BPH combined | 5 mg | Once daily | Single tablet manages both conditions |
PAH (Adcirca) | 40 mg | Once daily | Must not be combined with other PDE5 inhibitors |
The dose of all ED medications should be dictated by a doctor, and especially for men with impaired liver or kidney function. For men with the aforementioned, lower starting doses are usually prescribed.
How long do Tadalafil and other ED drugs last?
A great feature of tadalafil is just how long it lasts compared to other medications.
Medication | Approx. onset | Approx. duration |
Sildenafil (Viagra) | 30–60 minutes | Upto 12 hours (dm Ready plan) |
Vardenafil (Levitra) | 30–60 minutes | Up to 12 hours |
Avanafil (Spedra) | 15–30 minutes | Up to 6 hours |
Tadalafil (Cialis) | ~30 minutes | Up to 36 hours (dm Lasting plan) |
With tadalafil, the elimination half life is around 17.5 hours (22 hours in men over 65), indicating that this length of time must pass before the body has cleared half of the dose. For this reason, single doses can last up to 36 hours, leading to its moniker 'the weekend pill'. With its duration, this makes the dose of daily, low dose tadalafil consistent throughout the bloodstream.
TADALAFIL VS SILDENAFIL
Factor | Tadalafil | Sildenafil |
Duration | Up to 36 hours | Up to 12 hours |
Effect of food | Not affected | Absorption slowed by heavy meals |
Daily dosing option | Yes (2.5–5 mg) | Not typically |
Best suited for | Spontaneity, frequent activity | Planned, occasional use |
It's not really a case of which of these drugs is "better" – the most suitable medication for you depends on your level of sexual activity, and whether you wish to plan around the medication or not, along with how your body reacts to each medication.
Brand Name and Cost in Australia
Tadalafil is available under name Cialis, and also as various TGA-approved generic preparations. These are Apo-Tadalafil, Tadalafil Sandoz, Tadalafil GH, Tadalafil Alphapharm, and Tadalafil-RZ. All of these are Schedule 4-Prescription only- Medicines and must conform to the same quality and efficacy standards set out by the TGA.
The cost of generic tadalafil is generally considerably cheaper than the cost of brand-name Cialis. Some generic preparations are also subsidised by the Repatriation Pharmaceutical Benefits Scheme (RPBS) for eligible veterans and those with a DVA card. Otherwise, for most men, the cost is generally a private prescription price - please check with your doctor or pharmacist for current prices for your particular dose and brand.
Tadalafil: Side effects
In most cases, the side effects are relatively mild to moderate and are usually temporary while the body adjusts to the medication.
Side effect | How common | Notes |
Headache | Common | Usually mild; often improves with continued use |
Indigestion or heartburn | Common | More likely at higher doses |
Back pain | Common | Typically resolves within 1–2 days |
Muscle aches (myalgia) | Common | Can occur 12–24 hours after dosing |
Flushing | Common | Temporary warmth or redness of the face |
Nasal congestion | Common | Usually mild and short-lived |
Dizziness | Less common | More likely when combined with alcohol or blood pressure medication |
Nausea | Less common | Often related to dose level |
Serious Tadalafil Side Effects-Call a doctor NOW
These side effects are uncommon but demand an immediate doctor visit. Any of the following calls for stopping tadalafil and getting medical help right away.
- Priapism - Priapism is a rare but serious side effect that requires immediate medical attention. An erection lasting longer than four hours can cause permanent tissue damage if not treated promptly.
- A Sudden Decrease in Vision- This might occur in either one eye or both and can mean an occurrence of NAION (a form of optic nerve dysfunction that has occurred at rare intervals in patients). Men with diabetes, hypertension, and underlying heart disease are at higher risk for this particular disorder.
- An Occurrence of Sudden Hearing Loss- Very rarely has PDE5 medication led to a drop in the ability to hear, and sometimes it may be associated with tinnitus, the ringing in the ears, or vertigo/dizziness.
- A Severe Lowering of Blood Pressure- The greatest potential drug interaction; described in detail under Drug Interactions below.
- Angina during sex- A person suffering from chest pain, vertigo/dizziness, or nausea should not hesitate to stop their activity and contact a doctor, since this may be indicative of heart disease.
Is Tadalafil Safe?
Tadalafil has shown long-term tolerability, especially when taken long-term for BPH in multi-year trials for most healthy men. However, not every person is a candidate for taking this pill. A prescribing physician will need to confirm:
- Prior occurrences of NAION
- Serious heart disorders like recent heart attacks or stroke or unstable angina
- Very low or uncontrolled blood pressure
- Significant kidney or liver failure
- Risks that cause priapism, such as sickle cell anemia and structural anomalies of the penis
- Use of nitrates, either prescribed or recreational.
Drug interactions
Interacting substance | Risk | Guidance |
Nitrates (GTN, isosorbide) and “poppers” | Severe, potentially life-threatening drop in blood pressure | Absolute contraindication — never combine |
Riociguat (Adempas) | Dangerous hypotension | Should not be combined with tadalafil |
Alpha-blockers (tamsulosin, doxazosin, terazosin) | Additive blood pressure lowering, dizziness, or fainting | Use only under medical supervision with careful dose timing |
Other PDE5 inhibitors (sildenafil, vardenafil, avanafil) | Increased risk of hypotension and side effects | Should not be taken together |
Strong CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin) and grapefruit juice | Raised tadalafil blood levels | May require a lower dose; discuss with your doctor |
Excess alcohol | Increased risk of dizziness and low blood pressure | Limit intake, particularly when starting treatment |
Tips To Enhance the Effectiveness of Tadalafil:
- Start at the lowest recommended dose your doctor prescribes, especially with the first dose of tadalafil.
- Be able to adequately address cardiovascular risk factors (e.g., high cholesterol, hypertension, diabetes); cardiovascular health is key to how effective PDE-5 inhibitors can be.
- Limit alcohol, especially 4 hours prior to or post your dose.
- Physical exercises can help maintain good blood flow and may enhance your response over time.
Missed Dose, storage, and overdose
When taking tadalafil as a daily low dose, if you forget to take a tablet, take it as soon as you remember, unless it is nearing the time for your next dose, in which case the dose missed should be ignored and the next dose taken as per instructions. If using as a take when required therapy 'missing a dose' is impossible, the drug should be taken before intercourse only. Do not take doses more frequently than stated in the pack.
Tadalafil tablets should be kept at room temperature in a dry area away from direct sunlight and out of the reach of children. It is unlikely that taking more of tadalafil than is prescribed will increase its effectiveness, and it will considerably increase the chances of experiencing the most common and/or serious side effects: a bad headache, flushing, low blood pressure, or priapism.
If too much tadalafil is taken, call Poisons Information Centre 13 11 26 ( Australia) or local hospital or emergency service.
When You Should See a Doctor:
Call your doctor if any of the following occur.
- If you have new or worsening difficulties with erections.
- If you have a decrease in the strength of your urine stream, or an increase in frequency of urination, or if you are finding it difficult to start or stop urination.
- If you have a severe adverse effect to a PDE5 inhibitor, or the adverse effect does not resolve.
- If you suddenly lose some vision or hearing or have an erection that lasts more than 4 hours, you require emergency attention.
Buying Tadalafil Safely: Avoiding Counterfeit Medication
Buying medicines from overseas websites without needing a prescription runs the risk that they are neither safe nor effective. In Australia, genuine tadalafil can only be lawfully provided upon a registered medical practitioner's prescription, dispensed by a registered pharmacy.
Telehealth platforms that involve an AHPRA-registered doctor and a registered pharmacy provide a convenient and discreet way to obtain an alternative to a face-to-face GP appointment.
Access Tadalafil through DirectMeds
DirectMeds is an AHPRA-registered telehealth service designed for confidential, doctor-led access to tadalafil (and all other PDE5s). Whether for ED or for ED/BPH symptoms, you can be on treatment within minutes.
- Fill out our free, two-minute online assessment.
- Chat with an AHPRA-registered doctor in under five minutes
- Discuss your personalized treatment plan and optimal dosage/formulation
- Get your prescription and the medication delivered discreetly to your doorstep
Frequently Asked Questions For Tadalafil: Uses and Side Effects:
How much time does tadalafil take to take effect?
Tadalafil takes about 30 minutes to begin to take effect, with full effects kicking in over an hour later. The optimum effect of a daily low dose of tadalafil to achieve a sustained bloodstream level is 5-7 days.
How to differentiate Tadalafil and Sildenafil (Viagra)?
Tadalafil and sildenafil are both PDE5 inhibitors that work in a similar way. The main difference is duration of action. Tadalafil can remain effective for up to 36 hours, whereas sildenafil generally remains effective for up to 12 hours. Unlike sildenafil, tadalafil's absorption is not significantly affected by food, including high-fat meals.
Should I take tadalafil daily?
Yes. An approved dose taken at a low daily level (2.5mg to 5mg) has been approved by the TGA for the treatment of BPH and ED. This eliminates the need to predict when sexual intercourse is to take place. Your doctor will advise whether you would do better on daily or intermittent use.
How long can I safely take tadalafil for?
Tadalafil has an excellent long-term safety record for most healthy men, including a number of multi-year studies for its use in treating BPH. Continued regular monitoring by a doctor is still advised, particularly if there are cardiovascular risks.
What are the consequences of mixing tadalafil and alcohol?
Moderate amounts of alcohol taken with tadalafil should pose no serious risks. Drinking to excess can lead to increased dizziness and low blood pressure, as well as being detrimental to your erections.
Can tadalafil treat both ED and prostate enlargement?
Yes, tadalafil has been officially approved to treat both conditions-just a once daily dose of 5 mg can treat the urinary problems associated with BPH and help ED as well.
Is it embarrassing to have an online tadalafil prescription?
No. Telehealth consults for both ED and BPH are held confidentially and follow clinical guidelines just like any in-person consultation. Telehealth sites will use a packaging service to ensure a discreet package can be sent directly to you.
What is the cost of tadalafil in Australia?
Generally, the price of generic tadalafil is significantly less than the brand-name Cialis. This cost varies based on many factors, including dosage, number of tablets, and the dispensing pharmacy. RPBS subsidies do apply to some brands if eligible for veterans; other than this, most males would pay a private script cost-check with the doctor or pharmacist, which rate you apply to the dosage that you require.
Is it safe to purchase tadalafil online from offshore websites without a prescription?
No. This is one of the drugs that is most commonly falsified. Online vendors could provide the incorrect dosage or a harmful substance, so the only safe place to obtain tadalafil is through Australian licenced pharmacists, prescribed by an Australian doctor.