Can Tadalafil (Cialis) cause rectal bleeding?

From the Guidelines

Tadalafil is not directly associated with rectal bleeding as a common side effect, but it may increase the risk of bleeding when used with other medications, such as anticoagulants, due to its vasodilatory effects. The medication works by increasing blood flow to certain areas of the body, which can potentially worsen existing hemorrhoids or other rectal conditions. According to the study by 1, anticoagulants can increase the risk of bleeding complications, particularly in older adults. Additionally, the study by 1 highlights the importance of considering the risk of thrombosis and bleeding in patients with certain medical conditions, such as ulcerative colitis.

• Key points to consider:
  • Tadalafil may interact with blood-thinning medications, increasing bleeding risk
  • Patients with existing hemorrhoids or other rectal conditions may be at higher risk of bleeding
  • Anticoagulants can increase the risk of bleeding complications, particularly in older adults
  • The risk of bleeding should be carefully evaluated and monitored in patients taking tadalafil, especially when used in combination with other medications. If you experience rectal bleeding while taking tadalafil, you should stop the medication and seek medical attention promptly, as the bleeding could be unrelated to the medication and might indicate other conditions requiring treatment, as suggested by 1. Your healthcare provider may need to evaluate whether tadalafil is the cause or if another underlying condition is responsible, and they may recommend alternative treatments for your condition.

From the FDA Drug Label

1. 12 Effects on Bleeding Studies in vitro have demonstrated that tadalafil is a selective inhibitor of PDE5. PDE5 is found in platelets. When administered in combination with aspirin, tadalafil 20 mg did not prolong bleeding time, relative to aspirin alone. Tadalafil has not been administered to patients with bleeding disorders or significant active peptic ulceration Although tadalafil has not been shown to increase bleeding times in healthy subjects, use in patients with bleeding disorders or significant active peptic ulceration should be based upon a careful risk-benefit assessment and caution.

The FDA drug label does not directly address the question of whether tadalafil can cause rectal bleeding. However, it does discuss the effects of tadalafil on bleeding in general, stating that it has not been shown to increase bleeding times in healthy subjects, but use in patients with bleeding disorders or significant active peptic ulceration should be based on a careful risk-benefit assessment and caution 2.

From the Research

Tadalafil and Rectal Bleeding

• There is no direct evidence in the provided studies that suggests tadalafil can cause rectal bleeding 3, 4, 5, 6.
• The studies primarily focus on the efficacy and side effects of PDE-5 inhibitors, including tadalafil, in the treatment of erectile dysfunction, and do not mention rectal bleeding as a potential side effect.
• One study examines the effects of sildenafil on rectal sensitivity and tone in patients with irritable bowel syndrome, but it does not investigate the effects of tadalafil on rectal bleeding 5.
• Another study reviews patient-preference studies comparing tadalafil, vardenafil, and sildenafil, but it does not discuss rectal bleeding as a potential side effect of these medications 6.

Available Information

• The available studies provide information on the efficacy and side effects of PDE-5 inhibitors, including tadalafil, in the treatment of erectile dysfunction 3, 4, 6.
• They also discuss the effects of sildenafil on rectal sensitivity and tone in patients with irritable bowel syndrome 5.
• However, they do not provide direct evidence on the potential of tadalafil to cause rectal bleeding.