From the Guidelines
For erectile dysfunction, the recommended starting dose of Cialis (tadalafil) is 10 mg taken prior to anticipated sexual activity, with a maximum frequency of once daily, which can be adjusted based on individual response and tolerability, as supported by the American Urological Association guideline 1. The dose may be increased to 20 mg or decreased to 5 mg, and alternatively, a daily dosing regimen of 2.5 mg to 5 mg can be used regardless of timing of sexual activity, which maintains a constant level of the medication in the bloodstream.
- Tadalafil should be taken at least 30 minutes before sexual activity, and its effects can last up to 36 hours, which is longer than other ED medications.
- Patients with severe renal or hepatic impairment may require dose adjustments, and the medication should be used with caution in these cases, as noted in the guideline 1.
- Tadalafil works by inhibiting phosphodiesterase type 5 (PDE5), which increases blood flow to the penis by relaxing smooth muscles in blood vessel walls.
- It should not be taken with nitrates due to the risk of dangerous drops in blood pressure, and the choice of a specific PDE-5 inhibitor should be based on individual preferences, including ease of use, cost of medication, and adverse effects profile, as recommended by the American College of Physicians 1. Key considerations in prescribing tadalafil include:
- Balancing the goals of the patient and his partner for successful sexual activity with the need to minimize adverse effects
- Providing instructions on the appropriate use of the medication to maximize benefit and efficacy
- Monitoring for adverse effects, such as dyspepsia, headache, and flushing, which are commonly reported with PDE5i use 1.
From the FDA Drug Label
The recommended starting dose of tadalafil tablets for use as needed in most patients is 10 mg, taken prior to anticipated sexual activity. The dose may be increased to 20 mg or decreased to 5 mg, based on individual efficacy and tolerability. The recommended starting dose of tadalafil tablets for once daily use is 2.5 mg, taken at approximately the same time every day, without regard to timing of sexual activity. The tadalafil tablets dose for once daily use may be increased to 5 mg, based on individual efficacy and tolerability.
The recommended dosing for Cialis (tadalafil) in the treatment of erectile dysfunction is:
- For use as needed: 10 mg, taken prior to anticipated sexual activity, with a maximum dose of 20 mg and a minimum dose of 5 mg.
- For once daily use: 2.5 mg, taken at approximately the same time every day, without regard to timing of sexual activity, with a maximum dose of 5 mg 2.
From the Research
Cialis Dosing for Erectile Dysfunction
- The recommended dosing for Cialis (tadalafil) in the treatment of erectile dysfunction is either on-demand or once-daily dosing 3, 4.
- For on-demand dosing, the typical dose is 10mg taken prior to sexual activity, with a maximum frequency of once per day 3.
- For once-daily dosing, the recommended dose is 5mg taken at the same time every day, regardless of sexual activity 3, 5, 6.
- Studies have shown that both on-demand and once-daily dosing regimens are effective in improving erectile function, with once-daily dosing providing consistent therapeutic levels of tadalafil in the body 3, 4.
Efficacy of Cialis Dosing Regimens
- A multicenter, randomized, double-blind, placebo-controlled trial found that once-daily tadalafil 5mg and 10mg significantly improved erectile function compared to placebo 3.
- A review of several well-designed studies found that tadalafil 5mg once daily improved the total International Prostate Symptom Score (IPSS) and erectile function in men with benign prostatic hyperplasia (BPH) and erectile dysfunction 5.
- A systematic review and meta-analysis found that tadalafil daily dosing resulted in higher International Index for Erectile Dysfunction-Erectile Function domain scores compared to on-demand dosing, although the difference may not be clinically significant 4.