Tadalafil (Cialis) Dosing Recommendations for ED and BPH
For erectile dysfunction (ED), tadalafil should be started at 10 mg taken prior to anticipated sexual activity, with dose adjustments between 5-20 mg based on efficacy and tolerability, while for benign prostatic hyperplasia (BPH), the recommended dose is 5 mg once daily taken at approximately the same time every day. 1
Erectile Dysfunction (ED) Treatment Options
On-Demand Dosing for ED
- Starting dose: 10 mg taken prior to anticipated sexual activity
- Dose range: May be increased to 20 mg or decreased to 5 mg based on individual response
- Maximum frequency: Once per day
- Timing: Can improve erectile function up to 36 hours following dosing
- Administration: Can be taken without regard to food 1
Once-Daily Dosing for ED
- Starting dose: 2.5 mg taken at approximately the same time every day
- Dose adjustment: May be increased to 5 mg based on efficacy and tolerability
- Timing: Take without regard to timing of sexual activity 1
Benign Prostatic Hyperplasia (BPH) Treatment
- Recommended dose: 5 mg once daily taken at approximately the same time every day 1
- When combined with finasteride: 5 mg once daily for up to 26 weeks 1
Combined ED and BPH Treatment
- Recommended dose: 5 mg once daily taken at approximately the same time every day 1
- Studies show tadalafil 5 mg once daily improves both LUTS/BPH symptoms and erectile function 2, 3
Special Population Considerations
Renal Impairment
- Moderate impairment (CrCl 30-50 mL/min):
- For on-demand use: Start at 5 mg, maximum 10 mg not more than once every 48 hours
- For once-daily use (BPH or ED/BPH): Start at 2.5 mg, may increase to 5 mg based on response
- Severe impairment (CrCl <30 mL/min):
- For on-demand use: Maximum 5 mg not more than once every 72 hours
- For once-daily use: Not recommended 1
Hepatic Impairment
- Mild to moderate impairment (Child-Pugh Class A or B):
- For on-demand use: Should not exceed 10 mg once per day
- For once-daily use: Use with caution
- Severe impairment (Child-Pugh Class C): Not recommended for any dosing regimen 1
Efficacy and Clinical Considerations
- Daily tadalafil 5 mg significantly improves erectile function in men with ED 4
- In men with both ED and BPH, tadalafil 5 mg once daily improves both conditions simultaneously 3
- The 17.5-hour half-life of tadalafil allows for sustained therapeutic plasma levels with daily administration 4
- Patients using tadalafil can take advantage of its 36-hour duration of action, with studies showing patients attempt intercourse at various times after dosing 5
Important Precautions
- Do not use with nitrates in any form due to risk of severe hypotension 1
- Use with caution in patients taking alpha-blockers, though studies show tadalafil 5 mg can be safely combined with alpha-blockers for BPH treatment in most patients 6
- Common side effects include headache, dyspepsia, back pain, myalgia, nasal congestion, flushing, and limb pain 7, 8
- Patients should be instructed on proper use, including the need for sexual stimulation and that more than one trial may be required to establish efficacy 7
Treatment Algorithm
- Assess for contraindications (nitrate use, severe cardiovascular disease)
- For ED only:
- Start with 10 mg on-demand OR 2.5 mg daily
- Titrate based on response and tolerability
- For BPH only or combined ED/BPH:
- Use 5 mg once daily dosing
- Evaluate response after 4-12 weeks
- Adjust dose or consider alternative treatments if inadequate response
Remember that incorrect use accounts for many treatment failures, so proper patient education is essential for optimal outcomes 7, 8.