Recommended Dosing of Cialis (Tadalafil) for ED and BPH
For erectile dysfunction (ED), the recommended starting dose of tadalafil is 10 mg taken prior to anticipated sexual activity, which may be increased to 20 mg or decreased to 5 mg based on individual efficacy and tolerability. For benign prostatic hyperplasia (BPH), the recommended dose is 5 mg once daily. 1
Dosing Options for Erectile Dysfunction
As-Needed Dosing
- Starting dose: 10 mg taken before sexual activity
- Dose range: 5-20 mg based on response and tolerability 1
- Maximum frequency: Once per day 1
- Timing: Can be effective up to 36 hours after dosing 1
Once-Daily Dosing
- Starting dose: 2.5 mg taken at approximately the same time every day
- Maximum dose: May be increased to 5 mg once daily based on efficacy and tolerability 1
- Advantage: Allows for spontaneous sexual activity without timing medication 2
Dosing for Benign Prostatic Hyperplasia (BPH)
- Recommended dose: 5 mg once daily, taken at approximately the same time each day 1
- When combined with finasteride: 5 mg once daily for up to 26 weeks 1
Dosing for Combined ED and BPH
- Recommended dose: 5 mg once daily 1, 3
- Clinical benefit: Significantly improves both ED symptoms (measured by IIEF-EF) and BPH symptoms (measured by IPSS) 3, 4
Special Populations and Considerations
Renal Impairment
- Moderate impairment (CrCl 30-50 mL/min):
- For as-needed use: Start with 5 mg, maximum 10 mg every 48 hours
- For once-daily use: Start with 2.5 mg, may increase to 5 mg based on response 1
- Severe impairment (CrCl <30 mL/min):
- For as-needed use: Maximum 5 mg every 72 hours
- For once-daily use: Not recommended 1
Hepatic Impairment
- Mild to moderate impairment (Child-Pugh Class A or B):
- For as-needed use: Maximum 10 mg once per day
- For once-daily use: Use with caution 1
- Severe impairment (Child-Pugh Class C): Not recommended 1
Concomitant Medications
- Nitrates: Contraindicated due to risk of severe hypotension 1
- Alpha-blockers: Can be safely combined with tadalafil 5 mg once daily with minimal risk of hypotensive events 5
Efficacy and Side Effects
Efficacy
- Tadalafil improves successful sexual intercourse attempts in approximately 69% of men compared to 33% with placebo 2
- For BPH, tadalafil 5 mg significantly improves IPSS scores compared to placebo 6, 7
Common Side Effects
- Headache, dyspepsia, back pain, myalgia, nasal congestion, flushing, and dizziness 2, 8
- Side effects are generally mild to moderate in intensity 6
Clinical Pearls
- Tadalafil can be taken without regard to food 1
- Sexual stimulation is necessary for tadalafil to be effective for ED 2
- Multiple trials may be needed to establish efficacy 2
- In men with both ED and testosterone deficiency, combining tadalafil with testosterone therapy may be more effective than tadalafil alone 2
- For men with BPH and ED, tadalafil 5 mg once daily is the only medication that effectively treats both conditions simultaneously 4