Tadalafil Dosing for Erectile Dysfunction
For erectile dysfunction, tadalafil should be started at 10 mg taken prior to anticipated sexual activity, with the dose adjusted to 5 mg or 20 mg based on individual efficacy and tolerability. 1
As-Needed Dosing
- The recommended starting dose is 10 mg taken before anticipated sexual activity 1
- The dose may be increased to 20 mg or decreased to 5 mg based on individual response and side effects 1
- Maximum recommended dosing frequency is once per day 1
- Tadalafil can improve erectile function for up to 36 hours after dosing 1, 2
- No need to time medication with meals - can be taken with or without food 1
Daily Dosing Option
- For patients preferring daily dosing, the recommended starting dose is 2.5 mg taken at approximately the same time every day 1
- Daily dose may be increased to 5 mg based on efficacy and tolerability 1
- Daily dosing provides an alternative for couples who prefer spontaneous rather than scheduled sexual activity 3, 4
- Once-daily tadalafil (5 mg and 10 mg) has been shown to be well tolerated and significantly improve erectile function in men with ED 5
Dose Adjustments for Special Populations
Renal Impairment
- For moderate renal impairment (CrCl 30-50 mL/min) with as-needed dosing: Start with 5 mg, maximum 10 mg not more than once every 48 hours 1
- For severe renal impairment (CrCl <30 mL/min) with as-needed dosing: Maximum 5 mg not more than once every 72 hours 1
- Daily dosing is not recommended for patients with severe renal impairment 1
Hepatic Impairment
- For mild to moderate hepatic impairment: Maximum 10 mg once per day 1
- Tadalafil is not recommended for patients with severe hepatic impairment (Child-Pugh Class C) 1
Efficacy
- High-quality evidence shows that tadalafil significantly improves erectile function compared to placebo 6, 3
- Approximately 69% of men using tadalafil report successful sexual intercourse attempts compared to 33% with placebo 3, 7
- Unlike sildenafil and vardenafil, tadalafil's efficacy does not appear to be dose-dependent between 5 mg, 10 mg, and 20 mg doses 6, 4
- Tadalafil is effective across different age groups and ED severity levels 2, 8
Common Side Effects
- Most common adverse events include headache, dyspepsia (indigestion), back pain, myalgia, nasal congestion, and flushing 3, 9
- Tadalafil has lower rates of flushing compared to other PDE5 inhibitors 3
- Side effects are generally mild to moderate in severity 9
Important Considerations
- Tadalafil is contraindicated in patients taking nitrates due to risk of significant hypotension 3
- Sexual stimulation is necessary for tadalafil to be effective 3
- Men with diabetes and post-prostatectomy patients may have more severe ED at baseline and might respond less robustly to PDE5 inhibitors 3
- For men with ED and testosterone deficiency, combining tadalafil with testosterone therapy may be more effective than tadalafil alone 3