What is the proper way to take tadalafil (Cialis) 20 mg?

How to Take Tadalafil 20 mg

Tadalafil 20 mg should be taken as a single intact tablet (do not split) prior to anticipated sexual activity, with or without food, and can be effective for up to 36 hours after dosing. 1

Dosing Instructions

• Take the entire tablet as a single dose - do not split tadalafil tablets 1
• Can be taken with or without food 1
• For erectile dysfunction (ED), take prior to anticipated sexual activity 1
• Maximum recommended dosing frequency is once per day for most patients 1
• Sexual stimulation is necessary for tadalafil to be effective 2

Timing Considerations

• Tadalafil 20 mg has been shown to improve erectile function compared to placebo up to 36 hours following dosing 1, 3
• Significant erectogenic effect can begin as early as 16 minutes after taking tadalafil 20 mg 4
• Most patients (≥79%) attempt sexual intercourse at least once during the 4-36 hour window after taking tadalafil 5
• Many patients (≥53%) take advantage of the extended duration by attempting intercourse 12-36 hours after dosing 5

Special Populations and Dose Adjustments

• Renal impairment:

  • For creatinine clearance 30-50 mL/min: Maximum dose is 10 mg not more than once every 48 hours 1
  • For creatinine clearance less than 30 mL/min or on hemodialysis: Maximum dose is 5 mg not more than once every 72 hours 1

• Hepatic impairment:

  • For mild to moderate impairment (Child-Pugh Class A or B): Maximum dose should not exceed 10 mg once per day 1
  • For severe hepatic impairment: Generally not recommended 2

Important Safety Warnings

• Do not use tadalafil with nitrate medications due to risk of severe hypotension 6
• If using sildenafil or vardenafil, avoid taking nitroglycerin for at least 24 hours; for tadalafil, avoid nitroglycerin for at least 48 hours 6
• Tadalafil has a half-life of 17.5 hours, which is significantly longer than sildenafil and vardenafil (approximately 4 hours) 6

Common Side Effects

• Most common adverse events include dyspepsia (indigestion), headache, back pain, nasal congestion, and myalgia 2
• Tadalafil has lower rates of flushing compared to other PDE5 inhibitors 2

Clinical Pearls

• Incorrect use accounts for a large percentage of treatment failures - ensure patient understands proper administration 2
• Patients with diabetes or post-prostatectomy may respond less robustly to PDE5 inhibitors 2
• Many patients prefer tadalafil 20 mg over sildenafil 50 mg (66.3% vs 33.7%) when initiating ED treatment 7
• The extended duration of action allows for more spontaneous sexual activity without strict timing requirements 5, 8