What is the starting dose of Cialis (tadalafil) for erectile dysfunction?

Starting Dose of Cialis (Tadalafil) for Erectile Dysfunction

The recommended starting dose of Cialis for erectile dysfunction is 10 mg taken as needed prior to anticipated sexual activity, with dose adjustment to 20 mg or down to 5 mg based on efficacy and tolerability. 1

As-Needed Dosing (Standard Approach)

• Start with 10 mg taken prior to anticipated sexual activity 1
• The dose may be increased to 20 mg (maximum) or decreased to 5 mg based on individual response 1
• Maximum dosing frequency is once per day 1
• Tadalafil improves erectile function for up to 36 hours after dosing, allowing flexibility in timing of sexual activity 1
• Sexual stimulation is necessary for the medication to be effective 2

Once-Daily Dosing (Alternative for Spontaneous Activity)

• Start with 2.5 mg taken at approximately the same time every day, without regard to timing of sexual activity 1
• May increase to 5 mg once daily based on efficacy and tolerability 1
• This eliminates the need to time medication with sexual activity, providing an alternative for couples who prefer spontaneous rather than scheduled intimacy 3, 2

Dose Adjustments for Special Populations

Renal Impairment (As-Needed Dosing):

• Creatinine clearance 30-50 mL/min: Start with 5 mg, maximum 10 mg once every 48 hours 1
• Creatinine clearance <30 mL/min or hemodialysis: Maximum 5 mg once every 72 hours 1

Hepatic Impairment:

• Mild to moderate (Child-Pugh Class A or B): Do not exceed 10 mg once per day 1
• Severe hepatic impairment: Generally not recommended 2

Critical Safety Considerations

• Absolute contraindication with nitrates due to risk of severe, potentially fatal hypotension 2, 1
• Assess cardiovascular risk before prescribing; patients unable to perform moderate physical activity should be referred to cardiology 2
• Wait at least 48 hours after tadalafil before administering nitrates in emergency situations (longer than the 24 hours required for sildenafil) 4

Optimizing Treatment Success

• An adequate trial consists of at least 5 separate attempts at maximum dose before declaring treatment failure 2
• Titrate doses to find the optimal balance between efficacy and side effects 2
• If tadalafil fails, consider switching to a different PDE5 inhibitor before moving to second-line therapies 2
• Many treatment failures result from incorrect usage rather than true medication failure—ensure patients understand that sexual stimulation is required 2

Common Adverse Effects

• Most common side effects include dyspepsia, headache, back pain, nasal congestion, and myalgia 2
• Tadalafil has lower rates of flushing compared to other PDE5 inhibitors 2

Administration Details

• May be taken without regard to food 1
• Do not split tablets; entire dose should be taken 1