Does increasing my Tadalafil (tadalafil) dosage to 10 mg per day make sense for my erectile dysfunction (ED) treatment?

Tadalafil 10 mg Daily for Erectile Dysfunction

Increasing to 10 mg daily tadalafil does not make sense because tadalafil shows no dose-dependent improvement in erectile function between 5 mg, 10 mg, and 20 mg doses—meaning you will not gain additional efficacy by increasing from 5 mg to 10 mg daily, only potentially more side effects. 1, 2

Why This Recommendation

Lack of Dose-Response for Daily Tadalafil

• Tadalafil is unique among PDE5 inhibitors in that it does NOT demonstrate dose-dependent efficacy improvements between 5 mg, 10 mg, and 20 mg doses, unlike sildenafil and vardenafil which show clear dose-response relationships 1, 3

• The FDA label specifies that for once-daily use, the starting dose is 2.5 mg with potential increase to 5 mg based on efficacy and tolerability—there is no FDA-approved 10 mg once-daily dosing regimen for ED 2

• Clinical trial data shows that tadalafil 5 mg and 10 mg once daily produced nearly identical improvements in erectile function: IIEF-EF scores improved by +9.7 for 5 mg versus +9.4 for 10 mg, with SEP3 (successful intercourse) rates of 45.5% versus 50.1% respectively 4

Safety Concerns with Higher Daily Doses

• Higher cumulative daily doses significantly increase the risk of headache, dyspepsia, back pain, myalgia, and most critically, hypotension—especially dangerous if you require emergency nitrate administration 1

• The most common adverse events (headache, dyspepsia, back pain, upper abdominal pain, myalgia) occur in a dose-dependent fashion, meaning 10 mg daily will cause more side effects than 5 mg without additional benefit 4, 5

What You Should Do Instead

Optimize Your Current Regimen First

Before increasing your dose, evaluate whether you've had an adequate trial by addressing these modifiable factors that commonly cause apparent treatment failure 1, 3:

• Ensure adequate sexual stimulation is present—tadalafil requires sexual arousal to work 1
• Avoid heavy alcohol use which impairs erectile function and increases adverse effects 1
• Verify proper timing: For daily dosing, take at the same time each day regardless of sexual activity timing 2
• Complete at least 5-8 attempts at your current dose before declaring treatment failure 1, 3

Consider Alternative Strategies

If 5 mg daily tadalafil is insufficient after an adequate trial:

• Switch to as-needed dosing with tadalafil 10-20 mg taken prior to anticipated sexual activity, which is the FDA-approved regimen for higher doses 2

  • The as-needed 10 mg dose can be increased to 20 mg if needed for efficacy 2
  • This provides up to 36 hours of effectiveness per dose 2

• Evaluate for testosterone deficiency if you haven't already—men with low testosterone respond less robustly to PDE5 inhibitors, and combination therapy with testosterone may be more effective than tadalafil alone 1

• Try a different PDE5 inhibitor such as sildenafil, which does show dose-dependent improvement and may work better for you despite tadalafil's longer duration 3

Critical Safety Reminder

• Never use tadalafil with nitrates—the combination causes potentially fatal hypotension 1, 2
• If you require emergency nitrate administration, wait at least 48 hours after your last tadalafil dose 1, 3