Can You Break Cialis Tablets in Half?
No, you should not break Cialis (tadalafil) tablets in half—the FDA drug label explicitly states "Do not split Tadalafil tablets; entire dose should be taken." 1
Why Splitting Is Not Recommended
The manufacturer's instructions are clear that the entire dose must be taken as a whole tablet. 1 This is likely due to:
- Dose precision concerns: Splitting tablets may result in unequal dosing, compromising efficacy
- Formulation integrity: The tablet coating and formulation are designed to deliver the complete dose as manufactured
- Regulatory approval: Clinical trials establishing safety and efficacy used whole tablets, not split doses
Alternative Dosing Strategies
If the current dose is too strong or causing intolerable side effects, consider these FDA-approved alternatives instead of splitting tablets:
For As-Needed Dosing
- Start with 10 mg as the recommended initial dose 1
- Decrease to 5 mg if side effects are problematic 1
- Increase to 20 mg if 10 mg is well-tolerated but insufficiently effective 1
- Maximum frequency is once per day 1
For Daily Dosing
- Start with 2.5 mg once daily for erectile dysfunction 1
- Increase to 5 mg once daily based on efficacy and tolerability 1
- 5 mg once daily is the standard dose for BPH or combined ED/BPH treatment 1
Important Clinical Considerations
Tadalafil does NOT show dose-dependent improvement between 5 mg, 10 mg, and 20 mg doses—meaning higher doses don't necessarily work better, so dose selection should prioritize tolerability over assuming more is better. 2
Before declaring treatment failure or requesting dose adjustments, ensure the patient has completed an adequate trial: at least 5 separate attempts at the current dose with proper sexual stimulation, correct timing, and absence of modifiable factors like heavy alcohol use. 2
Common Pitfalls to Avoid
- Taking medication with large meals can reduce efficacy 2
- Sexual stimulation is required—PDE5 inhibitors don't work without arousal 2
- Heavy alcohol use impairs erectile function independent of medication 2
- Relationship issues significantly impact response 2
Special Population Dosing Adjustments
For patients with renal impairment requiring lower doses, the FDA provides specific guidance rather than tablet splitting: 1
- CrCl 30-50 mL/min (as-needed): Start with 5 mg, maximum 10 mg once every 48 hours
- CrCl <30 mL/min or hemodialysis (as-needed): Maximum 5 mg once every 72 hours
- CrCl 30-50 mL/min (daily): Start with 2.5 mg daily, may increase to 5 mg
The bottom line: Request a prescription for the appropriate lower-strength tablet rather than splitting higher-strength tablets. 1