From the Guidelines
Cialis (tadalafil) is available in two dosing regimens for erectile dysfunction treatment, with a recommended starting dose of 2.5 mg daily for daily use and 10 mg as-needed, taken at least 30 minutes before anticipated sexual activity, with a maximum frequency of once daily, as supported by the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline 1. For daily use, the dose may be increased to 5 mg daily based on individual response and tolerability, allowing for spontaneous sexual activity without timing concerns. For as-needed use, the dose may be adjusted to 5 mg if 10 mg causes side effects, or increased to 20 mg if the response is insufficient. As-needed dosing provides a longer window of effectiveness (up to 36 hours) compared to other ED medications. Tadalafil works by inhibiting PDE5 enzymes, increasing blood flow to the penis during sexual stimulation. Common side effects include headache, indigestion, back pain, muscle aches, flushing, and nasal congestion. Tadalafil should not be taken with nitrates or certain other medications, and dose adjustments may be necessary for patients with kidney or liver impairment, as noted in the guideline 1. It is essential to consider the potential interactions between tadalafil and other medications, such as nitrates, and to guide the decision on the use of phosphodiesterase type 5 inhibitors based on the need for continued nitrate therapy versus other alternative options available to the treating clinician, as recommended in the guideline 1. The guideline also highlights the importance of individualizing the dose of tadalafil to balance efficacy and minimize adverse effects, as supported by the American College of Physicians guideline 1. Overall, the recommended dosing regimens for tadalafil are based on the latest evidence and guidelines, prioritizing the patient's safety, efficacy, and quality of life.
Some key points to consider when prescribing tadalafil include:
- Starting dose: 2.5 mg daily for daily use or 10 mg as-needed
- Dose adjustment: based on individual response and tolerability
- Maximum frequency: once daily for as-needed use
- Potential interactions: with nitrates and other medications
- Common side effects: headache, indigestion, back pain, muscle aches, flushing, and nasal congestion
- Dose adjustments: necessary for patients with kidney or liver impairment, as noted in the guideline 1.
By following these guidelines and considering the individual patient's needs and medical history, healthcare providers can optimize the use of tadalafil for erectile dysfunction treatment, prioritizing the patient's safety, efficacy, and quality of life.
From the FDA Drug Label
The recommended starting dose of tadalafil tablets for use as needed in most patients is 10 mg, taken prior to anticipated sexual activity. The dose may be increased to 20 mg or decreased to 5 mg, based on individual efficacy and tolerability. The recommended starting dose of tadalafil tablets for once daily use is 2.5 mg, taken at approximately the same time every day, without regard to timing of sexual activity. The tadalafil tablets dose for once daily use may be increased to 5 mg, based on individual efficacy and tolerability.
The dosing for tadalafil (Cialis) is as follows:
- As needed: 10 mg prior to anticipated sexual activity, with a maximum frequency of once per day. The dose can be adjusted to 5 mg or 20 mg based on individual efficacy and tolerability.
- Daily: 2.5 mg once daily, which can be increased to 5 mg based on individual efficacy and tolerability 2.
From the Research
Cialis Dosing for Daily and As Needed for Erection
- The dosing of Cialis (tadalafil) can be either daily or as needed, depending on the patient's preference and medical history 3, 4.
- A study comparing the efficacy of tadalafil daily vs on-demand for erectile dysfunction found that patients taking tadalafil daily for 12 weeks scored higher in International Index for Erectile Dysfunction-Erectile Function domain scores, although the difference may not be clinically significant 4.
- Another study evaluated the efficacy and safety of long-term tadalafil 5 mg once daily combined with sildenafil 50 mg as needed at the early stage of treatment for patients with erectile dysfunction, and found that combined medication can better improve erectile function, especially for patients with severe ED 5.
- The half-life of tadalafil is 17.5 hours, and clinical studies suggest significant activity 24 hours post-dosing, allowing for flexible dosing regimens 3.
- A review of the literature on PDE-5 inhibitors, including tadalafil, found that these substances have similar efficacy and adverse effects, but tadalafil has a longer half-life and can be taken as needed or daily 6.
- A study on the influence of age on treatment outcomes in men with erectile dysfunction treated with two regimens of tadalafil found that patterns of sexual activity and efficacy over time did not differ significantly with ageing, and tadalafil was effective up to 36 hours after dosing for all age groups 7.