Tadalafil
Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026
Tadalafil is a long-acting PDE5 inhibitor approved for erectile dysfunction (ED), benign prostatic hyperplasia (BPH), and pulmonary arterial hypertension (PAH). Its prolonged duration of action (up to 36 hours) distinguishes it from sildenafil and vardenafil, earning it the nickname 'the weekend pill.' Low-dose daily tadalafil (2.5-5 mg) is uniquely approved for combined ED and BPH symptom management.
Exploratory record, not a reviewed medical publication.
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This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.
What the research says.
A quick, data-only summary. The full evidence, dosing, and sources are below.
Tadalafil is a long-acting PDE5 inhibitor approved for erectile dysfunction (ED), benign prostatic hyperplasia (BPH), and pulmonary arterial hypertension (PAH). NutriStack rates the supporting evidence as strong. Common adult dosing is 10-20 mg as needed before sexual activity (or 2.5-5 mg once daily for ED/BPH); 40 mg once daily for PAH (as prescribed by your physician), though a prescriber sets the actual dose. This profile indexes 10 sources.
- Longest duration of action among PDE5 inhibitors (up to 36 hours)
- Daily dosing option eliminates need for timing with sexual activity
- Uniquely approved for both ED and BPH
- Less affected by food intake than sildenafil
- Headache
- Dyspepsia
- Back pain and myalgia (unique to tadalafil due to PDE11 inhibition)
- Concurrent use with nitrates (absolute contraindication, severe hypotension)
- Concurrent use with riociguat (Adempas)
The bottom line
Evidence rating strong. Most-documented uses: longest duration of action among pde5 inhibitors (up to 36 hours), daily dosing option eliminates need for timing with sexual activity, uniquely approved for both ed and bph. 10 sources indexed (2020–2025), with 0 interaction records on file.
How it works, mechanistically.
Core mechanism
Selectively inhibits phosphodiesterase type 5 (PDE5), preventing degradation of cGMP in smooth muscle cells. This enhances nitric oxide-mediated vasodilation in the corpus cavernosum (for erection), the prostate and bladder (for BPH symptom relief), and the pulmonary vasculature (for PAH). Tadalafil is more selective for PDE5 over PDE6 than sildenafil, resulting in fewer visual side effects, but has more PDE11 inhibition (significance uncertain).2
Dosing & protocol.
Not significantly affected by food (unlike sildenafil); can be taken with or without meals. Bioavailability not precisely determined but clinical effect is reliable. Long half-life of 17.5 hours supports daily dosing.
Full safety detail.
Side effects
- Headache
- Dyspepsia
- Back pain and myalgia (unique to tadalafil due to PDE11 inhibition)
- Nasal congestion
- Flushing
- Limb pain
- Priapism (rare)
Contraindications
- Concurrent use with nitrates (absolute contraindication, severe hypotension)
- Concurrent use with riociguat (Adempas)
- Known hypersensitivity to tadalafil1,2
- Concurrent use with alpha blockers other than tamsulosin 0.4 mg (hemodynamic interaction)
- Conditions where sexual activity is inadvisable
- Severe hepatic impairment (not recommended)
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Meta-analyses & systematic reviews
4- 1A Systematic Review and Meta-Analysis of the Efficacy and Safety of Tamsulosin Plus Tadalafil Compared With Tamsulosin Alone in Treating Males With Lower Urinary Tract Symptoms Secondary to Benign Prostrate HyperplasiaPMIDZhou R, Che X, Zhou Z et al. · American journal of men's health · 2023
Zhou R, Che X, Zhou Z et al.. A Systematic Review and Meta-Analysis of the Efficacy and Safety of Tamsulosin Plus Tadalafil Compared With Tamsulosin Alone in Treating Males With Lower Urinary Tract Symptoms Secondary to Benign Prostrate Hyperplasia. American journal of men's health. 2023
- 2Phosphodiesterase 5 (PDE-5) inhibitors (sildenafil, tadalafil, and vardenafil) effects on esophageal motility: a systematic reviewPMIDShafiee A, Bahri RA, Teymouri Athar MM et al. · BMC gastroenterology · 2023
Shafiee A, Bahri RA, Teymouri Athar MM et al.. Phosphodiesterase 5 (PDE-5) inhibitors (sildenafil, tadalafil, and vardenafil) effects on esophageal motility: a systematic review. BMC gastroenterology. 2023
- 3Tamsulosin vs. Tadalafil as medical expulsive therapy for distal ureteral stones: a systematic review and meta-analysisPMIDBelkovsky M, Zogaib GV, Passerotti CC et al. · International braz j urol : official journal of the Brazilian Society of Urology · 2023
Belkovsky M, Zogaib GV, Passerotti CC et al.. Tamsulosin vs. Tadalafil as medical expulsive therapy for distal ureteral stones: a systematic review and meta-analysis. International braz j urol : official journal of the Brazilian Society of Urology. 2023
- 4Chinese herbal medicine combined with tadalafil for erectile dysfunction: a systematic review and meta-analysisPMIDWang YL, Geng LG, He CB et al. · Andrology · 2020
Wang YL, Geng LG, He CB et al.. Chinese herbal medicine combined with tadalafil for erectile dysfunction: a systematic review and meta-analysis. Andrology. 2020
Randomized controlled trials
1- 5Effect of Tadalafil on cardiac function and left ventricular dimensions in Duchenne muscular dystrophy: safety and cardiac MRI substudy results from a randomized, placebo-controlled trialPMIDCox D, Byrne B, Hammers DW et al. · BMC cardiovascular disorders · 2025
Cox D, Byrne B, Hammers DW et al.. Effect of Tadalafil on cardiac function and left ventricular dimensions in Duchenne muscular dystrophy: safety and cardiac MRI substudy results from a randomized, placebo-controlled trial. BMC cardiovascular disorders. 2025
Reference material
5- 6Brock GB et al. Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol. 2002;168(4 Pt 1):1332-1336.Source linkedPMID
- 7Oelke M et al. Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. Eur Urol. 2012;61(5):917-925.Source linkedPMID
- 8Galiè N et al. Tadalafil therapy for pulmonary arterial hypertension. Circulation. 2009;119(22):2894-2903.Source linkedPMID
- 9Gong B, Ma M, Xie W et al.. Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis. International urology and nephrology. 2017Source linkedPMID
- 10Grünig E, Jansa P, Fan F et al.. Randomized Trial of Macitentan/Tadalafil Single-Tablet Combination Therapy for Pulmonary Arterial Hypertension. Journal of the American College of Cardiology. 2024Source linkedPMID
Common questions.
Quick answers about Tadalafil, drawn from the data on this page.
What is Tadalafil?
Tadalafil is a long-acting PDE5 inhibitor approved for erectile dysfunction (ED), benign prostatic hyperplasia (BPH), and pulmonary arterial hypertension (PAH). Its prolonged duration of action (up to 36 hours) distinguishes it from sildenafil and vardenafil, earning it the nickname 'the weekend pill.' Low-dose daily tadalafil (2.5-5 mg) is uniquely approved for combined ED and BPH symptom management.
What is Tadalafil used for?
Commonly cited benefits of Tadalafil include: Longest duration of action among PDE5 inhibitors (up to 36 hours); Daily dosing option eliminates need for timing with sexual activity; Uniquely approved for both ED and BPH; Less affected by food intake than sildenafil. NutriStack rates the overall evidence as strong.
What is a typical dose of Tadalafil?
A typical adult dose of Tadalafil is 10-20 mg as needed before sexual activity (or 2.5-5 mg once daily for ED/BPH); 40 mg once daily for PAH (as prescribed by your physician). The commonly recommended form is Oral tablet. These are general ranges, not personalized advice; confirm the right dose with a clinician.
What are the side effects of Tadalafil?
Reported side effects include headache, dyspepsia, back pain and myalgia (unique to tadalafil due to pde11 inhibition), nasal congestion, flushing, limb pain. This is educational information; check with a healthcare professional before use.
How strong is the evidence for Tadalafil?
NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.
Use this with your stack
Tadalafil in NutriStack.
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