Everything to Know About Cialis: Use, Effectiveness, and Safety

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Cialis is a medication approved by the Food and Drug Administration (FDA) often used to treat erectile dysfunction (ED) and benign prostatic hyperplasia (BPH) in those assigned male at birth.

Cialis is taken as an oral tablet, either as a low dose daily medication or as a higher-dose “on-demand” medication. It is the brand name for tadalafil, a medication also used to treat ED.

Tadalafil is in a class of drugs called phosphodiesterase-5 (PDE5) inhibitors and is available in a generic form often called generic Cialis. Tadalafil has been on the market since 2018 and has the same primary ingredient as Cialis.

While the chemical make-ups of Cialis and tadalafil may be a little different from one another, tadalafil is generally just as effective as Cialis. This means that the biggest difference you’re likely to notice will just be the price.

Pros

• lasts up to 36 hours for some people, which is longer than Viagra
• can be taken as needed or on a daily, regular basis
• daily use allows for a more spontaneous sex life
• can be taken with or without food
• helps maintain erections longer
• some users say their orgasms are more intense

Cons

• can cause headaches and muscle aches
• must be swallowed whole
• can cause indigestion
• can make you appear flushed
• not available over-the-counter (OTC)

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Cialis works by increasing blood flow to the penis to help a person get and maintain an erection. It also blocks the PDE5 enzyme, which enhances the effects of nitric oxide (NO). NO activates a series of chemical reactions that increase blood flow to the penis by relaxing blood vessels.

Cialis also relaxes the smooth muscle in the prostate and the bladder. It doesn’t protect against sexually transmitted infections (STIs).

PDE5 inhibitors work by binding to an enzyme called PDE5, which normally breaks down cyclic guanosine monophosphate (GMP) molecules.

Cyclic GMP helps relax the smooth muscles within the blood vessels of your penis. This process significantly increases blood flow to these blood vessels, leading to an erection.

Cialis and other PDE5 inhibitors don’t cure ED or increase libido. Physical and psychological arousal is still necessary for the medications to help achieve and sustain an erection.

When sexually aroused, the parasympathetic nervous system activates, triggering the release of NO. The increased presence of NO is what increases the production of cyclic GMP.

ED

Cialis is primarily used to treat ED. Guidelines unanimously agree in considering PDE5 inhibitors as first line treatments for ED as long as it doesn’t interfere with your other medications or cause you to have any severe side effects.

BPH

Cialis and tadalafil are also prescribed to treat the symptoms of BPH, also known as an enlarged prostate.

Pulmonary arterial hypertension

Tadalafil is also FDA-approved to treat pulmonary arterial hypertension (PAH), which is high blood pressure affecting the arteries in the lungs. The typical dose for PAH is two 20-milligram tablets (40 mg) taken daily.

Adcirca is the brand name for tadalafil and is used to treat PAH.

Obtaining Cialis

Cialis and generic tadalafil are available with a prescription only. There is no OTC version, though there have been efforts in recent years to develop a nonprescription version of tadalafil.

Cialis is available as an oral tablet in several dosages, allowing individuals to take a low-dose tablet daily or a stronger dose on demand before sexual activity.

The daily doses are available in 2.5- and 5-mg tablets. Doctors usually start their patients on the 2.5-mg dose, though 5 mg may be appropriate if needed for greater efficacy.

A daily dose of 5 mg may be too much for some people and lead to undesirable side effects.

On-demand doses are available in 10- and 20-mg doses. Doctors usually recommend starting with a 10-mg dose and moving up to 20 mg if a stronger dose is needed to achieve the desired results.

A 2016 study found that while low-dose daily use may have produced a slightly weaker effect than the higher-dose, on-demand use in some study participants, there did not appear to be a major benefit with one approach over the other.

• With an on-demand dose, take Cialis at least 30 minutes prior to sexual activity, though understand that it could take up to 2 hours to take effect.
• Take daily doses at about the same time every day.
• Focus on managing stress.
• Maintain healthy communication with your partner.

Some of the most common side effects associated with Cialis are:

• headache
• flushing
• indigestion
• congestion
• back pain and muscle aches

Cialis is more likely to cause myalgia (muscle pain) when compared with other PDE5 inhibitors, according to a 2016 study on ED treatment published in the journal Nature Reviews Disease Primers .

Many Cialis or generic tadalafil users do not experience side effects, and those who do often have minor complaints that tend to go away once the drug is out of their system.

Muscle aches may last up to 2 days or so after taking your last dose.

More potential and serious symptoms include priapism, an abnormal, sometimes painful erection that lasts more than 4 hours.

Other concerning symptoms that should prompt a visit with a healthcare professional include sudden changes in vision and hearing, which occasionally occur with tinnitus and dizziness.

The price of brand-name Cialis will vary based on the dosage, the pharmacy or online service you choose, and any shipping and handling charges that may be included.

In general, a lower dose (5mg) that’s meant for daily use can cost around $20 to $32 per dose, and a higher dose (10mg and 20mg) meant for “as-needed” use can cost around $80 – $85 per dose. But discounts may be available when buying in bulk or through any website promotional offers.

It’s also worth considering generic Cialis (tadalafil) if brand-name Cialis is outside of your budget. Tadalafil has the same active ingredients as Cialis but is sold at a significantly lower price.

Brand-name Cialis	Generic Cialis (tadalafil)	Daily generic Cialis tadalafil
Hims	$958 per month (5mg)	$82 per month (5mg, 10mg, 20mg)	$82 per month (2.5mg, 5mg)
Roman	$20 – $80 per dose (5mg, 10mg, 20mg)	$11 – $44 per dose (5mg, 10mg, 20mg)	$8 per dose (2.5mg, 5mg)
Lemonaid	N/A	$8 per dose (5mg, 10mg, 20mg)	$8 per dose (5mg)
Optum Store	$17 – $85 per dose(2.5mg, 5mg, 10mg, 20mg)	$7 per dose (5mg, 10mg, 20mg)	$7 per dose (5mg)

*Prices as of March 2023

Unlike some other PDE5 inhibitors, Cialis may be taken with or without food. It’s unlikely to have any impact on its effectiveness or side effects.

Avoid grapefruit juice

Grapefruit and grapefruit juice can enhance levels of Cialis in the bloodstream, potentially increasing negative side effects.

Avoid heavy alcohol drinking

Moderate alcohol consumption should have little effect on how Cialis works. But heavy alcohol consumption can make it difficult to achieve an erection even with an ED medication.

Know your other medications

Cialis may interact with certain medications. In particular, you should not take Cialis if you’re also taking nitrates, which are medications that widen arteries to allow greater blood flow.

Nitrates are typically prescribed to treat angina (chest pain brought on by narrowed coronary arteries) or heart failure.

When taken with nitrates or antihypertensive medications called alpha-blockers, Cialis could cause a dangerous drop in blood pressure.

Cialis may lead to similar problems when used in combination with other antihypertensive drugs.

Other classes of drugs that may interfere with Cialis include:

• antiseizure medications
• certain antibiotics
• HIV medications
• oral antifungal medications

You should also avoid taking two PDE5 inhibitors in 1 day, as this can lead to a dangerous drop in blood pressure and other serious side effects.

Cialis and tadalafil are equally effective. The FDA works to ensure that the generic versions of all brand-name medications provide the same clinical benefits.

The main difference between Cialis and tadalafil is the cost.

Though prices vary considerably depending on the manufacturer and pharmacy where you’re buying the medication from, Cialis typically costs around $365 for 30 tablets. The generic versions cost about $100 for 30 tablets.

Cialis has been a widely available medication since gaining FDA approval in 2003. The medication is marketed and distributed by the company Eli Lilly and is sold in 2.5-, 5-, 10-, and 20-mg tablets. Eli Lilly is a large pharmaceutical company and manufacturer that also sells many other popular medications like Trulicity and Taltz.

Cialis has a generally positive reputation with customers because of its effectiveness and how long-acting it can be when taken daily. Since Cialis is available through pharmacies and several online ED medication services, overall customer satisfaction ratings can vary, especially since many of these online services put their most positive reviews out front.

If you are curious about user satisfaction with Cialis, make an appointment with your doctor or specialist to see if they think you could benefit from using Cialis.

While Cialis is widely prescribed around the world, the most well-known PDE5 inhibitor is Viagra (sildenafil), which is the first medication in this class of drugs to hit the market.

In addition to Cialis and Viagra, the other PDE5 inhibitors include:

• vardenafil (Levitra, Staxyn)
• avanafil (Stendra)

These medications work best when used in combination with doing other things to support your overall health, especially those that directly impact your cardiovascular health.

In addition to PDE5 inhibitors, there are alternatives to medications some people consider, along with healthy habits. Among them are supplements and pill-free options, like:

• L-arginine, an amino acid that helps manufacture nitric oxide
• red ginseng, also known as Panax ginseng, an herb sometimes taken to lower inflammation
• acupuncture, though research has shown conflicting results

Other habits that help sexual function

Making certain lifestyle changes can help fight ED, too. This includes things like:

• getting regular exercise when possible
• quitting smoking (if you smoke)
• getting 7 to 8 hours of sleep each night
• consuming nutrient-dense foods when possible
• finding ways to manage stress

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Cialis and Viagra each have their pros and cons, though the medications work similarly in the body.

Cialis has the advantage of lasting longer, with effects often lingering as long as 36 hours after taking the tablet.

Viagra usually lasts about 4 hours. Viagra is also an on-demand medication only, so the spontaneity that daily Cialis use allows is not an option with Viagra.

But Cialis is associated with muscle aches in the limbs in some users, a side effect not associated with Viagra. However, some research suggests that Viagra use may be associated with vision problems.

You can also find generic versions of both Cialis and Viagra.

Your lifestyle and personal experience with a particular medication may help you determine if Cialis, Viagra, or another PDE5 inhibitor is the right choice.

Cialis isn’t available over the counter. Your doctor has to prescribe Cialis for ED or other conditions the medication treats.

You may also be able to obtain this medication with the help of telemedicine services.

Companies like Hims and Roman offer online consultations with physicians who can prescribe ED medications that are then mailed to your home.

The cost of these online services can sometimes exceed conventional healthcare, though the convenience and discretion of this type of telemedicine service are appealing to many individuals.

Online ED treatment services

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How long does Cialis last?

Taking Cialis daily will make it easier for you to get and keep an erection for as long as you regularly take the medication. If you are only taking a higher dose of Cialis as needed, the ability to get an erection could last up to 36 hours, for some people.

What are the side effects of using Cialis?

Cialis can cause some side effects, including headaches, muscle aches, congestion, and indigestion.

Does taking Cialis make you erect or stay erect after orgasm?

No, while this is often a misunderstanding of the effects of Cialis, this medication doesn’t cause an erection all on its own or cause you to have an erection long past the point of orgasm.

People with ED symptoms are frequently unable to have a full erection when sexually aroused. Taking Cialis helps inhibit the PDE5 enzymes that may be preventing their erection. It is very unlikely that you will have an erection if you are taking Cialis and are not sexually aroused.

Additionally, Cialis won’t extend your erection past the point of orgasm or beyond when your erection would typically end following a sexual encounter.

If using Cialis causes you to maintain an erection for more than 4 hours, it can result in a serious condition called priapism. This can cause long-term damage if not treated immediately by a doctor.

How long do you stay erect with Cialis?

It’s important to note that since Cialis doesn’t keep you erect any longer than the amount of time you commonly experience an erection, it’s difficult to estimate the amount of time that you can expect to stay erect.

Cialis doesn’t extend how long you can stay erect but inhibits the PDE5 enzymes that could prevent or limit that person from having a full erection.

If a person is not experiencing ED symptoms, taking Cialis wouldn’t extend the amount of time that they stay erect or cause any noticeable changes to their sexual performance.

When it comes to ED medications like Viagra and Cialis, don’t think of them as sexual performance enhancers — think of them as treatment that helps some people with ED to have a full erection when sexually aroused.

Does Cialis last longer than Viagra?

Yes, Cialis in higher dosages can last up to 36 hours, while Viagra commonly lasts up to 4 hours. Talk with your doctor to see which medication best fits your sexual lifestyle.

Cialis, the brand version of the PDE5 inhibitor tadalafil, is one of the world’s most widely prescribed ED medications.

Generic tadalafil has been available since 2018 and has proven to be just as effective and safe as the brand name.

The drug is available in low daily doses that keep the medication in your system and allow for greater spontaneity. It’s also available in stronger, on-demand doses.

While Cialis and other ED drugs don’t “cure” the condition, they can treat the primary symptom by helping achieve and maintain erections.

If ED is affecting your life and relationship, you may want to consider trying tadalafil in some form.

It’s available by prescription only, so consult with a doctor about this and other possible ED treatments.

Last medically reviewed on March 24, 2023