Tadalafil Uses, Dosage, Side Effects & Brands in Pakistan – Complete Guide

What is Tadalafil?

Tadalafil is a widely used medicine that helps improve blood flow by relaxing the muscles in blood vessels. It is part of a group of medicines known as PDE5 inhibitors (short for phosphodiesterase type 5 inhibitors), which help improve blood flow in certain conditions. This class of drugs is mainly used for conditions linked to poor blood flow, such as erectile dysfunction (ED), benign prostatic hyperplasia (BPH), and pulmonary arterial hypertension (PAH).

Tadalafil became available for medical use in the United States in 2003, and today it is also sold as a generic medication. By 2022, it had become one of the most commonly prescribed medicines in the U.S., with over 3 million prescriptions filled that year.

Tadalafil is commonly known by the brand name Cialis, which is used to treat erectile dysfunction (ED) and benign prostatic hyperplasia (BPH). Another brand, Adcirca, is used for treating pulmonary arterial hypertension (PAH) in both men and women. Tadalafil usually starts working in about 30 minutes, and its effects can last up to 36 hours, which is why it’s often called the “weekend pill.”

No matter what condition it’s used for, tadalafil works by improving blood flow—whether to the penis, prostate, or lungs, depending on the treatment purpose.

Uses of Tadalafil

Tadalafil is used to treat three main health conditions, all related to poor blood flow. It helps by relaxing and widening the blood vessels, which allows better circulation to the affected areas.

1. Erectile Dysfunction (ED)

Tadalafil is widely prescribed to treat erectile dysfunction. It helps increase blood flow to the penis, making it easier to get and maintain an erection during sexual arousal. However, it requires physical stimulation to work and does not cause an automatic erection.
A systematic review confirms its safety and effectiveness for ED: NIH Meta-Analysis on Tadalafil for ED

2. Benign Prostatic Hyperplasia (BPH)

Tadalafil also helps reduce urinary symptoms caused by an enlarged prostate, such as a weak urine stream, frequent urination, or difficulty urinating. It relaxes the bladder and prostate muscles, easing these symptoms and reducing the need for surgery in some patients.
Read this clinical review on Tadalafil for BPH: PubMed Study on BPH Treatment

3. Pulmonary Arterial Hypertension (PAH)

Tadalafil, sold under the brand name Adcirca, is used to treat pulmonary arterial hypertension. This condition causes high blood pressure in the lungs, making it harder for the heart to pump blood. Tadalafil relaxes the lung blood vessels, improving breathing and physical activity.
See FDA approval and data for Adcirca (Tadalafil for PAH): FDA Label for Adcirca.

Tadalafil Uses in Urdu

How Should I Take Tadalafil?

Tadalafil is usually taken once a day or only when needed, based on the condition being treated. Always follow your doctor’s advice and the instructions on your prescription label. Please do not take more or less than what is recommended, and don’t use it for longer than prescribed.

• You can take Tadalafil with or without food.
• Swallow the tablet whole with water. Do not break, crush, or chew the tablet.
• If you are using Cialis for erectile dysfunction, take it before sexual activity. It may be taken up to 36 hours before planned intimacy, but no more than once per day.
• Tadalafil helps produce an erection only with sexual stimulation. It won’t work by just taking the pill alone.
• Do not use Cialis for ED if you are already using Adcirca for pulmonary arterial hypertension. These are different brands of the same drug and should not be taken together.

Storage: Keep the tablets at room temperature, away from heat and moisture.

What If I Miss a Dose?

• If you use Tadalafil only when needed, you’re not on a fixed dosing schedule, so you don’t need to worry about missed doses.
• If you are on a daily dose and miss it, take it as soon as you remember.
• If your next dose is near, skip the missed dose—don’t take a double dose.

What If I Overdose?

Taking too much Tadalafil can cause serious side effects like chest pain, dizziness, or a prolonged erection.

How Tadalafil Works (Mechanism of Action)

Tadalafil helps men achieve and maintain an erection by improving blood flow to the penis—but it only works when a man is sexually stimulated.

Here’s how it works:

• During sexual arousal, the body releases a natural chemical called nitric oxide (NO) in the penis.
• This nitric oxide helps the body produce a chemical called cyclic guanosine monophosphate (cGMP), which plays a key role in relaxing blood vessels.
• cGMP relaxes the smooth muscles in the corpus cavernosum (the sponge-like tissue in the penis), allowing more blood to flow in.
• The increased blood flow causes the penis to become hard and stay erect.

Tadalafil belongs to a class of drugs called PDE5 inhibitors. It works by blocking the enzyme PDE5, which normally breaks down cGMP. When PDE5 is blocked, cGMP levels stay higher, and the erection lasts longer.

Note: Tadalafil only works when there is sexual stimulation. It won’t cause an erection without arousal.

Why Tadalafil Lasts Longer (Duration of Action)

One of the main benefits of Tadalafil is its long half-life—about 17.5 hours, which means it stays in the body much longer than other PDE5 inhibitors like:

1. Sildenafil (Viagra) – half-life of 4–5 hours
2. Vardenafil (Levitra) – half-life of 4–5 hours

Because of this long duration, Tadalafil is often called “The Weekend Pill,” as its effects can last up to 36 hours. This long action time also allows Tadalafil to be used as a once-daily low-dose treatment for erectile dysfunction or daily therapy for pulmonary arterial hypertension (PAH).

Things to Know Before Using Tadalafil

Before using Tadalafil, it’s important to weigh the possible benefits against the risks to make sure it’s the right choice for you.. This decision should always be made in consultation with your doctor, especially if you have specific health conditions, allergies, or are in a certain age group.

1. Allergies

Inform your doctor if you have ever had an allergic reaction to Tadalafil or any similar medicine. Also mention if you are allergic to any foods, colors, preservatives, or animal products. For non-prescription products, always read the label and ingredient list carefully.

2. Children and Adolescents

Tadalafil products such as Cialis® and Chewtadzy® are not approved for use in children. The safety and effectiveness of these medicines have not been tested in children, so their use in pediatric patients is not recommended. Similarly, brands like Adcirca® and Alyq™, which are used for pulmonary arterial hypertension, have no confirmed safety data for use in children.

3. Older Adults (Geriatric Use)

Research shows that Tadalafil is generally safe for older adults. However, elderly patients may be more sensitive to the effects of the medication, such as drops in blood pressure or dizziness. Doctors may start with a lower dose and monitor closely to reduce the risk of side effects.

4. Breastfeeding Women

There is no clear data on whether Tadalafil passes into breast milk or harms a nursing baby. If you are breastfeeding, consult your doctor. They will weigh the potential benefits of Tadalafil against any possible risks to your child.

Drug Interactions with Tadalafil

Tadalafil can interact with many other medicines. Some combinations may be unsafe, while others may require dose adjustments or special precautions. Always tell your doctor or pharmacist about all the medicines you are taking before starting Tadalafil.

Medicines You Should Not Use with Tadalafil

Tadalafil should never be combined with the following medicines, as serious or dangerous interactions may occur:

• Nitrate medications (e.g., Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate, Pentaerythritol tetranitrate)
• Amyl Nitrite
• Riociguat and Vericiguat (used for heart failure and blood pressure)
• Boceprevir, Telaprevir (antiviral medications)

Using these combinations can lead to a sudden and serious drop in blood pressure, which may become life-threatening.

Medicines That May Require Caution

The following medicines can interact with Tadalafil and may require dose adjustments or close monitoring by your doctor:

• Alpha-blockers like Alfuzosin, Doxazosin, and Bunazosin (used for high blood pressure or prostate issues)
• Antibiotics such as Clarithromycin, Erythromycin
• Antifungals like Ketoconazole, Itraconazole
• HIV or Hepatitis C medicines like Ritonavir, Darunavir, Lopinavir, Cobicistat, Nelfinavir
• Seizure medications such as Carbamazepine, Phenytoin, Phenobarbital
• Cancer or hormonal therapy drugs like Apalutamide, Enzalutamide, Mitotane

Using these drugs together may affect how Tadalafil works or increase the risk of side effects.

Other Substances to Avoid

• Grapefruit or grapefruit juice can interfere with how Tadalafil is broken down in the body, increasing the risk of side effects.
• Alcohol (Ethanol) can cause low blood pressure, dizziness, or fainting when taken with Tadalafil.

If you consume these, talk to your doctor for guidance on how to use Tadalafil safely.

Tadalafil Side Effects

Like all medicines, Tadalafil can cause side effects in some people. While many are mild, some may require immediate medical attention.

Serious Side Effects – Seek Immediate Medical Help

Stop taking Tadalafil and get emergency medical help if you experience:

• Allergic reaction: Signs include hives, difficulty breathing, swelling of the face, lips, tongue, or throat.
• Chest pain, dizziness, or nausea during sex: These may indicate a serious heart-related side effect.
• Severe low blood pressure symptoms: Feeling light-headed or faint.
• Painful or prolonged erection: If an erection lasts longer than 4 hours, it can damage the penis and needs urgent treatment.
• Sudden vision changes or loss May signal a rare eye condition.
• Ringing in the ears or sudden hearing loss
• Signs of a heart attack: Chest pressure, pain spreading to the jaw or shoulder, sweating, and nausea.

Common Side Effects (Usually Mild)

These are more likely to be temporary and manageable:

• Headache
• Flushing (a warm, red, or tingling feeling)
• Nausea or upset stomach
• Stuffy or runny nose
• Muscle pain, back pain, or pain in arms or legs

If these side effects persist or become bothersome, talk to your doctor for advice.

Precautions Before Using Tadalafil

Before using Tadalafil, it’s important to share your complete medical history with your doctor. This helps reduce the risk of serious side effects and ensures the medication is safe for you.

1. Allergies

Inform your doctor if you are allergic to Tadalafil or any other medicines. Also mention any allergies to foods, dyes, preservatives, or animal products. If you’re unsure, ask your pharmacist for a full list of ingredients in the tablet.

2. Use in Women

If you are a woman taking Tadalafil for pulmonary hypertension, tell your doctor if you are:

• Pregnant
• Planning to become pregnant
• Breastfeeding

There is not enough research to confirm its safety during pregnancy or while nursing, so your doctor will guide you based on the benefits and risks.

3. Health Conditions to Mention

Tell your doctor if you have a history of any of the following:

• Heart disease (heart attack, angina, irregular heartbeat, or heart failure)
• High or low blood pressure
• Kidney or liver problems
• Stomach ulcers or bleeding issues
• Blood disorders such as sickle cell anemia, leukemia, or multiple myeloma
• Pulmonary veno-occlusive disease (PVOD)
• Any condition affecting the shape of the penis
• Sudden or partial vision loss, or a family history of retinitis pigmentosa
• Severe dehydration caused by vomiting, diarrhea, or excessive sweating
• Erections lasting more than 4 hours in the past

These conditions may affect how your body reacts to Tadalafil, and dose adjustments may be needed.

4. Before Surgery or Medical Procedures

Tell all your doctors, dentists, or surgeons that you are using Tadalafil. This is especially important in emergencies, as Tadalafil can interact with certain emergency medications (like nitrates) and affect your heart.

5. Alcohol Consumption

Limit alcohol use while taking Tadalafil. Drinking large amounts of alcohol (more than 5 drinks) can increase the risk of:

• Low blood pressure
• Dizziness
• Fainting
• Headache
• Fast heartbeat

Ask your doctor for safe guidelines based on your condition.

6. Sexual Activity Warning

If you’ve ever been told to avoid sexual activity due to heart problems, talk to your doctor before using Tadalafil. Stop activity immediately and seek emergency help if you experience:

• Chest pain
• Dizziness
• Nausea during sex

These could be signs of strain on your heart.

Comparison with Other PDE5 Inhibitors

While Tadalafil, Sildenafil (Viagra), and Vardenafil (Levitra) all belong to the same group of medications called PDE5 inhibitors, there are key differences in how they affect the body:

Duration of Action: Tadalafil has a significantly longer half-life (17.5 hours) compared to Sildenafil and Vardenafil, which last about 4 to 5 hours. This means Tadalafil stays active in the body much longer, allowing for more spontaneous sexual activity over a longer period—up to 36 hours—earning it the nickname “The Weekend Pill.”

Eye-related Side Effects: Sildenafil and Vardenafil affect PDE6, an enzyme found in the retina of the eye. This can cause blue-tinted vision or increased light sensitivity in some users. Tadalafil, in contrast, has minimal effect on PDE6, so these visual side effects are much less common.

Heart and Blood Vessel Effects: Both Sildenafil and Vardenafil also affect PDE1, found in the heart and blood vessels, which may lead to flushing, dizziness, or a fast heartbeat in some people. Tadalafil has very low activity on PDE1, so such effects are usually milder.

Muscle and Prostate Enzyme (PDE11): Tadalafil is unique in that it also inhibits PDE11, an enzyme found in the skeletal muscles, prostate, liver, kidney, pituitary gland, and testes. The clinical impact of PDE11 inhibition is still unclear, but it distinguishes Tadalafil from the others, as Sildenafil and Vardenafil have very little effect on PDE11.

History of Tadalafil

Tadalafil, commonly known by the brand name Cialis, was developed in the 1990s by ICOS Corporation in collaboration with Glaxo Wellcome. The active compound (IC351) showed promise as a PDE5 inhibitor, similar to Sildenafil (Viagra), which was approved in 1998.

In 2003, Tadalafil was approved by the U.S. FDA for the treatment of erectile dysfunction (ED). Its longer duration of action (up to 36 hours) quickly set it apart, earning it the nickname “Weekend Pill.”

Later, the FDA also approved Tadalafil for:

• Benign Prostatic Hyperplasia (BPH) in 2011
• Pulmonary Arterial Hypertension (PAH) in 2009 under the brand Adcirca

In 2007, Eli Lilly acquired ICOS and took over the global marketing of Cialis. Today, Tadalafil is available in both brand and generic forms and is prescribed worldwide for ED, BPH, and PAH.

Tadalafil Brand Names in Pakistan

In Pakistan, Tadalafil is available under various brand names for treating erectile dysfunction (ED), benign prostatic hyperplasia (BPH), and pulmonary arterial hypertension (PAH). Below are some of the commonly available brands:

Popular Brands for Erectile Dysfunction:

1. Cialis – Original international brand by Eli Lilly
2. Tadalis – Manufactured by Ajanta Pharma
3. Tadora – Common generic version
4. Tadacip – Cipla’s version of Tadalafil
5. Adcirca – Original brand for PAH, sometimes imported.

Conclusion

Tadalafil is a well-established and effective medication used to treat erectile dysfunction (ED), benign prostatic hyperplasia (BPH), and pulmonary arterial hypertension (PAH). Its long duration of action, up to 36 hours, makes it a preferred choice for many men, offering both flexibility and confidence.

Whether taken as needed or in a daily low dose, Tadalafil improves quality of life by helping restore normal sexual function and easing urinary symptoms in men with BPH. However, it’s important to use Tadalafil only under medical supervision, especially if you have heart conditions, take other medications, or are using it for PAH.

With a wide range of brand options available in Pakistan, patients can access both imported and affordable local versions. Always consult your doctor to choose the right dose and brand for your specific health condition.

Frequently Asked Questions (FAQs) about Tadalafil

Here are some commonly asked questions to help you better understand the use and safety of Tadalafil.

What is Tadalafil used for?

Tadalafil is mainly used to treat erectile dysfunction (ED) by increasing blood flow to the penis during sexual stimulation. It is also approved to treat benign prostatic hyperplasia (BPH)—a condition where the prostate enlarges and affects urination—and pulmonary arterial hypertension (PAH) by relaxing blood vessels in the lungs to improve exercise capacity.

How long does Tadalafil last?

Tadalafil has a long-lasting effect compared to other ED medications. A single dose can remain effective for up to 36 hours, allowing for more natural and flexible sexual activity without the need to rush. This is why it’s often referred to as the “weekend pill.”

How fast does Tadalafil work?

Tadalafil usually starts to work within 30 to 60 minutes after taking the tablet. However, it requires sexual stimulation to be effective—it won’t cause an erection on its own.

Can I take Tadalafil daily?

Yes, a low daily dose of Tadalafil (2.5 mg or 5 mg) is often prescribed for men who want to be ready for sexual activity at any time or for those treating both ED and BPH together. This daily option provides a continuous level of medication in the body.

Is Tadalafil safe?

Tadalafil is generally safe when taken as directed by your doctor. However, it may not be suitable for people with certain heart conditions or those who take medications like nitrates. Always inform your doctor about your medical history and current medications before starting Tadalafil.

Can women take Tadalafil?

While Tadalafil is not approved for sexual use in women, it is sometimes prescribed to both men and women to treat pulmonary arterial hypertension (PAH) under the brand name Adcirca. Women should only use it if specifically prescribed by their doctor for PAH.

Is Tadalafil better than Sildenafil (Viagra)?

Both medicines are effective for treating ED, but Tadalafil lasts longer—up to 36 hours—while Sildenafil usually works for about 4 to 6 hours. Tadalafil may be more convenient for men who want more flexibility, but the best option depends on your personal health, response, and your doctor’s advice.

Can I take Tadalafil with food or alcohol?

Yes, you can take Tadalafil with or without food, and it won’t affect how the medicine works. However, drinking excessive alcohol while taking Tadalafil can increase the risk of side effects such as low blood pressure, dizziness, or headaches, so moderation is advised.

What happens if I take too much Tadalafil?

Taking more than the recommended dose can lead to serious side effects such as chest pain, fainting, low blood pressure, or a prolonged and painful erection (priapism). If this happens, seek emergency medical help right away.

Is Tadalafil available in Pakistan?

Yes, Tadalafil is widely available in Pakistan under various brand names such as Cialis, Tadalis, Tadora, Tadapure, and others. Both imported and affordable local versions are available through pharmacies and online medical stores.