What is tadalafil used for?
- Two EU licensed tadalafil uses, both in adult men.
- The first is erectile dysfunction.
- The second, which was introduced later, is the urinary problems of an enlarged prostate, benign prostatic hyperplasia, for which the 5 mg daily tablet is used either alone or in combination with the erection indication.
- It is not licensed for women.
- The other tadalafil, Adcirca, at 40 mg a day, is indicated for the treatment of pulmonary arterial hypertension and represents an entirely different medicine for an entirely different disease.
How tadalafil works
- No signal, no action.
- The arousal goes to the penis, nitric oxide is released and this messenger, cGMP, rises in the erectile tissue.
- The muscle there relaxes and blood fills in.
- The enzyme that clears cGMP away again is called PDE5.
- Tadalafil hangs out on that enzyme so the messenger sticks around longer, and then it is easier to create an erection and keep it.
- That is also why the tablet by itself does not do anything either: no signal, no nitric oxide, nothing to protect.
- It is a fussy molecule, over 700 times keener on PDE5 than PDE6 in the retina: this accounts for why the blue tint some men see with sildenafil is seldom reported with tadalafil.
How long does tadalafil take to work, and how long does it last?
- Men in the home-use trials managed sex just 16 minutes after a tablet, but the product information says to take it half an hour before sex, and blood level peaks are only around two hours.
- And the tail is what makes it different.
- Half of the drug is still in the body 17.5 hours later, compared to about four for sildenafil, and that explains why we have this famous window.
- It was found to produce firmer erections and successful intercourse up to 36 hours after a single dose in three trials involving just over a thousand men.
- Dinner does not matter one way or another.
- Absorption was the same with a meal or without, and morning or evening, so for the timing question you have to wait half an hour and expect nothing without arousal.
- Advised gap before sex
- at least 30 minutes
- Peak blood level
- about 2 hours
- Window of effect
- up to 36 hours
| Licensed strengths | 2.5, 5, 10 and 20 mg |
|---|---|
| On-demand dose | 10 mg, up to 20 mg, no more than once a day |
| Daily dose | 5 mg, or 2.5 mg if not tolerated |
| Earliest response in trials | 16 minutes |
| Advised gap before sex | at least 30 minutes |
| Peak blood level | about 2 hours |
| Half-life | 17.5 hours |
| Window of effect | up to 36 hours |
| Food | no effect on absorption |
Tadalafil dosage: on demand or daily
- There are two forms of use, suited to different men.
- What everyone refers to as the on-demand way: the standard tadalafil dosage is 10 mg prior to anticipated sex, and if this is not sufficient, 20 mg represents the next licensed step and also the ceiling.
- Whatever the strength, one dose a day is the max, and because it lasts so long a tablet Friday night does not require one on Saturday.
- The tadalafil daily way is meant for men who would need to use it 2 or more times a week.
- A 5 mg tablet at approximately the same time each day, reduced to 2.5 mg if 5 mg is not tolerated well, produces a constant level after about five days and then timing no longer makes any difference whatsoever.
- The same 5 mg everyday dose is the one accepted for urinary symptoms of enlargement of the prostate.
- The product info adds one thing people forget: the daily routine is to be reviewed from time to time, not something that you continue on indefinitely by default.
Tadalafil 20mg and the stronger tablets
- The approved dosing for the tablets ranges from 2.5 mg to 20 mg.
- The tablets available here are tadalafil 20mg, 40mg, 60mg and 80mg and manufactured in India; the doses above 20 mg consist of multiples of the highest licensed dose rather than doses that have been studied.
- The product information notes that exposure increases linearly with dose, so a 40 mg tablet puts about twice as much drug in the blood as 20 mg, and any side effect listed thus becomes more likely at higher exposure.
- It does not say the window gets longer; the 36 hours was at 20 mg.
- The stronger tablets have their own page, and for the majority of men the truthful starting point is the Vidalista 20 pill, which is on par with a licensed dose.
Frequently asked questions
How long does tadalafil 20mg last?
It works for as long as 36 hours after you take it, and peaks around two hours later, and is strongest in the first hours after that peak. 36 hours does not translate as an erection for 36 hours. That means for about a day and a half after taking the drug, sexual stimulation will elicit an erection that is firmer and more reliable than it would be in the absence of the pill.
Is there a tadalafil 5mg daily tablet in this range?
No. Tadalafil 5mg is the licensed daily dose for men who expect to take the medicine at least twice per week, and for prostate symptoms. The range here starts at 20 mg, the on-demand dose, and so the tablets are not intended to be split into quarters. A man who takes the daily routine needs a 5 mg product.
Can I take two tadalafil 20mg tablets?
Not on the same day. The highest licensed strength is 20 mg; the maximum allowed dose per day is one. Two 20 mg tablets become 40 mg, double the licensed maximum, and with a half-life of about 17.5 hours the second tablet stacks with most of the first one. The 40 mg tablet sold here is exactly that, and the same caution is warranted.
Tadalafil vs Cialis: is there a difference?
Molecule, exposures and timeframe are identical. The original brand is Eli Lilly's Cialis. An EU-approved generic must demonstrate to a regulator that it delivers tadalafil into the blood in precisely the same manner; the tablets sold here are Indian generics which never underwent that process with an EU authority, so the onus of equivalent delivery rests solely with the manufacturer.
What if tadalafil did not work the first time?
Prior to deciding that it does not work, check three things. The drug does absolutely nothing by itself, so was there sexual stimulation? Was there at least 30 minutes, but preferably a couple of hours, between the tablet and the attempt? And was it 10 mg, in which case the licensed next step is 20 mg. Response is judged over a period of several attempts, not one. If 20 mg with stimulation and time still does nothing, the cause is almost always one that the drug cannot reach, blood vessel disease, a hormone problem or a relationship question, very much better suited to a doctor than to a higher tablet.
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