Warnings

Tadalafil

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Apr 07, 2025

Warnings

Tadalafil Risks, Warnings, and Complications

Tadalafil can cause or worsen health problems in certain high-risk individuals. Talk to your doctor or pharmacist about other treatment options for erectile dysfunction, benign prostatic hyperplasia, or pulmonary arterial hypertension if you are at an increased risk of complications from this medication. Some of the risks of taking tadalafil include:

CARDIOVASCULAR RISKS: Treatment of erectile dysfunction with tadalafil is not recommended in men who are at risk of heart problems due to exertion during sexual intercourse.
The use of this medication is not recommended in men with unstable angina, coronary artery disease, hypotension (low blood pressure), uncontrolled hypertension (high blood pressure), life-threatening arrhythmias (irregular heart rhythms), severe heart failure, recent stroke, or recent heart attack in the last 90 days. Patients with conditions such as aortic stenosis are more sensitive to the action of PDE-5 inhibitors which are vasodilators (they cause widening of blood vessels).
Tadalafil can result in a transient decrease in supine blood pressure even in healthy men. Your healthcare professional will carefully weigh the benefits vs risks of tadalafil before prescribing this medication to you for erectile dysfunction. Tell your doctor immediately or seek emergency medical help if you develop chest pain, difficulty breathing, dizziness, or fainting.
It may not be safe for you to take nitrates such as nitroglycerine for anginal chest pain if you have taken tadalafil in the last 48 hours. Seek emergency medical attention for chest pain so that if nitrate administration is necessary, it can be done under medical supervision.
DRUG INTERACTIONS: Taking tadalafil once daily with certain other medications can lead to potentially dangerous drug interactions. Before starting tadalafil therapy, tell your doctor if you are taking medications such as:
Nitrates (for example, nitroglycerine for anginal chest pain)
Alpha blockers such as doxazosin (Cardura), prazosin (Minipress), or terazosin
Antihypertensives (blood pressure medicines)
CYP3A4 inhibitors (for example, HIV medicines like ritonavir, indinavir, and cobicistat; antifungal medicines like ketoconazole; and antibiotics like erythromycin)
Alcohol
Other ED drugs
PRIAPISM: There are rare reports of priapism (a painful and prolonged penile erection lasting more than 4 hours) in patients taking PDE-5 inhibitors such as tadalafil. Seek immediate medical attention if you develop a painful erection that lasts longer than 4 hours. Priapism is a medical emergency. Without immediate treatment, it can result in permanent damage to the penile tissue and erectile dysfunction. Before starting tadalafil, tell your health care professional if you have any structural defects in the penis, such as Peyronie’s disease, cavernosal fibrosis, or angulation. Also, tell your doctor if you have sickle cell anemia, leukemia, or multiple myeloma - these conditions are linked to an increased risk of priapism.
SUDDEN VISION LOSS: Taking phosphodiesterase-5 (PDE5) inhibitors such as tadalafil has been linked to sudden loss of vision in one or both eyes. This can be a sign of a rare eye disorder called non-arteritic anterior ischemic optic neuropathy (NAION). Seek emergency medical attention if you develop any vision problems such as double vision, changes in color vision (inability to tell the difference between blue and green), or sudden loss of vision.
SUDDEN HEARING LOSS: There are reports of sudden hearing loss in people who took PDE-5 inhibitors, including tadalafil. Seek emergency medical care if you develop decreased hearing or sudden hearing loss. This may be accompanied by tinnitus (ringing in the ears) and dizziness.
HEPATIC IMPAIRMENT: Too much tadalafil can harm people with liver problems. The dose of tadalafil needs to be adjusted in people with mild to moderate hepatic impairment (reduced liver function due to liver disease). Tadalafil is not recommended in people with severe hepatic impairment. The maximum dose is 10 mg when tadalafil is taken as needed. Daily dosing of tadalafil has not been studied for safety in people with liver disease.
RENAL IMPAIRMENT: Tadalafil dose needs to be adjusted for people with renal impairment (decreased kidney function). Talk to your doctor about the maximum dose that is safe to take if you have kidney problems and decreased creatinine clearance.
BLEEDING DISORDERS: Tadalafil may not be safe for people with bleeding disorders or peptic ulcer disease. Your doctor will discuss the risks versus benefits with you if you have a blood disorder.
SEXUALLY TRANSMITTED DISEASES: Tadalafil does not provide protection against HIV and other sexually transmitted diseases. You need to use protection, such as condoms, for this purpose.

Precautions Before Starting Tadalafil

Tell your doctor if you have ever had an allergic reaction to tadalafil, any of the active or inactive ingredients in tadalafil formulations, other PDE-5 inhibitors, or any other medicines. Your pharmacy can give you a list of ingredients.

Give your doctor a complete list of medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible interactions with certain medications.

Tadalafil may not be safe for people with certain medical conditions. Tell your doctor if you have had a prolonged erection that lasted more than 4 hours, dehydration (diarrhea, vomiting, inability to keep down fluids, excessive sweating), pulmonary veno-occlusive disease (PVOD or blocked veins in the lungs), abnormal shape or structural problems of the penis, high cholesterol, diabetes, high blood pressure, low blood pressure, arrhythmias (irregular heartbeat), recent myocardial infarction (heart attack), congestive heart failure, chest pain (angina), stroke, peptic ulcer disease, circulation problems, bleeding disorders, sickle cell anemia, leukemia, multiple myeloma, heart disease, liver or kidney disease.

Also, tell your doctor if there is any history in your family of an inherited eye condition called retinitis pigmentosa that can cause loss of vision. Tell your doctor about any pre-existing eye problems or history of sudden vision loss, including blockage of blood flow in the nerves of the eye.

If you are a woman and are taking tadalafil for pulmonary arterial hypertension, tell your doctor if you are pregnant or planning a pregnancy soon.

Precautions During Use of Tadalafil

Keep all your medical and laboratory appointments while taking tadalafil. Your healthcare professional may adjust your tadalafil dose based on your response and tolerability.

Talk to your doctor about the risks of drinking alcohol while on tadalafil. Drinking large amounts of alcohol while on this medicine can lead to severe side effects such as headache, dizziness, fast heartbeat, and low blood pressure.

Talk to your doctor about whether you can eat grapefruit and drink grapefruit juice while taking tadalafil.

Call your doctor immediately if you develop chest pain during sexual activity. Refrain from further sexual activity until your doctor says it is okay.

Tell all your healthcare providers you are on tadalafil, especially before any surgery or emergency treatment for heart problems.

Tadalafil Drug Interactions

Taking tadalafil with certain other drugs can affect how the medications work. Possible drug interactions between tadalafil and other medications can increase the risk of severe adverse effects. Your doctor may need to change the doses of your medications, switch you to alternative treatments, or monitor your carefully for side effects if there are potential interactions.

You should not take tadalafil if you are currently taking or have recently taken riociguat (Adempas) or a nitrate medicine such as nitroglycerin (Nitrostat, Nitro-Dur, Minitran, Nitromist), isosorbide dinitrate (Dilatrate-SR, Isordil, in BiDil), or isosorbide mononitrate (Monoket). These medicines come as tablets, sublingual tablets, patches, ointments, sprays, and pastes.

Also, you should not take street drugs containing nitrates such as amyl nitrite (amyl nitrate) or butyl nitrate (commonly called poppers) while on tadalafil.

Tadalafil can also have interactions with the following medications:

Alpha blockers such as alfuzosin (Uroxatral), tamsulosin (Flomax, in Jalyn), doxazosin (Cardura), terazosin, and prazosin (Minipress)
Antiarrhythmics such as amiodarone (Cordarone, Pacerone),
Antifungal medications such as itraconazole (Onmel, Sporanox), fluconazole (Diflucan), ketoconazole (Nizoral, Extina, Ketozole, Xolegel), griseofulvin (Grifulvin, Gris-PEG), and voriconazole (Vfend)
Antiemetics for nausea and vomiting such as aprepitant (Emend)
Other medicines for pulmonary arterial hypertension such as bosentan (Tracleer)
Antiepileptic drugs like carbamazepine (Epitol, Tegretol, Carbatrol, Teril), phenobarbital, and phenytoin (Dilantin, Phenytek)
Antibiotics such as clarithromycin (Biaxin, in Prevpac), erythromycin (Erythrocin, E.E.S., E-Mycin), telithromycin (Ketek), rifabutin (Mycobutin), and rifampin (Rimactane, Rifadin, in Rifater, in Rifamate)
Calcium channel blockers such as diltiazem (Cardizem, Tiazac, Cartia) and verapamil (Calan, Verelan, Covera, in Tarka)
HIV medicines such as efavirenz (Sustiva, in Atripla), indinavir (Crixivan), ritonavir (Norvir, in Kaletra), nevirapine (Viramune), and nelfinavir (Viracept)
Cholesterol-lowering medicines such as lovastatin (Altocor, in Advicor)
Antihypertensive medications for high blood pressure
Antidepressants such as nefazodone and sertraline (Zoloft)
Other drugs for the treatment of erectile dysfunction
St. John’s wort

Give your doctor or pharmacist a complete list of your medications, including prescription drugs, over-the-counter medications, dietary supplements, and herbal remedies. Also, tell your health care professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medicines.

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