Cialis Side Effects
Generic Name: tadalafil
Please note - some side effects for Cialis may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
Side Effects of Cialis - for the Consumer
Cialis
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Cialis:
Seek medical attention right away if any of these SEVERE side effects occur when using Cialis:Cough; dizziness; flushing; headache; heartburn; mild back or muscle pain; stomach upset; stuffy or runny nose.
Severe allergic reactions (rash; hives; itching; difficulty breathing or swallowing; tightness in the chest; swelling of the mouth, face, lips, throat, or tongue); burning, numbness, or tingling; chest pain; confusion; decreased urination; fainting; fast or irregular heartbeat; memory loss; numbness of an arm or leg; one-sided weakness; prolonged, painful erection; red, swollen, blistered, or peeling skin; ringing in the ears; seizures; severe or persistent back or muscle pain; severe or persistent dizziness or headache; slurred speech; sudden decrease or loss of hearing; vision changes (eg, sudden decrease or loss of vision in one or both eyes).
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
TopCialis Side Effects - for the Professional
Cialis
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Tadalafil was administered to over 9000 men during clinical trials worldwide. In trials of Cialis for once daily use, a total of 1434, 905, and 115 were treated for at least 6 months, 1 year, and 2 years, respectively. For Cialis for use as needed, over 1300 and 1000 subjects were treated for at least 6 months and 1 year, respectively.
Cialis for Use as Needed for ED
In eight primary placebo-controlled clinical studies of 12 weeks duration, mean age was 59 years (range 22 to 88) and the discontinuation rate due to adverse events in patients treated with tadalafil 10 or 20 mg was 3.1%, compared to 1.4% in placebo treated patients.
When taken as recommended in the placebo-controlled clinical trials, the following adverse reactions were reported for Cialis for use as needed:
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a The term flushing includes: facial flushing and flushing |
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| Adverse Reaction | Placebo (N=476) |
Tadalafil 5 mg (N=151) | Tadalafil 10 mg (N=394) | Tadalafil 20 mg (N=635) |
| Headache | 5% | 11% | 11% | 15% |
| Dyspepsia | 1% | 4% | 8% | 10% |
| Back pain | 3% | 3% | 5% | 6% |
| Myalgia | 1% | 1% | 4% | 3% |
| Nasal congestion | 1% | 2% | 3% | 3% |
| Flushinga | 1% | 2% | 3% | 3% |
| Pain in limb | 1% | 1% | 3% | 3% |
Cialis for Once Daily Use for ED
In three placebo-controlled clinical trials of 12 or 24 weeks duration, mean age was 58 years (range 21 to 82) and the discontinuation rate due to adverse events in patients treated with tadalafil was 4.1%, compared to 2.8% in placebo-treated patients.
The following adverse reactions were reported in clinical trials of 12 weeks duration:
| Adverse Reaction | Placebo (N=248) |
Tadalafil 2.5 mg (N=196) |
Tadalafil 5 mg (N=304) |
| Headache | 5% | 3% | 6% |
| Dyspepsia | 2% | 4% | 5% |
| Nasopharyngitis | 4% | 4% | 3% |
| Back pain | 1% | 3% | 3% |
| Upper respiratory tract infection | 1% | 3% | 3% |
| Flushing | 1% | 1% | 3% |
| Myalgia | 1% | 2% | 2% |
| Cough | 0% | 4% | 2% |
| Diarrhea | 0% | 1% | 2% |
| Nasal congestion | 0% | 2% | 2% |
| Pain in extremity | 0% | 1% | 2% |
| Urinary tract infection | 0% | 2% | 0% |
| Gastroesophageal reflux disease | 0% | 2% | 1% |
| Abdominal pain | 0% | 2% | 1% |
The following adverse reactions were reported over 24 weeks treatment duration in one placebo-controlled clinical study:
| Adverse Reaction | Placebo (N=94) |
Tadalafil 2.5 mg (N=96) |
Tadalafil 5 mg (N=97) |
| Nasopharyngitis | 5% | 6% | 6% |
| Gastroenteritis | 2% | 3% | 5% |
| Back pain | 3% | 5% | 2% |
| Upper respiratory tract infection | 0% | 3% | 4% |
| Dyspepsia | 1% | 4% | 1% |
| Gastroesophageal reflux disease | 0% | 3% | 2% |
| Myalgia | 2% | 4% | 1% |
| Hypertension | 0% | 1% | 3% |
| Nasal congestion | 0% | 0% | 4% |
Cialis for Once Daily Use for BPH and for ED and BPH
In three placebo-controlled clinical trials of 12 weeks duration, two in patients with BPH and one in patients with ED and BPH, the mean age was 63 years (range 44 to 93) and the discontinuation rate due to adverse events in patients treated with tadalafil was 3.6% compared to 1.6% in placebo-treated patients. Adverse reactions leading to discontinuation reported by at least 2 patients treated with tadalafil included headache, upper abdominal pain, and myalgia. The following adverse reactions were reported.
| Adverse Reaction | Placebo (N=576) |
Tadalafil 5 mg (N=581) |
| Headache | 2.3% | 4.1% |
| Dyspepsia | 0.2% | 2.4% |
| Back pain | 1.4% | 2.4% |
| Nasopharyngitis | 1.6% | 2.1% |
| Diarrhea | 1.0% | 1.4% |
| Pain in extremity | 0.0% | 1.4% |
| Myalgia | 0.3% | 1.2% |
| Dizziness | 0.5% | 1.0% |
Additional, less frequent adverse reactions (<1%) reported in the controlled clinical trials of Cialis for BPH or ED and BPH included: gastroesophageal reflux disease, upper abdominal pain, nausea, vomiting, arthralgia, and muscle spasm.
Back pain or myalgia was reported at incidence rates described in Tables 1 through 4. In tadalafil clinical pharmacology trials, back pain or myalgia generally occurred 12 to 24 hours after dosing and typically resolved within 48 hours. The back pain/myalgia associated with tadalafil treatment was characterized by diffuse bilateral lower lumbar, gluteal, thigh, or thoracolumbar muscular discomfort and was exacerbated by recumbency. In general, pain was reported as mild or moderate in severity and resolved without medical treatment, but severe back pain was reported with a low frequency (<5% of all reports). When medical treatment was necessary, acetaminophen or non-steroidal anti-inflammatory drugs were generally effective; however, in a small percentage of subjects who required treatment, a mild narcotic (e.g., codeine) was used. Overall, approximately 0.5% of all subjects treated with Cialis for on demand use discontinued treatment as a consequence of back pain/myalgia. In the 1-year open label extension study, back pain and myalgia were reported in 5.5% and 1.3% of patients, respectively. Diagnostic testing, including measures for inflammation, muscle injury, or renal damage revealed no evidence of medically significant underlying pathology. Incidence rates for Cialis for once daily use for ED, BPH and BPH/ED are described in Tables 2, 3 and 4. In studies of Cialis for once daily use, adverse reactions of back pain and myalgia were generally mild or moderate with a discontinuation rate of <1% across all indications.
Across all studies with any Cialis dose, reports of changes in color vision were rare (<0.1% of patients).
The following section identifies additional, less frequent events (<2%) reported in controlled clinical trials of Cialis for once daily use or use as needed. A causal relationship of these events to Cialis is uncertain. Excluded from this list are those events that were minor, those with no plausible relation to drug use, and reports too imprecise to be meaningful:
Body as a Whole — asthenia, face edema, fatigue, pain
Cardiovascular — angina pectoris, chest pain, hypotension, myocardial infarction, postural hypotension, palpitations, syncope, tachycardia
Digestive — abnormal liver function tests, dry mouth, dysphagia, esophagitis, gastritis, GGTP increased, loose stools, nausea, upper abdominal pain, vomiting, gastroesophageal reflux disease, hemorrhoidal hemorrhage, rectal hemorrhage
Musculoskeletal — arthralgia, neck pain
Nervous — dizziness, hypesthesia, insomnia, paresthesia, somnolence, vertigo
Renal and Urinary — renal impairment
Respiratory — dyspnea, epistaxis, pharyngitis
Skin and Appendages — pruritus, rash, sweating
Ophthalmologic — blurred vision, changes in color vision, conjunctivitis (including conjunctival hyperemia), eye pain, lacrimation increase, swelling of eyelids
Otologic — sudden decrease or loss of hearing, tinnitus
Urogenital — erection increased, spontaneous penile erection
Postmarketing Experience
The following adverse reactions have been identified during post approval use of Cialis. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These events have been chosen for inclusion either due to their seriousness, reporting frequency, lack of clear alternative causation, or a combination of these factors.
Cardiovascular and Cerebrovascular — Serious cardiovascular events, including myocardial infarction, sudden cardiac death, stroke, chest pain, palpitations, and tachycardia, have been reported postmarketing in temporal association with the use of tadalafil. Most, but not all, of these patients had preexisting cardiovascular risk factors. Many of these events were reported to occur during or shortly after sexual activity, and a few were reported to occur shortly after the use of Cialis without sexual activity. Others were reported to have occurred hours to days after the use of Cialis and sexual activity. It is not possible to determine whether these events are related directly to Cialis, to sexual activity, to the patient's underlying cardiovascular disease, to a combination of these factors, or to other factors [see Warnings and Precautions (5.1)].
Body as a Whole — hypersensitivity reactions including urticaria, Stevens-Johnson syndrome, and exfoliative dermatitis
Nervous — migraine, seizure and seizure recurrence, transient global amnesia
Ophthalmologic — visual field defect, retinal vein occlusion, retinal artery occlusion
Non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, has been reported rarely postmarketing in temporal association with the use of phosphodiesterase type 5 (PDE5) inhibitors, including Cialis. Most, but not all, of these patients had underlying anatomic or vascular risk factors for development of NAION, including but not necessarily limited to: low cup to disc ratio (“crowded disc”), age over 50, diabetes, hypertension, coronary artery disease, hyperlipidemia, and smoking. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors, to the patient's underlying vascular risk factors or anatomical defects, to a combination of these factors, or to other factors [see Warnings and Precautions (5.4)].
Otologic — Cases of sudden decrease or loss of hearing have been reported postmarketing in temporal association with the use of PDE5 inhibitors, including Cialis. In some of the cases, medical conditions and other factors were reported that may have also played a role in the otologic adverse events. In many cases, medical follow-up information was limited. It is not possible to determine whether these reported events are related directly to the use of Cialis, to the patient's underlying risk factors for hearing loss, a combination of these factors, or to other factors [see Warnings and Precautions (5.5)].
Urogenital — priapism [see Warnings and Precautions (5.3)].
TopSide Effects by Body System - for Healthcare Professionals
Cardiovascular
Cardiovascular side effects have included angina pectoris, chest pain, hypotension, hypertension, myocardial infarction, postural hypotension, palpitations, syncope, and tachycardia.
Dermatologic
Dermatologic side effects have included pruritus, rash, and sweating.
Gastrointestinal
Gastrointestinal side effects have included dyspepsia, diarrhea, dry mouth, dysphagia, esophagitis, gastroesophageal reflux, gastritis, loose stools, nausea, upper abdominal pain, and vomiting.
General
General side effects have included asthenia, face edema, facial flushing, fatigue, and pain in a limb.
Genitourinary
Genitourinary side effects have included increased erection and spontaneous penile erection.
Hepatic
Hepatic side effects have included abnormal liver function tests such as an increased GGTP.
Musculoskeletal
Musculoskeletal side effects have included back pain or myalgia, arthralgia, and neck pain.
Respiratory
Respiratory side effects have included nasal congestion, dyspnea, epistaxis, pharyngitis, nasopharyngitis, upper respiratory tract infection, and bronchitis.
Nervous system
Nervous system side effects have included headache, dizziness, hypesthesia, insomnia, paresthesia, somnolence, migraine and vertigo. Postmarketing experience has included seizure and seizure recurrence and transient global amnesia.
Ocular
Ocular side effects have included blurred vision, changes in color vision, conjunctivitis (including conjunctival hyperemia), eye pain, increased lacrimation, and swelling of the eyelids.
Non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, has been reported rarely postmarketing in temporal association with the use of phosphodiesterase type 5 (PDE5) inhibitors, including tadalafil.
Other
Other side effects have included cases of sudden decrease or loss of hearing reported postmarketing in temporal association with the use of PDE5 inhibitors, including tadalafil. In some cases, medical conditions and other factors were reported that may have also played a role in the otologic adverse events. In many cases, medical follow-up information was limited. It is not possible to determine whether these reported events are related directly to the use of tadalafil, to the patient's underlying risk factors for hearing loss, a combination of these factors, or to other factors.
Hypersensitivity
Hypersensitivity side effects have included Stevens-Johnson syndrome and exfoliative dermatitis.
TopMore Cialis resources
- Cialis Monograph (AHFS DI)
- Cialis Prescribing Information (FDA)
- Cialis MedFacts Consumer Leaflet (Wolters Kluwer)
- Cialis Advanced Consumer (Micromedex) - Includes Dosage Information
- Cialis Consumer Overview
- Tadalafil Professional Patient Advice (Wolters Kluwer)
- Adcirca MedFacts Consumer Leaflet (Wolters Kluwer)
- Adcirca Prescribing Information (FDA)
- Adcirca Consumer Overview
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