Tadalafil Side Effects

Medically reviewed by Drugs.com. Last updated on Mar 19, 2025.

Applies to tadalafil: oral suspension, oral tablet.

Precautions

It is important that you tell all of your doctors that you take tadalafil. If you need emergency medical care for a heart problem, it is important that your doctor knows when you last took tadalafil.

If you will be taking this medicine for pulmonary arterial hypertension, it is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.

If you take tadalafil for pulmonary arterial hypertension, do not take Cialis® or other PDE5 inhibitors, such as sildenafil (Revatio® or Viagra®) or vardenafil (Levitra®). Cialis® also contains tadalafil. If you take too much tadalafil or take it together with these medicines, the chance for side effects will be higher.

If you experience a prolonged erection for more than 4 hours or a painful erection for more than 6 hours, contact your doctor immediately. This condition may require prompt medical treatment to prevent serious and permanent damage to your penis.

This medicine does not protect you against sexually transmitted diseases (including HIV or AIDS). Use protective measures and ask your doctor if you have any questions about this.

It is important to tell your doctor about any heart problems you have now or may have had in the past. This medicine can cause serious side effects in patients with heart problems.

Do not use this medicine if you are also using riociguat or a nitrate medicine, often used to treat angina (chest pain). Nitrate medicines include nitroglycerin, isosorbide, Imdur®, Nitro-Bid®, Nitrostat®, Nitro-Dur®, Transderm Nitro®, Nitrol® Ointment, and Nitrolingual® Spray. Some illegal ("street") drugs called "poppers" (such as amyl nitrate, butyl nitrate, or nitrite) also contain nitrates. If you need to use a nitrate medicine, take it at least 48 hours after your last dose of tadalafil.

Do not drink excessive amounts of alcohol (eg, 5 or more glasses of wine or 5 or more shots of whiskey) when taking tadalafil. When taken in excess, alcohol can increase your chances of getting a headache or dizziness, increase your heart rate, or lower your blood pressure.

If you experience sudden loss of vision in one or both eyes, contact your doctor immediately.

Check with your doctor right away if you have a sudden decrease in hearing or loss of hearing, which may be accompanied by dizziness and ringing in the ears.

Do not eat grapefruit or drink grapefruit juice while you are using this medicine. Grapefruit and grapefruit juice may change the amount of this medicine that is absorbed in the body.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Common side effects of tadalafil

Some side effects of tadalafil may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Serious side effects of tadalafil

Along with its needed effects, tadalafil may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking tadalafil:

For healthcare professionals

Applies to tadalafil: oral suspension, oral tablet, oral tablet chewable.

General adverse events

The most commonly reported adverse reactions were headache, nausea, dyspepsia, back pain, myalgia, flushing, nasopharyngitis, and pain in the extremity. These adverse reactions were dose dependent, transient, and generally mild or moderate.^[Ref]

Cardiovascular

• Very common (10% or more): Flushing (up to 14%)
• Common (1% to 10%): Hypertension, hot flush
• Uncommon (0.1% to 1%): Hypotension
• Frequency not reported: Unstable angina pectoris, postural hypotension, ventricular arrhythmia
• Postmarketing reports: Myocardial infarction, sudden cardiac death, stroke, chest pain, palpitations, and tachycardia, have been reported in temporal association with the use of this drug.^[Ref]

Most patients that experienced side effects such as myocardial infarction, sudden cardiac death, stroke, palpitations, and tachycardia had preexisting cardiovascular risk factors. Many of these events were reported to occur during or shortly after sexual activity.^[Ref]

Gastrointestinal

• Very common (10% or more): Dyspepsia (up to 13%), nausea (up to 11%)
• Common (1% to 10%): Diarrhea, gastroesophageal reflux disease, abdominal pain, gastroenteritis, constipation
• Uncommon (0.1% to 1%): Vomiting
• Frequency not reported: Dry mouth, dysphagia, esophagitis, gastritis, loose stools, nausea, upper abdominal pain, hemorrhoidal hemorrhage, rectal hemorrhage^[Ref]

Musculoskeletal

• Very common (10% or more): Myalgia (up to 14%), back pain (up to 12%), pain in extremity (up to 11%)
• Common (1% to 10%): Pain in limb, musculoskeletal stiffness
• Uncommon (0.1% to 1%): Arthralgia, muscle spasm
• Frequency not reported: Neck pain^[Ref]

Nervous system

• Very common (10% or more): Headache (up to 42%)
• Common (1% to 10%): Dizziness (1%)
• Rare (less than 0.1%): Transient global amnesia, transient ischemic attacks
• Frequency not reported: Hypesthesia, somnolence, syncope, paraesthesia
• Postmarketing reports: Migraine, seizure and seizure recurrence^[Ref]

Respiratory

• Very common (10% or more): Nasopharyngitis (up to 13%), upper and lower respiratory tract infection (up to 13%)
• Common (1% to 10%): Nasal congestion (including sinus congestion), cough, influenza, pulmonary hypertension, rhinitis
• Uncommon (0.1% to 1%): Dyspnea, epistaxis
• Frequency not reported: Pharyngitis^[Ref]

Genitourinary

• Common (1% to 10%): Urinary tract infection, menorrhagia (including uterine bleeding)
• Uncommon (0.1% to 1%): Penile hemorrhage, hematospermia
• Rare (less than 0.1%): Prolonged erections
• Frequency not reported: Erection increased, spontaneous penile erection
• Postmarketing reports: Priapism^[Ref]

Other

• Common (1% to 10%): Peripheral edema, fatigue, edema
• Uncommon (0.1% to 1%): Tinnitus
• Rare (less than 0.1%): Facial edema
• Frequency not reported: Vertigo, asthenia, pain
• Postmarketing reports: Cases of sudden decrease or loss of hearing have been reported in temporal association with the use of this drug.^[Ref]

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.^[Ref]

Dermatologic

• Uncommon (0.1% to 1%): Rash, urticaria, hyperhidrosis (sweating)
• Rare (less than 0.1%): Angioedema
• Frequency not reported: Pruritus
• Postmarketing reports: Stevens-Johnson syndrome, exfoliative dermatitis^[Ref]

Ocular

• Uncommon (0.1% to 1%): Ocular hyperemia, eye pain, eyelid edema
• Rare (less than 0.1%): Changes in color vision
• Frequency not reported: Blurred vision, conjunctivitis (including conjunctival hyperemia), eye pain, lacrimation increased
• Postmarketing reports: Visual field defect, retinal vein occlusion, and retinal artery occlusion. Non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, has been reported in temporal association with the use of this drug.^[Ref]

Most of the patients with NAION, but not all, had underlying anatomic or vascular risk factors, including but not necessarily limited to: Low cup to disc ratio ("crowded disc"), age over 50, diabetes, hypertension, coronary artery disease, hyperlipidemia, and smoking.^[Ref]

Renal

• Uncommon (0.1% to 1%): Hematuria
• Frequency not reported: Renal impairment^[Ref]

Hepatic

• Frequency not reported: Abnormal liver function tests, GGTP increased^[Ref]

See also:

Frequently asked questions

• Cialis vs Viagra - What's the difference between them?
• Cialis: 7 Important Things to Know

Further information

Tadalafil side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer