Testosterone
hormonePrescription testosterone replacement for men with confirmed low testosterone.
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No. 054medication
Tadalafil
Tadalafil is a medication that is FDA-approved, prescription only.
Also known as Cialis, Adcirca, generic Cialis
Tadalafil is a PDE5 inhibitor, the same drug class as sildenafil. It helps blood flow into the penis during sexual arousal and also eases urinary symptoms of an enlarged prostate. It is known for a longer window of effect than sildenafil.
Is Tadalafil FDA-approved?
Approved by the FDA. A licensed clinician has to decide it is right for you and prescribe it. Cialis was FDA-approved in 2003 and is indicated for erectile dysfunction, the urinary symptoms of BPH, or both. Generic tadalafil from many makers is FDA-approved. Prescription only in the US.
As of October 7, 2026.
Key takeaways
- Tadalafil (Cialis) is an FDA-approved prescription pill for erectile dysfunction, the urinary symptoms of an enlarged prostate (BPH), or both.
- It only works with sexual stimulation, and the label reports improved erections for up to 36 hours.
- It must never be combined with nitrate heart medicines or riociguat.
- Generic tadalafil is FDA-approved and widely available, but Medicare Part D excludes drugs used only for erectile dysfunction.
How does Tadalafil work?
During arousal, nerves release nitric oxide, which raises a messenger called cGMP that relaxes the smooth muscle in penile blood vessels so blood can flow in. The enzyme PDE5 breaks cGMP down. Tadalafil blocks PDE5, so the signal lasts longer and an erection is easier to get and keep.
It does not create desire or cause an erection on its own. Because PDE5 is also found in the prostate and bladder, relaxing muscle there is thought to explain why it eases urinary symptoms of BPH.
Does insurance cover tadalafil, and what does it cost?
Drugs@FDA lists many FDA-approved generic versions of Cialis, which is why cash prices from pharmacies and telehealth services are usually far lower than for the brand. Drugs@FDA: Cialis, NDA 021368
Medicare's Part D manual excludes drugs when used to treat sexual or erectile dysfunction. The same drugs can count as Part D drugs when prescribed for another FDA-approved use, so coverage for BPH depends on the plan and the reason it is prescribed. Private plans set their own rules. CMS: Medicare Prescription Drug Benefit Manual, Chapter 6 (Part D drugs and formulary requirements)
FDA warns that many "natural" sexual enhancement products sold online and in stores contain hidden sildenafil or tadalafil, which can be dangerous with nitrates. Buying a cheap supplement is not a safe substitute for a prescription. FDA: Sexual enhancement and energy product notifications (hidden ingredients)
What does the evidence say about Tadalafil?
Strong human evidenceLarge randomized trials and a 2021 network meta-analysis of 179 trials show PDE5 inhibitors, tadalafil among them, improve erections compared with placebo.
What to expect
What trials and prescribing information measured over time. Everyone responds differently.
- With or without food
The Cialis label says it may be taken without regard to food, and that it has no effect without sexual stimulation.
- Up to 36 hours
The label says erections improved compared with placebo for up to 36 hours. A 2003 trial found more successful attempts than placebo at both 24 and 36 hours.
- Ongoing
The AUA advises that more than one try may be needed before judging whether a PDE5 inhibitor works.
What do clinicians say about Tadalafil?
Urologists treat PDE5 inhibitors like tadalafil as a well-proven option for erectile dysfunction, after a conversation about heart health and other medicines.
The AUA guideline says men with erectile dysfunction should be informed about FDA-approved oral PDE5 inhibitors, including their benefits and risks, unless they are contraindicated.
American Urological Association: Erectile Dysfunction guideline (2018)The AUA guideline also says erectile dysfunction is a risk marker for underlying cardiovascular disease, and that men should be counseled about it.
American Urological Association: Erectile Dysfunction guideline (2018)The AUA advises telling men that sexual stimulation is needed and that more than one try may be needed to judge whether it works.
American Urological Association: Erectile Dysfunction guideline (2018)The Cialis label lists headache, indigestion, back pain, muscle aches, nasal congestion and flushing as the most common side effects, and warns about sudden vision loss, sudden hearing loss and erections lasting over 4 hours.
DailyMed: Cialis (tadalafil) prescribing informationA 2021 network meta-analysis of 179 randomized trials found every PDE5 inhibitor beat placebo and concluded sildenafil and tadalafil should be the first options considered.
Oral PDE5 inhibitors for erectile dysfunction: network meta-analysis and multicriteria decision analysis (World J Urol 2021)
Summaries of published guidelines, drug labels, regulators and reviews, each attributed to its source. DiscoverMedica does not employ clinicians.
Is Tadalafil right for you, and who should avoid it?
Often considered for
- Adult men with erectile dysfunction who do not take nitrates
- Men with urinary symptoms from an enlarged prostate (BPH), with or without erectile dysfunction
- Men who prefer a longer window of effect than sildenafil offers
Not a fit, or needs extra care
- Anyone taking nitrates (such as nitroglycerin) in any form, or riociguat
- Men advised to avoid sexual activity because of heart disease
- Anyone who has had sudden vision loss from NAION, or with severe kidney or liver disease, without specialist advice
- People taking alpha blockers or strong CYP3A4 inhibitors, unless the prescriber has planned for it
Only a licensed clinician who knows your history can decide whether it is right for you.
What are the risks and side effects of Tadalafil?
- Never combine it with nitrates (such as nitroglycerin) or riociguat: blood pressure can fall dangerously.
- Common side effects on the label are headache, indigestion, back pain, muscle aches, flushing and nasal congestion.
- Seek care for an erection lasting over 4 hours, sudden vision loss or sudden hearing loss.
- Heavy drinking, alpha blockers and grapefruit juice can raise the risk of low blood pressure or higher drug levels.
What should you ask a clinician about Tadalafil?
- Is my heart healthy enough for sexual activity and a PDE5 inhibitor?
- Do any of my medicines, especially nitrates or alpha blockers, rule it out?
- Could my erectile dysfunction be an early sign of a heart or blood vessel problem?
These save with the compound when you add it to My Journal, so they’re on the printout for your visit.
How do people get Tadalafil through telehealth?
Answer an online questionnaire about your symptoms, heart health, blood pressure and medicines.
A licensed clinician reviews it, often without a video visit, and prescribes if it is safe for you.
Generic tadalafil ships in discreet packaging, or the prescription goes to a pharmacy you choose.
Message the clinician about side effects or if it is not working; the AUA notes more than one try may be needed.
What programs often include
- Clinician review and prescription
- Ongoing messaging with the care team
- Discreet shipping on a refill schedule
How some providers do it
- HimsLists generic tadalafil and tadalafil chews after an online visit with a provider; plans are paid upfront.
- RoLists generic tadalafil and brand Cialis on a monthly plan after an online consultation.
- AgelessRxLists as-needed tadalafil, billed monthly or quarterly, after an online consultation.
- Amazon PharmacyFills generic tadalafil from your own prescriber, with insurance or cash pricing.
From each provider’s own site, checked October 7, 2026. Programs change, so confirm the details before you sign up.
Where can I get Tadalafil?
13 providers list Tadalafil on DiscoverMedica, lowest listed price first.
$2/pill with mail orderlisted price†
Start at Lemonaid Health As low as $6 per pilllisted price†
Start at Rex MD From $24/molisted price†
Start at Hims From $25/mo + membershiplisted price†
Start at Hone Health Starting at $53.99/molisted price†
Start at Maximus see site
Start at Amazon Pharmacy BlueChewBlueChew TAD compounded tadalafil chewable
Compounded, not FDA-approvedClinician consult required
see site
Start at BlueChew † Prices as listed by the provider when we checked; they change.
How much does Tadalafil cost?
Listed prices run from $24 to $53.99 a month across 4 providers, as checked October 7, 2026.
Prices as listed by the provider when we checked; they change. Membership or consult fees may be separate; see each provider.
Tadalafil: questions, answered
What are the most common side effects of tadalafil?
The Cialis label lists headache, indigestion, back pain, muscle aches, flushing and nasal congestion as the most common. Back and muscle pain are more typical of tadalafil than sildenafil. Rare but urgent problems are an erection lasting over 4 hours, sudden vision loss and sudden hearing loss. Never combine it with nitrates, because blood pressure can drop dangerously.
How long does tadalafil last?
The Cialis label reports improved erections compared with placebo for up to 36 hours, which is why it is sometimes called "the weekend pill". That is a window of possibility, not a constant erection: it only works with sexual stimulation. A 2003 randomized trial found more successful attempts than placebo at both 24 and 36 hours.
Is tadalafil the same as Cialis?
Yes. Tadalafil is the active ingredient in Cialis, which Lilly brought to market after FDA approval in 2003. Drugs@FDA lists many approved generic versions that FDA considers equivalent to the brand. The same ingredient is also sold as Adcirca for pulmonary arterial hypertension, a separate prescription use.
Does insurance or Medicare cover tadalafil?
Medicare Part D excludes drugs used only to treat erectile dysfunction, under CMS rules. Tadalafil prescribed for another FDA-approved use, such as BPH, may be treated differently, so ask your plan. Private insurers set their own rules. Because generics are widely available, many people pay cash through a pharmacy or telehealth service instead.
Can women take tadalafil?
The Cialis label states it is not indicated for use in women. Its approved uses are erectile dysfunction and BPH in men, and pulmonary arterial hypertension under the Adcirca name. A woman with sexual concerns should ask a clinician about options studied and approved for women rather than using a PDE5 inhibitor off-label.
Can I drink alcohol with tadalafil?
The Cialis label warns that substantial drinking together with tadalafil can increase the chance of low blood pressure, dizziness, fast heartbeat and headache. Alcohol can also make erections harder on its own. If you drink, keep it modest and ask your clinician how alcohol fits with your other medicines.
Important safety information
Key risks
- Never combine it with nitrates (such as nitroglycerin) or riociguat: blood pressure can fall dangerously.
- Common side effects on the label are headache, indigestion, back pain, muscle aches, flushing and nasal congestion.
- Seek care for an erection lasting over 4 hours, sudden vision loss or sudden hearing loss.
- Heavy drinking, alpha blockers and grapefruit juice can raise the risk of low blood pressure or higher drug levels.
Talk to a clinician first, or avoid it, if
- Anyone taking nitrates (such as nitroglycerin) in any form, or riociguat
- Men advised to avoid sexual activity because of heart disease
- Anyone who has had sudden vision loss from NAION, or with severe kidney or liver disease, without specialist advice
- People taking alpha blockers or strong CYP3A4 inhibitors, unless the prescriber has planned for it
This is not a complete list of risks. Read the full prescribing information and any Medication Guide, and talk to a licensed clinician or pharmacist about your own situation. If you have a severe reaction, call 911. You can report side effects to the FDA through MedWatch at 1-800-FDA-1088.
Sources
- DailyMed: Cialis (tadalafil) prescribing information
- Drugs@FDA: Cialis, NDA 021368
- American Urological Association: Erectile Dysfunction guideline (2018)
- Oral PDE5 inhibitors for erectile dysfunction: network meta-analysis (World J Urol 2021)
Also checked for this guide
- Porst et al.: Tadalafil for erectile dysfunction at 24 and 36 hours, randomized trial (Urology 2003)
- CMS: Medicare Prescription Drug Benefit Manual, Chapter 6 (Part D drugs and formulary requirements)
- FDA: Sexual enhancement and energy product notifications (hidden ingredients)
Guide reviewed October 7, 2026.
Educational information only, not medical advice. It does not replace a conversation with a licensed clinician.
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