What Is Cialis Pills?
How long does it take for Cialis to work?
Cialis works fairly quickly to treat your ED, BPH symptoms, or both conditions. Studies show that the medication may work as quickly as 30 minutes after you take your dose. However, in some people, the medication may take up to 6 hours until you notice it working.
On average, it takes about 2 hours for Cialis to peak. This is how long it takes for you to have the highest level of medication in your body. This is when the drug should work the best to treat your ED, symptoms of BPH, or both conditions.
How long does Cialis last?
Cialis can work for up to 36 hours in your body.
To treat erectile dysfunction (ED), your doctor may have you take Cialis only as needed before sexual activity. (See the “Cialis dosage” section above to learn more.) In this case, Cialis may keep working for up to 36 hours in helping you have and maintain erections during that time.
However, if you take Cialis each day for either benign prostatic hyperplasia (BPH) or ED, you’ll always have medication in your system. Therefore, it will continue to work throughout the day.
Cialis uses
The Food and Drug Administration (FDA) approves prescription drugs such as Cialis to treat certain conditions. Cialis may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.
Cialis for benign prostatic hyperplasia (BPH)
Cialis is approved by the FDA to treat the symptoms of benign prostatic hyperplasia.
BPH is a condition that occurs in men as they age. It happens when the prostate gland slowly increases in size but isn’t cancerous. As the prostate gland gets bigger, it begins to push on your bladder. So eventually you may experience symptoms of BPH, including:
needing to urinate often, especially at night
straining to urinate
producing a weak stream of urine
being unable to urinate
feeling that your bladder didn’t empty after urinating
Effectiveness
Cialis was an effective medication to treat symptoms of BPH in clinical trials.
Researchers used a scale called the International Prostate Symptom Score (IPSS). IPSS is a questionnaire that was given to people to determine if their BPH symptoms improved. The symptoms included urinary urgency (sudden need to urinate), weak urine stream, and straining to urinate.
A higher score meant that symptoms of BPH were worse. The goal was to have a lower score, which indicates that people have had fewer and less severe symptoms of BPH.
The studies looked at people with BPH who took Cialis or a placebo (treatment with no active drug). Researchers found that people who took:
Cialis had a decrease in their IPSS score of 4.8 to 5.6 points
a placebo had a decrease in their IPSS score of 2.2 to 3.6 points
This means that the Cialis group noticed a larger decrease in the number and severity of BPH symptoms than the placebo group.
Cialis for erectile dysfunction (ED)
Cialis is FDA-approved to treat erectile dysfunction.
ED is a condition in which a man may have trouble having or maintaining an erection so they can have sex. There are many different causes of ED, including:
illness
conditions that can affect the nerves or blood, such as diabetes or high cholesterol
emotional factors, such as stress, depression, or anxiety
Sometimes ED can be helped by simply addressing the cause, such as treating an illness or anxiety. In other cases, you may need medication such as Cialis to treat your ED.
Effectiveness
Cialis was shown in clinical trials to be an effective medication to treat ED. The drug was studied using part of a survey called the Index of Erectile Function (IIEF). A higher score on the IIEF meant that erectile function was better, so ED symptoms improved. The people in the study took the survey after 4 weeks.
One trial looked at people who took 20 mg of Cialis or a placebo only when needed to treat their ED.
People who took Cialis had their IIEF scores improve by 6.9 to 9.3 points. This means that their ED symptoms eased while they were taking Cialis.
People who took a placebo either lost points or improved by a maximum of only 0.3 points. Losing points on the scale means that their ED symptoms worsened.
In another trial, people took 2.5 mg or 5 mg of Cialis, or a placebo on an everyday basis to treat their ED.
The study showed that for people who took any strength of Cialis, their IIEF scores improved by 6.1 to 9.7 points. This means that their ED symptoms eased while they were taking Cialis.
In comparison, people who took a placebo had improvements of only 0.9 to 1.2 points.
Cialis for ED and BPH
Cialis is FDA-approved to treat both ED and the symptoms of BPH together. These are two different conditions and aren’t usually caused by the same issues. For details on ED and BPH, see the “Cialis for benign prostatic hyperplasia (BPH)” and “Cialis for erectile dysfunction (ED)” sections above.
In some cases, medications for BPH, such as dutasteride (Avodart), may cause a lower libido (sex drive) and result in ED. However, ED and BPH are common in aging males, and aren’t necessarily related.
Effectiveness
Cialis was an effective medication in clinical trials for people with both ED and BPH. The studies used two different questionnaires, one for ED symptoms and one for BPH symptoms, to determine how well the medication worked.
Measuring results for BPH symptoms
To measure improvement of BPH, researchers used a scale called the International Prostate Symptom Score (IPSS). IPSS is a questionnaire that was given to people to determine if their BPH symptoms improved. The symptoms included urinary urgency (sudden need to urinate), weak urine stream, and straining to urinate.
A higher score meant that symptoms of BPH were worse. The goal was to have a lower score, which indicates that people have had fewer and less severe symptoms of BPH.
Researchers found the following:
People with both ED and BPH who took Cialis had a decrease in their IPSS scores of 6.1 points.
In comparison, people who took a placebo had a decrease in their score of about 3.8 points.
This means that, on average, people who took Cialis noticed a larger decrease in their BPH symptoms than people who took a placebo.
Measuring results for ED
To measure the improvement of ED symptoms, researchers used part of a survey called the Index of Erectile Function (IIEF). People with both ED and BPH took the survey after 4 weeks. A higher score on the IIEF meant that erectile function was better, so ED symptoms improved.
Researchers found the following:
People who took Cialis had an increase in their IIEF scores of about 6.5 points.
In comparison, people who took a placebo had an increase of only 1.9 points.
This means that people who took Cialis usually had greater erectile function than people who took a placebo.
Off-label use for Cialis
In addition to the uses listed above, Cialis may be used off-label for other purposes. Off-label drug use is when a drug that’s approved for one use is used for a different one that’s not approved. Below is an example of an off-label use for Cialis.
Cialis for ureteral stones
Cialis isn’t FDA-approved to treat ureteral stones. However, it may be used off-label for this purpose. A clinical trial compared Cialis with tamsulosin (Flomax), a drug that’s often used to treat ureteral stones. The study showed that more people who took Cialis were able to pass their stones than people who took tamsulosin.
Ureteral stones usually start out as kidney stones and then move into the ureter (the tube that urine travels in from the kidney to the bladder). Kidney stones are minerals that form a stone inside a kidney.
Cialis may work to treat ureteral stones by relaxing the ureter muscles. This makes the ureter wider, which can help you pass the stones more easily.
If you have questions about taking Cialis for ureteral stones, talk with your doctor.
Cialis and alcohol
Both alcohol and Cialis can decrease your blood pressure. So if you drink alcohol while taking this medication, it’s recommended that you don’t drink too much. This may help prevent your blood pressure from becoming too low.
Having five or more drinks (five shots or glasses of wine or beer) along with Cialis can increase the risk of side effects. In addition to decreased blood pressure, these side effects can include:
increased heart rate
dizziness
headache
If you drink alcohol, talk with your doctor about what amount is safe to drink while you’re taking Cialis.
Alternatives to Cialis
Other drugs are available that can treat your erectile dysfunction (ED), symptoms of benign prostatic hyperplasia (BPH), or both. Some medications may be a better fit for you than others. If you’re interested in finding an alternative to Cialis, talk with your doctor. They can tell you about other drugs that may work well for you.
Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.
Alternatives for benign prostatic hyperplasia (BPH)
Examples of other drugs that may be used to treat symptoms of BPH include:
alfuzosin (Uroxatral)
doxazosin (Cardura)
silodosin (Rapaflo)
tamsulosin (Flomax)
dutasteride (Avodart)
finasteride (Proscar)
Alternatives for erectile dysfunction (ED)
Examples of other drugs that may be used to treat ED include:
sildenafil (Viagra)
vardenafil (Levitra)
avanafil (Stendra)
Alternatives for ED and BPH
Cialis is the only medication that the Food and Drug Administration (FDA) has approved to treat both ED and symptoms of BPH together. However, other combinations of drugs may be used for this purpose. Also, other single medications may be used off-label to treat both ED and symptoms of BPH together.
Examples of other drugs that may be used to treat ED and symptoms of BPH together include:
sildenafil (Viagra)
vardenafil (Levitra)
finasteride (Proscar) and sildenafil
finasteride and vardenafil
Cialis overdose
Using more than the recommended dosage of Cialis can lead to serious side effects.
Don’t use more Cialis than your doctor recommends.
Overdose symptoms
Doses of up to 500 mg of Cialis have been tested. Doses of up to 100 mg have also been given to people once a day. Overdose symptoms were similar to the normal side effects people have had after taking Cialis. (For more about side effects, see the “Cialis side effects” section above.)
What to do in case of overdose
If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.
Cialis use with other drugs
If you’re taking Cialis, you usually won’t have to use other medications with it.
But if you have a prostate condition called benign prostatic hyperplasia (BPH), your doctor may first prescribe a drug called finasteride (Proscar).
Finasteride is a first-line treatment (the first treatment used) when medications are recommended for BPH. This is because the drug shrinks the prostate by blocking the growth of prostate cells. Cialis treats the symptoms of BPH by reducing the prostate gland muscle tone, but it doesn’t block the growth of the cells.
Finasteride can help also ease symptoms of BPH, such as having to urinate suddenly and more often. However, this medication can cause negative sexual side effects such as decreased libido (sex drive) and erectile dysfunction. To help ease these side effects, your doctor may have you also take Cialis.
If you have questions about using Cialis and finasteride, talk with your doctor.
What can I take to enhance Cialis?
You shouldn’t take anything in addition to Cialis to enhance the drug, unless your doctor tells you to.
Cialis expiration, storage, and disposal
When you get Cialis from the pharmacy, the pharmacist will add an expiration date to the label on the package or bottle. This date is typically 1 year from the date they dispensed the medication.
The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.
Storage
How long a medication remains good can depend on many factors, including how and where you store the medication.
You should store Cialis tablets at 77°F (25°C). But you can keep them between 59°F and 86°F (15°C and 30°C) for short periods of time, if needed. Store Cialis in a tightly sealed container away from light. And avoid keeping this medication in areas where it could get damp or wet, such as bathrooms.
Disposal
If you no longer need to take Cialis and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.
This article provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.
Cialis interactions
Cialis can interact with several other medications. It can also interact with certain foods.
Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase the number of side effects or make them more severe.
Cialis and other medications
Below is a list of medications that can interact with Cialis. This list doesn’t contain all drugs that may interact with Cialis.
Before taking Cialis, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Cialis and nitrates
You shouldn’t take Cialis if you’re taking a medication called a nitrate. This type of drug may be used for chest pain. Taking nitrates along with Cialis can cause a serious decrease in your blood pressure.
Examples of nitrates include:
nitroglycerin
isosorbide mononitrate (Monoket)
isosorbide dinitrate (Isordil)
However, in some cases, you doctor may give you a nitrate: for example, if you have chest pain and your life is at risk, and it’s been at least 48 hours since your last dose of Cialis. After you receive the nitrate, your doctor will likely monitor you to make sure your blood pressure doesn’t drop to an unsafe level.
Cialis and alpha-blockers
Both Cialis and medications called alpha-blockers can cause a decrease in blood pressure. So taking these medications together can cause blood pressure to drop further.
If you have benign prostatic hyperplasia (BPH) and are taking a medication called an alpha-blocker, you shouldn’t use Cialis.
And if you have erectile dysfunction (ED) and are taking an alpha-blocker, your doctor will likely lower your dose of Cialis.
Examples of alpha-blocker drugs include:
tamsulosin (Flomax)
alfuzosin (Uroxatral)
doxazosin (Cardura)
Before taking Cialis, tell your doctor about any medications that you use, including alpha-blockers.
Cialis and medications that lower blood pressure
Cialis may reduce your blood pressure. So if you’re taking other medications to reduce your blood pressure, using Cialis along with them may cause a larger drop in blood pressure.
Examples of blood pressure medications include:
amlodipine (Norvasc)
metoprolol (Toprol XL, Lopressor)
enalapril (Vasotec)
Before you start Cialis treatment, tell your doctor if you’re taking any blood pressure drugs. They may give you a lower dose of Cialis or monitor you more often.
Cialis and medications to treat heartburn
If you’re taking Cialis and use antacids to treat heartburn, the antacids may decrease the level of Cialis that your body absorbs. This means that you may not get the full dose of Cialis, so it may not work as well to treat your ED or symptoms of BPH.
Examples of antacids include:
calcium carbonate (Tums)
aluminum hydroxide/magnesium hydroxide (Mylanta)
Before you start using Cialis, tell your doctor if you’re taking antacids. Talk with them about how far apart to take the doses of each drug if you need to use both medications.
Cialis and CYP3A4 inhibitors
Cialis is broken down in your body by an enzyme in your liver called CYP3A4. (An enzyme is a protein that aids chemical changes in your body.) Certain drugs can inhibit (block) this enzyme from working. So if the enzyme is unable to break down Cialis, the level of Cialis in your body may get too high. This can be dangerous and may increase your risk of side effects from Cialis. (For more about side effects, see the “Cialis side effects” section above.)
Examples of medications that can block CYP3A4 from working include:
antifungal drugs, such as:
ketoconazole
itraconazole (Sporanox)
antibiotic drugs, such as:
erythromycin (Ery-Tab)
HIV medications, such as:
ritonavir (Norvir)
Before starting Cialis treatment, talk with your doctor about any medications that you’re taking. They’ll be able to determine if the drugs are CYP3A4 inhibitors and if they can interact with Cialis. In some cases, your doctor may recommend a lower dose of Cialis or a different medication to treat your ED, symptoms of BPH, or both.
Cialis and CYP3A4 inducers
Cialis is broken down in your liver by an enzyme called CYP3A4. Certain drugs may induce (increase the activity of) CYP3A4, making it work better or faster than usual. This means that your body may break down Cialis more quickly than it should, so the drug may not affect you.
Examples of drugs that induce CYP3A4 include:
rifampin (Rifadin)
carbamazepine (Tegretol)
phenytoin (Dilantin)
phenobarbital
Before you start to use Cialis, talk with your doctor about any medications that you’re taking. They’ll be able to determine if the drugs are CYP3A4 inducers and if they can interact with Cialis. In some cases, your doctor may recommend a different medication to treat your ED, symptoms of BPH, or both.
Cialis and guanylate cyclase stimulators
You shouldn’t take Cialis if you’re using a type of drug called a guanylate cyclase stimulator. This kind of medication is used to treat people with pulmonary hypertension (a type of high blood pressure in your lungs). Using a guanylate cyclase stimulator along with Cialis may cause your blood pressure to become dangerously low.
An example of a guanylate cyclase stimulator is riociguat (Adempas). This medication can be used to treat pulmonary hypertension (PH) that happens in your arteries of your lungs (pulmonary arterial hypertension) or PH that happens due to a blood clot in your lungs.
Before taking Cialis, talk with your doctor about any medications you’re using for pulmonary hypertension. If you’re taking riociguat, they’ll likely recommend a different medication to treat your ED, BPH symptoms, or both.
Cialis and herbs and supplements
There aren’t any herbs or supplements that have been specifically reported to interact with Cialis. However, you should still check with your doctor or pharmacist before using any of these products while taking Cialis.
Cialis and foods
Here’s some information about how Cialis may interact with alcohol and grapefruit.
Alcohol
Both alcohol and Cialis can decrease your blood pressure. So if you drink alcohol while taking this medication, it’s recommended that you don’t drink too much. This may help prevent your blood pressure from becoming too low. For more information, see the “Cialis and alcohol” section above.
Grapefruit
While you take Cialis, it’s best to avoid eating grapefruit and drinking grapefruit juice.
Cialis is broken down in your body by an enzyme in your liver called CYP3A4. Grapefruit blocks that enzyme from working. So if the enzyme is unable to break down Cialis, the level of Cialis in your body may get too high. This can be dangerous and may increase your risk of side effects from Cialis. (For more about side effects, see the “Cialis side effects” section above.)
Cialis precautions
This drug comes with several precautions. Before taking Cialis, talk with your doctor about your health history. Cialis may not be right for you if you have certain medical conditions or other factors affecting your health. These include:
Heart problems. Sexual activity has an impact on your heart function. So if you have a history of heart problems, talk with your doctor before taking Cialis. These heart problems can include a heart attack or an irregular heart rhythm. Your doctor will be able to tell you if your heart is healthy enough for you to have sex. And if you have symptoms such as chest pain or an irregular heartbeat while taking Cialis, you should stop any sexual activity and see a doctor as soon as possible.
Pulmonary hypertension. If you have pulmonary hypertension (a type of high blood pressure in your lungs), talk with your doctor before taking Cialis. In some cases, you may be taking a medication called riociguat (Adempas) to treat your pulmonary hypertension. And using this medication along with Cialis may cause your blood pressure to become dangerously low. You shouldn’t take Cialis if you’re taking riociguat for pulmonary hypertension.
Blood pressure problems. Cialis can cause both high blood pressure and low blood pressure. So if you already have either of these conditions, Cialis may make it worse. And you may be at a higher risk for symptoms from changes in blood pressure. (To learn more, see “Changes in blood pressure” in the “Side effect details” section above.) If you have a history of blood pressure problems, tell your doctor before you take Cialis. During your treatment, they may have you monitor your blood pressure more often to make sure it doesn’t become too high or too low.
Stroke. Cialis may increase your risk for stroke, especially if you have a history of stroke. In studies conducted after Cialis was approved, some people with a history of heart problems had strokes. If you have a history of stroke, be sure to talk with your doctor before taking Cialis. They’ll be able to determine if the medication is safe for you.
Liver problems. If you have a history of liver problems, such as hepatitis or liver failure, your body may not break down Cialis quickly enough. This means that the drug can build up in your system, which may increase your risk of side effects from the medication. (To learn more, see the “Cialis side effects” section above.) If you have liver problems, be sure to talk with your doctor before taking Cialis. They may have you start with a low dose.
Kidney problems. If you have kidney problems, such as chronic kidney disease, your body may not be able to get rid of Cialis as quickly as it should. This means that the medication may build up in your body, which can cause serious side effects. (To learn more, see the “Cialis side effects” section above.) If you have kidney problems, tell your doctor before you take Cialis. They may have you start with a low dose of the medication.
Severe vision loss. If you have any history of vision loss, talk with your doctor before taking Cialis. This vision loss may include having vision conditions such as non-arteritic anterior ischemic optic neuropathy (NAION). Using Cialis when you have vision loss may increase your risk for developing vision side effects. (See “Loss of vision” in the “Side effect details” section to learn more.) Your doctor may recommend a different medication than Cialis.
Retinitis pigmentosa. If you have retinitis pigmentosa (a genetic eye condition that may cause vision loss), you shouldn’t use Cialis. Taking Cialis when you have vision loss may increase your risk for developing vision side effects. (See “Loss of vision” in the “Side effect details” section to learn more.) Your doctor may recommend a different medication than Cialis.
Stomach ulcers. It’s possible that Cialis may increase your risk for bleeding. So if you have a history of stomach ulcers, taking Cialis may increase your risk of developing bleeding ulcers. (Stomach ulcers are sores in the lining of your stomach or intestine, and they may bleed.) Talk with your doctor before taking Cialis if you have a history of stomach ulcers. They may recommend a different treatment.
Bleeding problems. Cialis may increase your risk for bleeding. If you have a history of bleeding problems, such as hemophilia, taking Cialis may further increase your risk for bleeding. Talk with your doctor before taking Cialis if you have a history of bleeding problems. They may recommend a different treatment.
Deformed penis or Peyronie’s disease. If you have a deformed penis or a history of Peyronie’s disease (a curved penis), tell your doctor before taking Cialis. You may be at an increased risk for developing a long-lasting erection if you take the drug. Blood may become trapped in the penis and lead to an erection lasting longer than 4 hours, which can be dangerous and cause lasting damage. Your doctor will probably have you take a low dose of Cialis or use the medication with caution.
History of erections lasting longer than 4 hours. If you have a history of prolonged erections or priapism, you may be at an increased risk for developing them while taking Cialis. A prolonged erection is one that lasts more than 4 hours. And priapism is a painful erection that lasts more than 6 hours. Both conditions are considered emergencies and need to be treated right away to prevent long-term damage. So if you’ve had prolonged erections or priapism in the past, tell your doctor before you take Cialis. They may have you carefully monitor your condition after using Cialis.
Blood cell problems. Blood cell problems can includesickle cell anemia and blood cancers such as multiple myeloma or leukemia. If you have a blood cell problem, tell your doctor before using Cialis. You may be at an increased risk for developing a long-lasting erection when taking the drug. Erections lasting longer than 4 hours can be dangerous and may cause permanent damage. Your doctor may recommend a low dose of Cialis if you have blood cell problems.
Allergic reaction. If you’ve had an allergic reaction to Cialis or any of its ingredients, you shouldn’t take Cialis. Ask your doctor what other medications are better options for you.
Pregnancy. Cialis isn’t approved for use in women. And it’s not known if the medication is safe to take during pregnancy. For more information, please see the “Cialis and pregnancy” section above.
Breastfeeding. Cialis isn’t approved for use in women. And it’s not known if this medication is safe to take while breastfeeding. For more information, please see the “Cialis and breastfeeding” section above.
Note: For more information about the potential negative effects of Cialis, see the “Cialis side effects” section above.