Cialis® (Tadalafil) Side Effects: What to Expect

If you’ve just started taking Cialis®, don’t be alarmed if you feel a little off.

Like other medications for the treatment of erectile dysfunction (ED), Cialis — and its generic version, tadalafil — can cause adverse effects at first. Fortunately, most tadalafil side effects are mild and resolve on their own over time.

But what’s normal and what’s not?

If you’ve heard rumors about the side effects of tadalafil, like hair loss or body odor, we’re here to set the record straight. 

Below, we’ll explain:

• What you can expect when using this treatment for ED (besides better erections) 

• Common and uncommon side effects of Cialis

• Drug interactions that may come from taking Cialis with other medications 

Here’s a look at Cialis’s less-fun side.

Cialis has several common side effects, many of which also happen with other drugs used to treat erectile dysfunction, like sildenafil (generic Viagra®), vardenafil (Levitra®), and avanafil (Stendra®).

One difference is that Cialis is active in the body for longer than other oral ED meds, meaning its side effects can last longer too.

Potential side effects of Cialis include:

• Headaches

• Indigestion

• Heartburn

• Back pain

• Muscle aches

• Facial flushing

• Nasal congestion

• Nasopharyngitis (common cold symptoms)

• Pain in limbs

Keep scrolling for details.

1. Headaches

Headaches are a common side effect of oral ED medications, and Cialis is no exception. The things we do for love, eh?

In fact, headaches are among the most frequently reported adverse effects of tadalafil, making an appearance in all clinical trials of the medication. 

According to a 2008 review of studies on tadalafil, 15 percent of men who used this medication at its highest recommended dose (20 milligrams) experienced headaches.

Headaches can still be common for those who take a lower 10-milligram dose of Cialis, affecting about 12 percent of men.

Most of the time, Cialis-induced headaches are mild and become less intense over time. That said, Cialis’s long half-life means a dull headache might stick around for several hours after the fun’s over.

If you’re prone to headaches after taking Cialis, our guide to treating headaches from ED drugs may help.

2. Indigestion

If you’ve ever taken Cialis and felt butterflies in your stomach before the clothes came off, it may not have been lust. There’s a pretty good chance it was just a little indigestion.

Indigestion is the second-most common side effect of tadalafil, affecting eight to 10 percent of users, depending on dosage.

Indigestion is a common side effect of most oral ED medications, which are known as phosphodiesterase 5 inhibitors (PDE5 inhibitors for short).

3. Heartburn

Why does Cialis heartburn occur? The medication relaxes the lower esophageal sphincter (the part of the body that normally stops stomach contents from going back up the esophagus). This may lead to heartburn as stomach acid travels from your stomach upward into your esophagus.

If you get acid reflux, an upset stomach, or other digestive issues after taking Cialis, making small changes — like drinking more water or using antacid medicine — can make this side effect easier to manage. 

If you experience Cialis heartburn often, discuss your dosage with your healthcare provider.

Tadalafil 20-milligram side effects are often more noticeable than 10-milligram or 5-milligram side effects when it comes to acid reflux and indigestion. Adjusting your dosage might help keep the heat between the sheets and not inside your chest.

4. Back Pain

No, you’re not just getting too old for this — Cialis can cause back pain too. Roughly three to six percent of men who take it develop back pain, and the discomfort tends to set in around 12 to 24 hours after taking the medication.

What’s the Cialis back pain solution? Well, many people report that it usually fades on its own within 48 hours.

In the meantime, you might consider treating mild to moderate back pain from tadalafil with over-the-counter pain relief, like ibuprofen or aspirin.

5. Muscle Aches

Like Viagra and other ED medications, a small percentage of men who use Cialis experience myalgia. Another word for muscle pain, myalgia affects muscles, ligaments, tendons, and connective tissues.

In clinical trials of Cialis, one to four percent of men reported muscle pain as an adverse effect. And this side effect was more common with higher dosages.

Here’s some good news: Muscle aches from Cialis or other ED medications are typically mild and tend to last only while the medication is active in the body.

6. Facial Flushing

Feeling your cheeks getting red after taking Cialis? It may not just be those two glasses of wine you had at dinner. 

Tadalafil is a vasodilator, meaning it improves blood flow throughout your body, including to the erectile tissue of your penis. But this medication is also used to treat symptoms of BPH (benign prostatic hyperplasia) under the brand name Adcirca®. And it’s sometimes prescribed for pulmonary arterial hypertension (PAH), a form of high blood pressure affecting the arteries in the lungs.

Because Cialis dilates blood vessels, facial flushing can happen around your nose, cheeks, chin, and forehead. This side effect can also occur elsewhere on your body.

Around three percent of men who use Cialis experience facial flushing. This side effect is more typical with moderate and high doses. Like other side effects of Cialis, it usually fades as your body metabolizes the medication over the course of several hours.

Since facial flushing is a common oral ED medication side effect, switching to another drug might not help the issue. 

7. Nasal Congestion

Tadalafil can affect nitric oxide levels inside your nasal cavity, giving you a stuffy nose that could make it difficult to take in the pheromones.

As with many other Cialis side effects, nasal congestion tends to fade on its own as your body processes the medication.

While a stuffy nose is a common side effect of oral ED medications, switching from Cialis to shorter-lasting options like Viagra or Levitra might make sense. These meds remain active in the body for shorter periods and may make this side effect subside more quickly.

8. Nasopharyngitis (Common Cold Symptoms)

Some men who use Cialis to treat ED report cold-like symptoms (nasopharyngitis) after taking the medication.

The common cold is caused by a viral infection, not Cialis. However, since this medication affects the soft tissue inside the nose and throat, some users experience suspiciously similar symptoms. 

But rest easy — you’re not sick. Not from Cialis, at least.

9. Pain in Limbs

Limb pain is a real-deal side effect. In clinical trials, one to three percent of men who used Cialis reported leg pain and, on occasion, pain in their other limbs.

This side effect was most common in guys who took 10 to 20 milligrams of Cialis a day.

There are no known long-term side effects of tadalafil. In fact, studies have shown this medication is well tolerated over the long term (if you can handle the shorter-term side effects).

However, quick reminder, fellas: Even though it hasn’t been associated with long-term issues, that doesn’t mean you should ever use more than the prescribed amount — especially if you’re using Cialis daily.

Cialis has an impressively long half-life — one dose can last up to 36 hours (hence, its nickname “the weekend pill”). But you can also take Cialis daily at a lower dose if you’re the kinda guy who needs more assurance than for 36 hours at a time. 

In general, the common effects of daily tadalafil are similar to those when it’s taken as needed before sexual activity. 

But because daily-use Cialis is prescribed at a lower dosage, some side effects appear less common and are generally less severe.

For instance, in clinical trials, 11 to 15 percent of men reported headaches from Cialis at a dose of 5 to 20 milligrams. In comparison, only three to six percent of men who took Cialis every day at a dose of 2.5 or 5 milligrams reported headaches.

Other side effects, such as dyspepsia and back pain, were also reported less frequently by men prescribed Cialis for daily use. 

Our guide to daily Cialis has more info about the advantages and disadvantages of using Cialis every day to treat ED.

Here’s where things get a little more serious. While most side effects mentioned above are relatively benign (that’s doctor-talk for “pretty mild”), the side effects below — although rare — require immediate care. 

So pay attention.

Serious adverse effects of Cialis might include:

• Priapism (a painful erection lasting four hours or longer)

• Optic nerve damage

• Loss of hearing

• Interactions with other prescription medications

Here’s what to look out for.

Priapism

Priapism is a prolonged, often painful erection lasting four hours or longer. While it might sound awesome in theory, in practice, it’s a medical emergency that requires immediate attention to avoid damaging the erectile tissue.

Though it’s possible to experience a prolonged erection after using Cialis, this is an extremely uncommon side effect. 

If you get a persistent or painful erection after using tadalafil, it’s crucial to seek medical care immediately. 

Optic Nerve Damage

Although exact data isn’t available, tadalafil was listed as one of several PDE5 inhibitors linked to rare reports of NAION (non-arteritic anterior ischemic optic neuropathy) in a study of sildenafil (Viagra) and optic nerve damage.

This condition can develop when blood supply to the optic nerve is reduced, potentially reducing your field of vision.

Optic nerve damage could cause or contribute to vision loss (including retinitis pigmentosa). Like priapism, this is an extremely rare side effect that only affects a tiny percentage of Cialis users.

It’s also worth noting that NAION appears to occur mostly in people with a pre-existing risk factor for eye damage, like a small cup-to-disc ratio.

Hearing Issues

Cialis has been linked to decreased hearing sensitivity or hearing loss.

Cases of sudden hearing loss caused by Cialis are very uncommon. And evidence suggests that some of the reported cases may be linked to underlying medical conditions.

That’s why it’s vital to tell your healthcare provider every single thing. 

If you take Cialis to treat ED and notice any changes in your hearing, it’s best to stop taking the medication and seek medical advice immediately. 

Allergic Reaction to Cialis

Beyond tadalafil side effects, it’s possible to have an allergic reaction to tadalafil or other inactive ingredients used in the manufacturing process.

Common symptoms of allergic reaction include hives, rash, swelling of the lips, throat, and tongue, and difficulty breathing or swallowing.

If you experience any of the above symptoms or other possible signs of an allergic reaction after taking Cialis, seek emergency medical help.

Other Rare Side Effects

Other uncommon side effects of Cialis include chest pain, ringing in the ears, and skin issues.

Does Cialis raise blood pressure? As a vasodilator, tadalafil is more likely to lower your blood pressure, which is why it should never be combined with other ED medications or antihypertensive drugs.

However, in clinical trials, high blood pressure was reported in just one percent of patients taking 2.5-milligram tadalafil and three percent of patients taking the 5-milligram dose.

Let your healthcare provider know if you develop these or other tadalafil side effects.

Tadalafil side effects aren’t the only concern when taking this drug.

As mentioned, Cialis can interact with other PDE5 inhibitors for ED, as well as medications prescribed to treat hypertension (high blood pressure), fungal infections, heart disease, heart failure, bleeding disorders, ulcers, and other medical conditions.

Be sure to share any and all prescription drugs you’re taking with your healthcare provider before starting this medication.

Interaction With Blood Pressure Medications

Tadalafil can interact with nitrates used to treat hypertension, angina (chest pain), and other heart problems. This could cause abnormally low blood pressure that may lead to loss of consciousness, heart attack, or even cardiac arrest (sudden death). Yikes. 

If you take nitrates like nitroglycerin, isosorbide dinitrate, or isosorbide mononitrate to treat hypertension (high blood pressure) or angina, you shouldn’t take Cialis. 

Besides nitrates used to treat cardiovascular conditions, ED medications can interact with certain recreational drugs that contain nitrates, like amyl nitrate “poppers.”

Interaction With Antifungal Medications

Cialis can interact with some oral antifungal medications, like itraconazole or ketoconazole, used to treat ringworm, dandruff, or fungal nail infections. These medications, which inhibit the CYP3A4 enzyme, may increase your exposure to the effects of Cialis.

Some other medications that affect CYP3A4, like the antibiotic erythromycin, may also interact with Cialis.

Grapefruit juice can be a problem too. If you want to take Cialis at night, you may have to stop eating grapefruit in the morning. 

Our guide to Cialis and grapefruit interactions explains more about this weird relationship.

If you’re prescribed these medications, your healthcare professional may adjust your dosage of Cialis to reduce your risk of developing side effects. 

The FDA (U.S. Food and Drug Administration) suggests taking Cialis at a maximum as-needed dosage of 10 milligrams no more than once per 72 hours — or a daily dosage of 2.5 milligrams — if you’re prescribed any other medication that inhibits CYP3A4.

Other Medications That May Interact With Cialis

Other medications may also interact with Cialis, including:

• Ritonavir. This antiretroviral medication inhibits CYP3A4 and may increase the effects of Cialis in the body.

• Alpha-blockers. When taken with Cialis, alpha-blockers can cause a drop in blood pressure. These medications are frequently prescribed to manage high blood pressure, benign prostatic hyperplasia (enlarged prostate), and other conditions. This includes Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), and Jalyn® (dutasteride and tamsulosin HCl).

• Other PDE5 inhibitors. Other PDE5 inhibitors, such as sildenafil (Viagra), vardenafil (Levitra), and avanafil (Stendra), will interact with Cialis.

Are side effects avoidable when you take prescription medications? Sometimes — if you follow the rules.

And there are some important rules to follow when it comes to ED pills:

• Make sure you get them from a reputable source.

• Don’t take street drugs or gas station supplements.

• Inform a healthcare provider of other medications and supplements you’re taking.

• Take only the prescribed dosage.

Getting the right pills is important. Cialis comes in tablet form, making it convenient for treating ED. Although some online vendors advertise liquid versions of Cialis, these products are unregulated in the United States.

Dosage is also critical to your safety. If you’re prescribed as-needed Ciali, a normal dose should start working within 30 to 60 minutes and can last up to about 36 hours. But taking more won’t make it work any better.

Although there’s no simple, one-size-fits-all way to completely eliminate side effects from Cialis, there are several other things you can do to reduce your side effect risk.

Limit Alcohol Consumption

As much as you may love those two glasses of wine on date night (and the nightcap before hitting the hay), try to limit your alcohol consumption while taking Cialis. 

Drinking alcohol with Cialis can increase your risk of experiencing side effects. Also, “whiskey dick” is a punishment we wouldn’t wish on our worst enemy.

The best way to do this is to avoid any alcohol consumption. But if you typically drink while out on dates or just as part of your normal lifestyle, cutting down your intake to one to two small servings can help. 

Only Use Cialis as Prescribed

Drug labels exist for a reason. Most potential side effects of Cialis are dose-dependent, meaning they become more common at higher doses. Sorry to be a broken record, but only use the dosage of Cialis prescribed to you. 

If you find it hard to get or maintain an erection after using Cialis, don’t adjust your dosage on your own. Instead, let your healthcare provider know about your concerns. 

Don’t Take Cialis More Than Once a Day

Cialis is a long-lasting ED medication that’s not intended for use more than one time a day. A single dose of Cialis should produce a noticeable improvement in your erections that continues for up to 36 hours.

If you don’t notice any improvements after taking your medication, don’t take a second dose of tadalafil. Rain-check sexy time if needed, and get in touch with your healthcare provider about potentially adjusting your dosage or trying a new ED med.

Avoid Grapefruit

This one seems out of place unless you’re familiar with grapefruit’s reputation as a blood pressure bad boy. Grapefruit juice can increase the serum concentrations of tadalafil and other medications in your body, which can lead to overdose-like results. Stick with water — it’s good for you.

Although Cialis is widely known as a treatment for erectile dysfunction, it’s also approved by the FDA to treat benign prostatic hyperplasia.

An enlarged prostate is common in older men and typically carries symptoms of lower urinary tract problems, which can become bladder problems over time.

Tadalafil is typically taken daily for BPH. The potential side effects and interactions of Cialis are the same whether it’s used for ED or BPH, so it is important to be aware of these effects before using this medication.

It’s normal to experience one or several minor side effects from Cialis. Luckily, serious side effects are uncommon.

Still, this type of medication should improve your quality of life, not reduce it. The point is to have a great time getting laid, not to spend a bunch of time reading health information on the internet.

Let’s make this one of the last deep dives you do to understand your risks. 

Here’s what to remember about tadalafil side effects if you’ve started taking Cialis or are about to take your first tadalafil dose:

• Don’t ignore side effects. If you’re prescribed Cialis for erectile dysfunction or benign prostatic hyperplasia and notice a concerning or problematic side effect, talk to your healthcare provider as soon as possible.

• Your dosage can change to fix problems. Remember, tadalafil 5-milligram side effects tend to be less severe than those experienced with 10- or 20-milligram dosages. Your provider may recommend adjusting your Cialis dosage if you’re experiencing side effects.

• Other ED drugs can work if Cialis doesn’t. In some cases, your provider may suggest switching to another ED drug, like sildenafil (Viagra), vardenafil (Levitra), or avanafil (Stendra). These medications are shorter-acting than Cialis, so any side effects you experience may fade away sooner.

Side effects aren’t something you’re stuck with. We offer several FDA-approved ED medications online, following a consultation with a licensed healthcare provider who’ll determine if prescription drugs are appropriate for your symptoms.

You can learn more about the causes of and treatments for ED in our complete guide to erectile dysfunction.