Tadalafil Side Effects and Management

Common Side Effects

The American Urological Association notes that tadalafil has lower rates of dyspepsia compared to other PDE5 inhibitors 1
The most frequently reported adverse events follow a dose-response pattern, meaning higher doses increase the likelihood of side effects, according to the Journal of Urology 1
Tadalafil has the lowest rates of flushing among all PDE5 inhibitors, as reported by the Journal of Urology and Praxis Medical Insights 1, 2

The American College of Cardiology recommends explicitly asking about all forms of nitrate use before prescribing tadalafil, due to the risk of dangerous hypotension 2, 3
Patients on tadalafil should be assessed for cardiovascular fitness for sexual activity before prescribing, with low-risk patients able to safely receive tadalafil, according to the Mayo Clinic Proceedings 2, 3, 4
The European Society of Cardiology notes that high-risk patients should defer sexual activity until cardiac condition is stabilized and be referred to cardiology 3, 4

The National Kidney Foundation recommends using tadalafil with caution at lower initial doses in mild to moderate renal impairment due to delayed metabolism 1
The American Association for the Study of Liver Diseases notes that tadalafil is generally not recommended in severe renal or liver disease 1, 2

The International Society for Sexual Medicine recommends proper patient education, including the need for sexual stimulation for tadalafil to work, and avoiding taking with large meals 1
The European Association of Urology suggests an adequate trial consists of at least 5 separate attempts at maximum dose before declaring treatment failure 2
The American Urological Association recommends starting with standard dosing and titrating down if side effects are bothersome, as lower doses maintain similar efficacy 1, 2