How Tadalafil Helps With Benign Prostatic Hyperplasia

Tadalafil for the treatment of benign prostatic hyperplasia

In men, lower urinary tract symptoms (LUTS) are primarily attributed to benign prostatic hyperplasia (BPH). Therapeutic options are targeted to relax prostate smooth muscle and/or reduce prostate enlargement. Areas covered: This article reviews the major preclinical and clinical data on PDE5 inhibitors with a specific focus on tadalafil. It includes details of the role of the nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) – PDE5 pathway in the LUT organs (bladder and prostate) in addition to the available data on tadalafil in patients with LUTS secondary to BPH with or without erectile dysfunction (ED). Expert opinion: Preclinical and clinical data have clearly demonstrated that PDE5 inhibitors induce bladder and prostate relaxation, which contributes to the improvement seen in storage symptoms in both animal models of bladder and prostate hypercontractility. Tadalafil is effective both as a monotherapy and add-on therapy in patients with LUTS secondary to BPH. Furthermore, as LUTS-BPH and ED are urological disorders that commonly coexist in aging men, tadalafil is more advantageous than α1-adrenoceptors and should be used as the first option. Tadalafil is a safe and tolerable therapy and unlike α1- adrenoceptors and 5-alpha reductase inhibitors, which can cause sexual dysfunctions, tadalafil improves sexual function.

Keywords: Tadalafil; benign prostatic hyperplasia; bladder; cyclic GMP; erectile dysfunction; lower urinary tract; phosphodiesterase type 5; prostate.

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How Tadalafil Helps With Benign Prostatic Hyperplasia

Naveed Saleh, MD, MS, is a medical writer and editor covering new treatments and trending health news.

Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.

Jamin Brahmbhatt, MD, is a board-certified urologist and Chief of Surgery at Orlando Health South Lake Hospital.

Cialis (tadalafil), an erectile dysfunction medication, can also treat urinary symptoms of benign prostatic hyperplasia (BPH), or enlarged prostate.

Prior to this finding, there were only two options for urination difficulties in those with BPH:

5-alpha reductase inhibitors like Proscar (finasteride) and Avodart (dutasteride) that shrink the size of the prostate over six to 12 months

Although alpha blockers and 5-alpha reductase inhibitors are effective for helping with urination, they can have side effects that affect sexual function. Alpha blockers can cause retrograde ejaculation, or when semen enters the bladder and the person may no longer see ejaculate come out anymore; and 5-alpha reductase inhibitors can decrease libido. Some individuals take both medications, which can really dampen their sexual functioning if they are having both side effects.

Since 2011, Cialis (tadalafil) has been approved by the FDA for daily use in treatment for men with enlarged prostate, or BPH. It’s the same medication as for sexual and erectile dysfunction, but it’s just taken daily as a lower dose. This has the potential to make Cialis doubly beneficial for both urination and sexual functioning in men with enlarged prostate.

What Is BPH?

If you have BPH, you probably need no introduction to its inconvenient, annoying and sometimes very serious symptoms. However, for all of us who are uninitiated, here’s some info on this condition.

Benign prostatic hyperplasia is a noncancerous (nonmalignant) enlargement of the prostate gland. In men, the prostate makes part of the male ejaculate, or semen. In men with BPH, the prostate can become significantly larger and cause urinary obstruction. Of note, the prostate is a doughnut-shaped gland that surrounds the urethra or “pee” tube; the prostate sits just below the bladder.

Although prostate cancer can include enlargement and tissue expansion and many of the same initial symptoms as BPH, BPH isn’t cancer. It’s a benign condition which most men aged 50 or older experience to some degree. Moreover, BPH likely confers no additional risk of developing prostate cancer.

In most men, BPH is asymptomatic and causes no recognizable symptoms. About one-third of American men, however, can experience the following initial symptoms:

Weak urine stream which starts and stops
Feeling that you still have to pee even after you just finished urinating
Trouble initiating a urine stream (hesitancy)
An increased urge to urinate at night (nocturia)

Over time, BPH can lead to more serious problems such as urinary tract infections, kidney, and bladder damage. (The obstruction caused by a hyperplastic prostate can cause urine backup which damages the kidney and bladder.)

Initial treatment for BPH is behavior changes, such as decreasing excess caffeine intake. Men with symptomatic BPH typically have the option to start alpha blockers (tamsulosin, terazosin or doxazosin) and 5-alpha reductase inhibitors (finasteride or dutasteride).

Although both types of BPH medications contain alpha in their names the mechanisms of these drugs are completely different. Alpha blockers relax smooth muscle in the bladder neck and prostate in order to improve urine flow and relieve urinary obstruction. While alpha blocker medication acts quickly within seven days typically, 5-alpha-reductase inhibitors target the hormonal underpinnings of BPH and not only help with urinary flow, but, if taken long enough, can actually shrink the prostate and postpone the need for surgery.

Peak effects with 5-alpha reductase inhibitors take longer to be noticed and are achieved after six months of use. The effects of these two types of medications have a greater effect when used together.

Beyond medication, urologists can offer surgical treatments like prostate resection (remove parts of the prostate), implants (lift and hold the prostate tissue so it no longer blocks the urethra), laser ablation (laser used to remove excess tissue), or steam vaporization (steam used to remove excess tissue). Even these surgeries can have sexual side effects.

Adding Cialis to the Mix

For reasons we can all probably appreciate, a big complaint among many men receiving treatment with alpha blockers, 5-alpha-reductase inhibitors or both is that in 5% to 15% of people, such meds mess with erectile function, libido, and ejaculation. To counteract this unwanted adverse effect, urologists and primary care physicians have started adding Cialis to the medication mix.

Furthermore, in 2011, the FDA had already approved Cialis for treatment of BPH symptoms, too. Thus, in men with BPH, Cialis demonstrates double efficacy—it helps with urination, and it helps with erectile dysfunction.

Fortunately, the science supports the practice of adding drugs chiefly aimed at erectile dysfunction to BPH medication regimens. In a huge randomized-control trial sponsored by Eli Lilly, makers of Cialis (go figure), 695 men were given either Cialis or placebo in addition to the 5-alpha reductase inhibitor finasteride.

Results were very encouraging with statistically significant improvements in sexual desire, orgasmic function, erectile function, and overall sexual satisfaction observed in those taking Cialis with finasteride. Moreover, adverse effects were few and tolerable. Results were measured at four, 12, and 26 weeks of therapy using a questionnaire titled the International Index of Erectile Function.

Closing Thoughts

If you or someone you love is experiencing sexual difficulties secondary to BPH medications like finasteride and aren’t already on Cialis, be sure to discuss it with your primary care physician or urologist. The addition of Cialis to your treatment regimen may help with your sex life and symptoms of BPH itself.

On a related note, because of its hormonal effects, lower-dose finasteride is also marketed as Propecia, a drug given for hair loss. Although people who typically take Propecia are younger men with fewer erectile dysfunction issues, and Propecia is lower dose than Proscar, Propecia may also interfere with sexual functioning and possibly male fertility. If you’re taking finasteride to prevent hair loss and are experiencing erectile dysfunction, libidinal problems, or fertility issues, be sure to inform your prescribing physician.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Institute of Diabetes and Digestive and Kidney Diseases. Prostate enlargement (benign prostatic hyperplasia).

Mysore V. Finasteride and sexual side effects. Indian Dermatol Online J. 2012;3(1):62-5. doi:10.4103/2229-5178.93496

Fode M, Sønksen J, McPhee SJ, Ohl DA. Disorders of the Male Reproductive Tract. In: Hammer GD, McPhee SJ. eds. Pathophysiology of Disease: An Introduction to Clinical Medicine, Seventh Edition. New York, NY: McGraw-Hill; 2013.

By Naveed Saleh, MD, MS
Naveed Saleh, MD, MS, is a medical writer and editor covering new treatments and trending health news.

Cialis and Prostate Health

This could be why it alleviates urinary symptoms associated with BPH. Cialis was approved for BPH after studies found that men who took 5 milligrams per day had improvements in both BPH and ED symptoms. The majority of side effects from Cialis are mild. [1]

Is Acid Reflux A side effect of Cialis? Possible side effects of Cialis include flushing, aside from a prolonged erection which is an emergency. Cialis may also cause headache, nasal congestion, heartburn, back pain, and muscle pain.

You can take Cialis and Flomax together.

The purpose of this study was to see if taking tadalafil (Cialis) and tamsulosin (Flomax) together would improve both urinary symptoms and erectile dysfunction. This combination of treatments was both safe and effective in reducing urinary symptoms and improving erectile function. [2]

Is Vidalista the same as Cialis? Tadalafil comes in many different forms, one of which is Generic Vidalista 40. Centurion Laboratories, an Indian company, produces it. Tadalafil is the main active element in the drug. It is used for ED or erectile dysfunction and lasts up to 36 hours.

How does Cialis affect urine?

Cialis is the first ED drug to be approved for treating benign prostatic hyperplasia (BPH). Commonly known as enlarged prostate, symptoms include difficulty starting to urinate, a weak urine stream, sudden urge to urinate, and frequent urination at night. [3]

Does alcohol stop Cialis from working? You could have problems if you take Cialis and drink too much. If you drink alcohol while taking Cialis, it can lower your blood pressure, which can be dangerous. If you experience headache, dizziness or fainting, you could fall and suffer fractures or other injuries.

Cialis is used to treat what?

In ED, Cialis acts by increasing the levels of a chemical called cyclic guanosine monophosphate (cGMP). This chemical helps increase blood flow to the penis. The chemical also relaxes muscle cells in the bladder, which helps to relieve urinary difficulties. This is likely to be why it eases the urinary symptoms of BPH.

Will Cialis make you bigger? This is false. Cialis cannot enlarge a man’s penis. However, the medication does increase blood flow to the area. Cialis may cause penises that don’t fully erect to appear larger.

What is the effect of Cialis on prostate size?

Cialis has been approved by the FDA as a treatment for enlarged prostate on September 6th, 2011. This medication may be prescribed to treat men who have both an enlarged prostate and erectile dysfunction (ED). Cialis is the first ED drug that has been approved for treating benign prostatic hyperplasia (BPH).

Does Cialis reduce prostate size?	Does Cialis Work for BPH?
Does Cialis help reduce prostate size?	Can Cialis shrink the prostate?

Can you take Cialis recreationally? You may be putting your health at risk if you use prescription oral erectile dysfunction medications without a medical need. For example, you could end up with counterfeit drugs.

Can Cialis help reduce the size of an enlarged prostate?

The FDA has approved Cialis for the treatment of enlarged prostate on Oct. 6, 2011. It can also be used to treat men who have both an enlarged prostate and erectile dysfunction (ED). Cialis is the first ED drug that has been approved for treating benign prostatic hyperplasia (BPH). [4]

How long does it take for Cialis to work for BPH?

60% to 70% of men enjoyed clinical improvement in LUTS after treatment with tadalafil. Approximately half reported improvement after 1 week of treatment. Approximately 70% reported improvement by 4 weeks.

How long does it take cialis 5mg to work for treating BPH?

Approximately 60% to 70% of men who took tadalafil for treatment of lower urinary tract symptoms reported clinical improvement. Approximately half of the men reported improvement after one week of treatment, and approximately 70% reported improvement after four weeks of treatment.

How long does it take for Cialis to work for BPH?

In randomized clinical trials, sildenafil, vardenafil, and tadalafil have all been shown to reduce lower urinary tract symptoms in men with BPH. Several studies enrolled over 1,000 men in trials that were brief, lasting 8 to 12 weeks. Both men with moderate and severe lower urinary tract symptoms improved. [5]

What are the benefits of Flomax and Cialis for treating BPH?

Cialis is a good option for men with both benign prostatic hyperplasia and erectile dysfunction. Flomax is most commonly used to treat symptoms of benign prostatic hyperplasia (BPH). Both of these drugs can cause a drop in blood pressure. They wouldn’t be a good choice for you if you already have low blood pressure or if your blood pressure varies. [6]

Treating BPH: What’s the Difference Between Cialis and Flomax?

Benign prostatic hyperplasia (BPH) is a condition that affects the prostate gland, which is part of a man’s reproductive system. BPH can cause uncomfortable urinary symptoms, like a frequent or urgent need to go. This can occur in the middle of the night sometimes.

BPH is common among older men. It affects up to 50 percent of men in their 50s and as many as 90 percent of men in their 80s.

Treatment for BPH has come a long way in the last two decades. Today, several medicines are available to relieve urinary symptoms. Tadalafil (Cialis) and tamsulosin (Flomax) are just two of the drugs prescribed for BPH. Here’s a deeper look at what BPH is, how these medicines work, and their possible side effects.

Normally, the prostate adds fluid to semen. As you age, the gland can start to grow, which may cause problems.

The urethra, which is the tube urine travels through on its way out of the bladder, runs right through the prostate. Over time, the prostate can grow large enough to press down on and squeeze the urethra. This pressure narrows the exit.

This can make it more difficult for the bladder to release urine. Eventually, the bladder may become so weak that it can’t release urine normally.

lifestyle changes, such as training the bladder to reduce bathroom trips or drinking fewer alcoholic and caffeinated beverages to reduce the urge to go
medicines that relax the muscles of the prostate and bladder
procedures to remove excess prostate tissue

Cialis was originally developed to treat erectile dysfunction (ED), which is difficulty getting an erection. Researchers then discovered that the drug also helps relieve BPH symptoms. In 2011, the U.S. Food and Drug Administration approved Cialis for men who have both BPH and ED.

In ED, Cialis works by increasing the levels of a chemical called cyclic guanosine monophosphate, or cGMP. This chemical increases blood flow to the penis. The chemical also relaxes muscle cells in the bladder and prostate. This may be why it eases the urinary symptoms of BPH.

Cialis was approved for BPH after studies had found men who took 5 milligrams per day had improvements in both BPH and ED symptoms.

Most side effects from Cialis are mild. These can include:

nausea
diarrhea
a headache
indigestion
back pain
muscle pain
a stuffy nose
flushing of the face

Because Cialis widens your arteries to let more blood flow to the penis, it can cause your blood pressure to drop. That’s why the drug isn’t recommended for men who already take drugs that lower blood pressure such as nitrates or alpha-blockers. Consuming alcohol can also increase this risk.

In rare cases, men have suddenly lost vision or hearing after taking Cialis and other drugs in its class. If you experience hearing or vision loss, you should tell your doctor right away.

Cialis is available in generic form, which can cost less than the brand name version.

Tamsulosin (Flomax) was one of the first drugs available to treat the urinary symptoms of BPH. It’s been around since the late 1990s.

Flomax is part of a drug class called alpha-blockers. These drugs work by relaxing smooth muscles in the prostate and bladder neck to let urine flow more freely.

Flomax, or another alpha-blocker, is usually the first drug prescribed for men with mild to moderate urinary symptoms from BPH.

Because Flomax also affects blood pressure, you shouldn’t use it if you already have low blood pressure. Since its effects on blood pressure are brief and somewhat unpredictable, it’s not a good choice to treat high blood pressure.

Side effects from Flomax are usually mild. These can include:

Rarely, men have developed more serious side effects, such as:

dizziness or lightheadedness when standing or sitting up, which can be due to low blood pressure
fainting
chest pain
prostate cancer
a heart attack
an allergic reaction

Talk to your doctor before taking Flomax if you’ve had a severe allergic reaction to sulfa drugs. You may be at an increased risk for an allergic reaction to Flomax.

This drug can also affect your eyes, and it may interfere with cataract or glaucoma surgery. If you’re planning to have eye surgery, you should tell your doctor before starting Flomax.

Talk to your doctor before taking Flomax if you also take an ED drug or blood pressure medication. When combined with Flomax, these can lower your blood pressure too much and increase symptoms like lightheadedness or fainting.

Like Cialis, Flomax is available in generic form, which can cost less than the brand name version.

Cialis and Flomax are just two of many drugs that are approved to treat BPH. Whenever you’re considering any new medicine, it’s important to discuss all of your options with your doctor. Find out how these drugs can help your symptoms and what side effects they might cause. Choose the drug that offers the best relief with the fewest risks.

Which drug you choose may also depend on what other health conditions you have. Cialis is a good option for men with both BPH and ED. Flomax is primarily for BPH. Both of these drugs can cause a drop in blood pressure and wouldn’t be a good choice for you if you already have low blood pressure or if your blood pressure varies.

How Tadalafil Helps With Benign Prostatic Hyperplasia

Tadalafil for the treatment of benign prostatic hyperplasia

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How Tadalafil Helps With Benign Prostatic Hyperplasia

What Is BPH?

Adding Cialis to the Mix

Closing Thoughts

Cialis and Prostate Health

You can take Cialis and Flomax together.

How does Cialis affect urine?

Cialis is used to treat what?

What is the effect of Cialis on prostate size?

Can Cialis help reduce the size of an enlarged prostate?

How long does it take for Cialis to work for BPH?

How long does it take cialis 5mg to work for treating BPH?

How long does it take for Cialis to work for BPH?

What are the benefits of Flomax and Cialis for treating BPH?

Treating BPH: What’s the Difference Between Cialis and Flomax?