Side effects of tadalafil – Brand names: Cialis, Adcirca

Erupção fixa por droga provocada por tadalafil – Relato de Caso

1 PhD – Head of venereological department, City Institute for Skin and Venereal Diseases – Belgrade, Serbia.

Milica Markovic

2 Specialist – Dermatovenereologist, City Institute for Skin and Venereal Diseases – Belgrade, Serbia.

Sandra Sipetic

3 PhD – Professor of Epidemiology, Institute of Epidemiology, School of Medicine, Belgrade University – Belgrade, Serbia.

1 PhD – Head of venereological department, City Institute for Skin and Venereal Diseases – Belgrade, Serbia.

2 Specialist – Dermatovenereologist, City Institute for Skin and Venereal Diseases – Belgrade, Serbia.

3 PhD – Professor of Epidemiology, Institute of Epidemiology, School of Medicine, Belgrade University – Belgrade, Serbia.

MAILING ADDRESS: Milica Markovic, Dzordza Vasingtona, 17, 11000 – Belgrade, – Serbia, E-mail: sr.tenue@ivopopim

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Fixed drug eruptions (FDE) are commonly reported type of mucocutaneous drug eruption. The aim of this paper is to present a patient with multiple mucocutaneous erythema fixum type lesions caused by oral tadalafil use. A short course of topical corticosteroid therapy resulted in complete resolution of all lesions leaving residual hyperpigmentation of the involved skin sites. Mucosal oral lesions were effectively treated with gingival hyaluronic acid 0.2% gel. Conclusion: when assessing a patient of any age with drug eruptions, a thorough personal history should be obtained, in particular data on regular or recreational use of phospodiesterase type 5 inhibitors.

Abstract

A erupção fixa por droga é um tipo de erupção mucocutânea comumente relatada, provocada pela administração de de drogas. O objetivo deste artigo é apresentar um paciente com múltiplas lesões mucocutâneas do tipo do eritema fixo, causadas pelo uso do tadalafil oral. Um breve período de tratamento com corticosteroides tópicos levou à completa resolução de todas as lesões, deixando hiperpigmentação residual nas áreas cutâneas envolvidas. As lesões da mucosa oral foram tratadas efetivamente com gel de ácido hialurônico gengival a 0,2%. Conclusão: ao avaliar o paciente com erupção fixa por druga, de qualquer idade, deve ser obtido seu histórico pessoal completo, especialmente dados sobre uso regular ou recreativo de inibidores de fosfodiesterase tipo 5.

INTRODUCTION

The fixed drug eruption (FDE) presents a commonly reported type of mucocutaneous drug eruption characterized by erythematous patches that develop within hours after ingestion of a drug. It usually recurs at the same site upon subsequent exposure to the same drug. 1 The lesions may be solitary or multiple and may affect any part of the skin and mucosa; moreover, FDE frequently involves the genitalia. A large number of drugs have been reported to elicit fixed drug eruptions. 2

In recent years drugs used for the treatment of erectile dysfunction have been increasingly prescribed for men; however, phospodiesterase type 5 inhibitors (PDE5i) gained popularity even among men without erectile dysfunction to enhance sexual performance satisfaction. 3

Herein we report a rare case of tadalafilinduced fixed drug eruption in a 30-year old man who used it as a recreational drug.

CASE REPORT

A 30-year old man referred to City Institute for Skin and Venereal Diseases complaining of recurrent red spots on the skin and genitalia. They appeared on the same skin sites and resolved three times consecutively during 6 months. The subjective symptom was only mild pruritus. Physical examination during the first visit revealed a solitary erythematous patch, 2cm in diameter, on the penile shaft. Treatment with topical corticosteroid cream resulted in complete resolution of the lesion in a few days. Apart from the clinically suggestive patch, at first visit the diagnosis of erythema fixum could not be complemented with the appropriate anamnestic data since the patient denied oral ingestion of any drug preceding the onset of the lesion. He was advised to carefully look for skin and genital lesions if using oral antibiotics or nonsteroid anti-inflammatory drugs. The next episode of disseminated patches developed suddenly on the penis, right forearm and left periorbital region, nevertheless the patient did not come to the clinic for examination. Instead, he applied topical corticosteroid cream on his own, for a couple of days. Few weeks after the complete resolution of all patches they reappeared on identical sites of the skin, with one new lesion on the buccal mucosa. Upon referral, the third episode clinically presented with multiple erythematous violaceous disseminated patches on the penile shaft, right elbow, left periorbital region as well as patches and erosions on buccal mucosa and hard palate ( Figures 1 , ,2 2 and and3). 3 ). The patient was worried and motivated for cooperation so his thorough medical history revealed that each episode was elicited by the same event – recreational use of tadalafil for enhancement of coital excitement and pleasure, approximately once every 3 months during the previous year. The patient denied any other concurrent symptoms and diseases; complete blood count, biochemical parameters, serum aminotransferase values and urine analysis were all within normal physiological ranges.

A short course of topical corticosteroid therapy once again resulted in complete resolution of all lesions leaving residual hyperpigmentation of the involved skin sites. Mucosal oral lesions were effectively treated with gingival hyaluronic acid 0.2% gel.

DISCUSSION

Fixed drug eruptions (erythema fixum) are a distinctive variant of drug induced dermatosis with characteristic recurrence at the same skin and/or mucosal sites after repeated administration of the same drug. Sites of predilection include: lips, extremities and genitalia; lesions are sharply demarcated, round to oval measuring several centimeters in diameter. Erythema fixum presents as solitary or multiple patches, usually localized, however repeated episodes might have increased the number and size of the lesions, as described in the case presented herein. Pruritus and burning sensation may well be associated symptoms. 1

Fixed drug eruption may be elicited by various drugs, however the most frequently implicated medications are antibiotics (especially trimethoprim-sulfamethoxazole) followed by nonsteroidal anti-inflammatory drugs. 4

The current epidemiological literature on erectile dysfunction suggests that approximately 5-20% of men have moderate-to-severe ED. 5 Oral inhibitors of phosphodiesterase type 5 are considered first-line therapies for ED. One of them, tadalafil, has demonstrated significant improvement of erectile function for up to 36 hours after dosing, and is well tolerated, less then 5% of the patients discontinue the use because of adverse effects. 6 In the study of Bechara et al. 3 , 21.5% of healthy men between 18 and 30 years old used PDE5i as a recreational drug, mostly associated with alcohol or other drugs; our patient belongs to the above mentioned age group and was also a recreational tadalafil user with no known erectile dysfunction. To the best of our knowledge, a literature review regarding drugs used for treatment of erectile dysfunction reveals only one reported case of FDE caused by tadalafil. 7 Beach et al. described a recurrent circleshaped lesion on the penis of a 56-year old man who repeatedly used tadalafil. In our case, multiple patches including penile lesion, extremities and oral mucosa involvement have been observed.

To confirm the diagnosis of FDE different skin tests including patch, prick and oral challenge test with suspected drugs may be performed. 8 However, the diagnosis itself usually relies on typical clinical manifestation of lesion(s), the course of recurrent attacks preceded by the use of same drug.

The first line treatment for FDE is prevention of attacks and recurrences, which is done simply by avoiding the offended drug if possible. Discontinuation of the drug itself is usually the only necessary treatment; in addition, topical corticosteroids might as well be effective in lesion regression.

To our knowledge this is the second case reported in the literature which describes fixed drug eruption elicited by tadalafil use. Having in mind the increase of recreational use of tadalafil and other PDE5i-s, the anamnestic procedure in patients with suspected drug reaction should include questions regarding use of erectile dysfunction drugs. The data on regular or recreational use of PDE5i-s and tadalafil in particular should not be missed when assessing patients of any age with drug eruptions.

Footnotes

* Work conducted at City Institute for Skin and Venereal Diseases – Belgrade, Serbia.

Financial Support: This work is supported by the Ministry for Science and Technology of Serbia, through Contract No.175042 (2011-2014).

REFERENCES

1. Lee AY. Fixed drug eruptions. Incidence, recognition, and avoidance. Am J Clin Dermatol. 2000; 1 :277–285. [PubMed] [Google Scholar]

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3. Bechara A, Casabe A, De Bonis W, Helien A, Bertolino MV. Recreational use of phosphodiesterase type 5 inhibitors by healthy young men. J Sex Med. 2010; 7 :3736–3742. [PubMed] [Google Scholar]

4. Mahboob A, Haroon TS. Drugs causing fixed eruptions: a study of 450 cases. Int J Dermatol. 1998; 37 :833–838. [PubMed] [Google Scholar]

5. Kubin M, Wagner G, Fugl-Meyer AR. Epidemiology of erectile dysfunction. Int J Impot Res. 2003; 15 :63–71. [PubMed] [Google Scholar]

6. Young JM, Feldman RA, Auerbach SM, Kaufman JM, Garcia CS, Shen W, et al. Tadalafil improved erectile function at twenty-four and thirty-six hours after dosing in men with erectile dysfunction: US trial. J Androl. 2005; 26 :310–318. [PubMed] [Google Scholar]

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Articles from Anais Brasileiros de Dermatologia are provided here courtesy of Sociedade Brasileira de Dermatologia

Side effects of tadalafil – Brand names: Cialis, Adcirca

Like all medicines, tadalafil can cause side effects in some people, but many people have no side effects or only minor ones.

Common side effects

Common side effects of tadalafil happen in more than 1 in 100 people.

If you’re taking it for erection problems you’re unlikely to get side effects as you’re only taking it for a short time.

If you’re taking tadalafil for pulmonary hypertension and get these side effects, there are things you can do to help cope with them:

Make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller.

Headaches should usually go away after the first week of taking tadalafil. Talk to your doctor if they last longer than a week or are severe.

It may help if you stick to simple meals and avoid rich or spicy food. If you’re taking tadalafil for pulmonary hypertension, it may help to take it after a meal or snack.

Try cutting down on coffee, tea and alcohol. It might help to keep the room cool and use a fan. You could also spray your face with cool water or sip cold or iced drinks.

The flushing should go away after a few days.

If you need something to ease the discomfort, try taking an antacid, but do not put off going to the doctor if it bothers you. They may be able to prescribe an extra medicine to protect your stomach.

Speak to a pharmacist or doctor. They may be able to recommend a nasal spray that helps.

If you get unusual muscle ache that is not from exercise or physical work, ask your pharmacist to recommend a suitable painkiller. Talk to your doctor if the aches continue.

Side effects will usually go away when you stop taking the tablets. Talk to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Urgent advice: Go to A&E straight away if:

you have sudden loss of vision or sudden problems with your hearing – stop taking tadalafil if this happens
you have a prolonged or painful erection, especially if it lasts for more than 2 hours

Immediate action required: Call 999 now if:

Stop taking tadalafil if you get any of these symptoms.

If you get chest pain during or after sex and you usually use nitrates, such as glyceryl trinitrate (GTN), do not take them to treat your chest pain.

Serious allergic reaction

In rare cases, tadalafil can cause a serious allergic reaction (anaphylaxis).

Immediate action required: Call 999 or go to A&E now if:

you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
you’re wheezing
you get tightness in the chest or throat
you have trouble breathing or talking
your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

Other side effects

These are not all the side effects of tadalafil. For a full list, see the leaflet inside your medicine packet.

You can report any suspected side effect using the Yellow Card safety scheme.

More in Tadalafil

Page last reviewed: 11 November 2022
Next review due: 11 November 2025

What are the side effects of Cialis?

If you take Cialis to treat erectile dysfunction (ED), find out about the side effects and how to manage them.

How to avoid the side effects of Cialis

It is not always possible to avoid the side effects of medication but most of the time your body gets used to the treatment and side effects will go away on their own. If your side effects are bothering you a lot, you should speak to your doctor. They can help you to manage any side effects and may discuss lowering your dose.

Cialis usually comes in 10mg tablets, but if your side effects are bothering you or not going away, you may be able to take Cialis Daily 5mg tablets. Your doctor can discuss this with you in more detail so you can find the best ED treatment for you. You should also let your doctor know if your medications change as this could cause side effects.

Take Cialis exactly as your doctor has prescribed. If you take more than you should, it will not be more effective but you are more at risk of side effects. If you get side effects like a headache or a flushed face, you should lower the dose or stop taking it altogether until you’ve spoken to your doctor. You should also avoid alcohol.

What are the most common side effects of Cialis

Side effects can be labelled common, uncommon and rare. This is recorded by the number of people who have the side effect when taking the medication in trials and over time. Below are some of the most common side effects of Cialis, as well as the uncommon and rare side effects too.

Most common side effects (affect 1 to 10 in every 100 users) include:

a stuffy/blocked nose
flushed (red) face
headache
indigestion
muscles aches
pain in your arms, legs or back

Uncommon side effects (affect 1 to 10 in every 1000 users) include:

a prolonged erection
breathing problems
blood in urine
blurred vision or eye pain
changes to blood pressure levels
dizziness
heart palpitations
high heart rate
nausea or vomiting
nose bleeds
stomach ache
swollen hands, feet or ankles
tiredness or fatigue

Rare side effects (affect 1 to 10 in every 10,000 users) include:

blood in semen
fainting
hearing loss
itchy skin or rash (hives)
memory loss
seizures
sweating

Other rare side effects that can occur at a very low (unrecorded) rate include migraines, serious skin rashes, severe allergic reactions, stroke, or heart attack. If you have any side effects you should contact your doctor so they can give you advice on how to manage them. They will tell you if you need to change your dosage or medication.

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Things you can do to help you make the treatment most effective

To make Cialis most effective you should take it as directed by your doctor or on your medication packet. When taking Cialis 10mg tablets, make sure to take it at least 30 minutes before sex. If you take a Cialis Daily tablet, you should take it at the same time every day. This helps to keep the levels of Cialis steady in your body.

You should also avoid alcohol whilst using Cialis, especially if you find it is not working as it should or causing side effects. Alcohol can cause a headache and make it harder for you to increase the blood flow to your penis, even if you take Cialis. It can also lower your blood pressure, which could cause you to feel dizzy or faint.

You should try to stay relaxed when using the treatment and make sure you are sexually aroused to get the best effect. When taking Cialis, avoid eating a heavy meal or one full of fatty or greasy foods. This could cause Cialis to take longer to work and could affect how well it works. Avoid drinking grapefruit juice if you take Cialis, as this can increase the levels of the medication in your body, which could increase the risk of side effects.

Cialis side effects: What you should know

Cialis (tadalafil) is a prescription brand-name medication. It’s approved by the Food and Drug Administration (FDA) for use in males* to treat:

Depending on how your doctor prescribes Cialis for you, you may take the medication only as needed. Or, you may take it once per day every day. Either way, if you and your doctor agree that Cialis is effective for you, you’ll likely take the drug long term.

Like other drugs, Cialis can cause side effects. Read on to learn about potential common side effects of Cialis, as well as mild and serious side effects. For a general overview of Cialis, including details about its uses, see this article.

* Sex and gender exist on spectrums. Use of the term “male” in this article refers to sex assigned at birth.

Cialis can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days or weeks. But if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took Cialis in clinical trials:

* To learn more information about this side effect, see “Side effect specifics” below.

Mild side effects can occur with Cialis use. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to the Cialis prescribing information.

Mild side effects that have been reported with Cialis include:

upset stomach and indigestion *
muscle pain
stuffy nose or runny nose
pain in your arms or legs
upper respiratory infection
cough
diarrhea
urinary tract infection *
abdominal (belly) pain

These side effects may be temporary, lasting a few days or weeks. But if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Cialis and want to tell the FDA about it, visit MedWatch.

* For more information about this side effect, see “Side effect specifics” below.

Cialis may cause serious side effects. The list below may not include all possible serious side effects of the drug. For more information, you can refer to the Cialis prescribing information.

If you develop serious side effects while taking Cialis, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects that have been reported and their symptoms include:

Hearing changes. Symptoms can include:

trouble hearing

dizziness

hearing loss

ringing in your ears

an erection that lasts longer than 4 hours

pain in your penis

* For more information about this side effect, see “Side effect specifics” below.

While there’s no way to completely avoid Cialis side effects, here are some tips that can help decrease your risk for side effects:

Tell your doctor and pharmacist about all of the medications you take. This includes vitamins, herbs, and supplements. Your doctor and pharmacist can check to see if any of the medications you take could interact with Cialis.
Tell your doctor about your complete medical history, including any medical conditions you have. This helps your doctor determine if Cialis is safe for you to take.
If you drink alcohol, avoid or minimize drinking it while taking Cialis. Alcohol use can increase your risk for certain side effects.
Take Cialis exactly as your doctor prescribes. You should not change your dosage of Cialis without first talking with your doctor.

For more information on lowering your risk for side effects of Cialis, see the “Side effect specifics” section below.

Cialis may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

Can Cialis cause side effects that are long term? Or do Cialis side effects go away?

Most side effects of Cialis go away on their own with time. But some side effects may be long term, including the following rare side effects:

Sudden decrease in vision or loss of vision. This can affect one or both eyes, and can be permanent.

Talk with your doctor or pharmacist if you have additional questions about how long Cialis side effects can last.

What can be the side effects of taking Cialis daily?

These are just a few of the more common side effects reported by people who took Cialis daily in clinical trials:

For a list of side effects reported by people taking Cialis in clinical trials, including people who took the drug daily, see the “Mild side effects of Cialis” and “Serious side effects of Cialis” sections above. You may also view the drug’s prescribing information.

* For more information about this side effect, see “Side effect specifics” below.

What are the side effects of Cialis vs. Viagra?

Cialis and Viagra can both be prescribed to treat erectile dysfunction (ED). These drugs contain the same active ingredient (tadalafil) and belong to the same medication class (phosphodiesterase 5 [PDE5] inhibitors).* So, these drugs share many of the same side effects.

The table below compares some of the mild side effects of Cialis and Viagra:

Can occur with Cialis	Can occur with Viagra	Can occur with both Cialis and Viagra
• pain in your arms or legs	• abnormal vision • dizziness • nausea • rash	• back pain† • flushing • headache • heartburn† • muscle pain • stuffy nose

Below are some serious side effects that Cialis and Viagra (when taken individually) may cause:

If you have additional questions about how Cialis and Viagra compare, talk with your doctor or pharmacist.

* A medication class is a group of drugs that work in a similar way.
† For more information about this side effect with Cialis use, see “Side effect specifics” below.

Do Cialis side effects vary based on whether I’m taking a high or low dose (2.5 mg, 5 mg, 10 mg, or 20 mg)?

Yes, side effects caused by Cialis can vary depending on the strength you’re taking. But most side effects of the drug don’t differ much based on the dose you take. In general, some side effects may be more likely to occur or may be slightly worse with higher doses of Cialis.

To see full details on how Cialis side effects varied by dose in clinical trials, view the drug’s prescribing information.

What are the side effects of generic Cialis?

The generic version of Cialis is tadalafil. (A generic drug is an exact copy of the active drug in a brand-name medication.)

Side effects of tadalafil are the same as those caused by brand-name Cialis. Your doctor or pharmacist can provide more information about how Cialis and generic tadalafil compare.

Learn more about some of the side effects that Cialis may cause.

Blood pressure changes, including high blood pressure

Taking Cialis can cause changes in blood pressure, including high blood pressure.

Blood pressure changes weren’t common in people taking Cialis in clinical trials. Low blood pressure was more likely to occur than high blood pressure, but both are possible. These changes tend to be mild.

Symptoms of blood pressure changes can include:

If you already have high blood pressure or another heart condition, blood pressure changes while taking Cialis may be serious.

Taking certain medications along with Cialis can increase your risk for blood pressure changes. Drinking alcohol can also make this side effect more likely.

What you can do

Before you start taking Cialis, tell your doctor about any medical conditions you have, especially any heart conditions. You should also tell them about all of the medications you take. They can determine whether Cialis is safe for you based on this information.

It’s very important that you do not take medications called nitrates, including nitroglycerin, while you’re taking Cialis. Nitrates are drugs used to treat heart conditions, such as angina (chest pain). Taking Cialis with a nitrate could cause a dangerous decrease in blood pressure.

It’s unlikely that you’ll be asked to monitor your blood pressure while taking Cialis. But if you have symptoms of low blood pressure, your doctor may have you monitor your blood pressure at home. Your doctor will use these blood pressure readings to make sure that it’s safe for you to keep taking Cialis.

Also, if you drink alcohol, talk with your doctor about how much may be safe for you to have while taking Cialis.

Side effects that affect the eyes and vision

Although rare, taking Cialis can cause side effects that affect the eyes and vision. These side effects weren’t common in clinical trials, though.

Specifically, sudden vision loss in one or both eyes is a rare side effect of Cialis. This is because phosphodiesterase 5 (PDE5) inhibitors, such as Cialis, can cause non-arteritic anterior ischemic optic neuropathy (NAION). With NAION, blood flow to your optic nerve is cut off. Your optic nerve sends information from your eyes to your brain.

Other rare side effects reported in clinical trials of Cialis include:

What you can do

Immediately stop taking Cialis and get emergency medical help if you have sudden loss of vision in one or both eyes.

If you have any eye problems, or if you’ve been told that you have a “crowded” optic disc, make sure your doctor knows this before you start Cialis treatment. People with a crowded optic disc may be at increased risk for NAION.

If you have symptoms of eye side effects other than vision loss, contact your doctor right away. They’ll likely want to see you to evaluate your symptoms.

Heartburn

Cialis can cause heartburn, although this side effect wasn’t common in clinical trials.

What you can do

Heartburn caused by Cialis may go away on its own after a few hours or days.

But if you have heartburn that doesn’t go away, talk with your doctor. Your doctor may recommend treatment for this side effect. This could include dietary changes, such as avoiding foods that trigger heartburn, or a medication such as calcium carbonate (Tums).

Headache

Headache is a possible side effect of Cialis. This was one of the more common side effects reported by people taking the drug in clinical trials.

Alcohol use with Cialis can increase your risk for headaches while taking Cialis.

In rare cases, headache can be a symptom of blood pressure changes. Changes in blood pressure are a rare but potentially serious side effect of Cialis. (See “Blood pressure changes, including high blood pressure” above.)

What you can do

In most cases, a headache caused by Cialis should go away on its own after a few hours or days.

If you have headaches while taking Cialis, talk with your doctor about treatments that might be safe for you. Depending on other medical conditions you may have, your doctor may recommend an over-the-counter pain relief medication. Examples include acetaminophen (Tylenol) and ibuprofen (Advil, Motrin).

Also, if you drink alcohol, talk with your doctor about how much may be safe for you to have while taking Cialis.

If you have headaches that don’t go away, contact your doctor. Although rare, this could be a symptom of blood pressure changes, including high or low blood pressure. Your doctor may want to see you to further evaluate your symptoms.

Heart-related side effects

Taking Cialis can cause some heart-related side effects. These were rarely reported by people taking the medication in clinical trials. Although they’re rare, these side effects can be serious.

Heart-related side effects reported by people taking Cialis in clinical trials include:

Cialis can also cause changes in blood pressure, which are discussed above in “Blood pressure changes, including high blood pressure.”

What you can do

Before you start taking Cialis, tell your doctor about any medical conditions you have, especially any heart conditions. You should also tell them about any medications you take. This helps them make sure that Cialis is safe for you to take.

You should not take Cialis if you have any of the following heart conditions:

chest pain that occurs during sex (a type of chest pain that occurs when you’re resting) that’s been diagnosed as Class 2 or higher within the past 6 months
uncontrolled high or low blood pressure

Sexual activity can cause strain on your heart. Having sex when your heart isn’t healthy enough can lead to symptoms such as chest pain. People whose hearts aren’t healthy enough for sex should not take Cialis. Your doctor can tell you more about your heart health and taking Cialis.

It is very important that you do not take medications called nitrates, including nitroglycerin, while you’re taking Cialis. Nitrates are drugs used to treat heart conditions, such as angina (chest pain). Taking Cialis with a nitrate could cause a dangerous decrease in blood pressure.

Back pain

Taking Cialis can cause back pain. This was one of the more common side effects reported by people taking the medication in clinical trials.

For most people, back pain caused by Cialis went away on its own within 12 to 48 hours. Most people’s back pain was mild or moderate and was helped by over-the-counter pain relief medication. But there were rare instances of severe back pain. And in a few cases, people stopped taking Cialis due to back pain that didn’t go away.

In general, back pain caused by Cialis most commonly affects the lower back, and sometimes spreads down to the glutes and thighs. In people in clinical trials, lying down or being in a horizontal body position seemed to make the pain worse.

What you can do

In most cases, back pain caused by Cialis should go away on its own after a few hours or days.

If you have back pain with Cialis, talk with your doctor about treatments you can safely take. Depending on other medical conditions you may have, your doctor may recommend an over-the-counter pain relief medication. Examples of these drugs include acetaminophen (Tylenol) and ibuprofen (Advil, Motrin).

Allergic reaction

As with most drugs, Cialis can cause an allergic reaction in some people.

Symptoms can be mild or serious and can include:

rash
itching
swelling under your skin, typically in your lips, eyelids, feet, or hands
swelling of your mouth, tongue, or throat, which can make it hard to breathe

Note: Flushing by itself can be a mild side effect of Cialis. But if flushing occurs with any of these other symptoms of allergic reaction, you should contact your doctor right away.

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking Cialis. But if your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Be sure to talk with your doctor about your health history before you take Cialis. This drug may not be the right treatment for you if you have certain medical conditions or other factors that affect your health. The conditions and factors to consider include:

Blood pressure problems and heart problems. Taking Cialis may cause changes in blood pressure, including high or low blood pressure. And, sexual activity can cause strain on your heart. Due to these risks, it’s very important to tell your doctor about any blood pressure or heart problems you have. Your doctor can determine if your heart is healthy enough for sexual activity, and whether it’s safe for you to take Cialis.

Pulmonary hypertension. Some drugs used to treat pulmonary hypertension should not be used with Cialis, because this combination can cause a dangerous decrease in blood pressure. Be sure to tell your doctor if you have pulmonary hypertension, and whether you take any medications to treat it. Your doctor can determine whether it’s safe for you to take Cialis.

Stroke. Taking Cialis can increase your risk for stroke. You should not use Cialis if you’ve had a stroke within the past 6 months. Make sure to tell your doctor if you have a history of stroke before you take Cialis.

Kidney problems or liver problems. If you have problems with your kidneys or liver, your body may not be able to break down Cialis as quickly as usual. This means the medication can build up in your body, which can increase your risk for side effects. Tell your doctor about any kidney or liver problems you have before you take Cialis. They may start you on a lower Cialis dose than usual.

Retinitis pigmentosa. Retinitis pigmentosa is a rare genetic eye condition that causes vision loss. Cialis can rarely cause vision loss as a side effect. Because of this, you should not use Cialis if you have retinitis pigmentosa. Your doctor may be able to recommend other treatments for your condition.

Blood cell problems. People with blood cell problems may be at higher risk for priapism (a prolonged, painful erection) with Cialis. These problems include sickle cell anemia, as well as blood cancers, such as leukemia or multiple myeloma. Your doctor may prescribe a lower than usual dose of Cialis for you if you have a condition that affects your blood cells.

Allergic reaction. You should not take Cialis if you’ve ever had an allergic reaction to Cialis or any of its ingredients. Talk with your doctor or pharmacist about which other treatments are better choices for you.

Alcohol use with Cialis

You should avoid or minimize alcohol use while taking Cialis. This is because alcohol can lower your blood pressure. Cialis can also cause blood pressure changes, including low blood pressure. So the combination of Cialis and alcohol could make this side effect worse, and potentially dangerous.

If you drink alcohol, talk with your doctor about how much is safe for you to have before you start taking Cialis.

Pregnancy and breastfeeding while taking Cialis

Cialis isn’t approved for use in females.* It’s not known whether the drug is safe to use while pregnant or breastfeeding.

If you have questions about Cialis and pregnancy or breastfeeding, talk with your doctor.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Side effects from Cialis can occur, including mild and serious side effects. Some mild side effects of the drug go away with time and don’t require medical attention. But if you have symptoms of serious side effects, you should contact your doctor.

If you’d like to learn more about Cialis, talk with your doctor or pharmacist. They can help answer any questions you have about side effects from taking the drug.

Besides talking with your doctor, you can do some research on your own. These articles might help:

More information on Cialis. For details on other aspects of Cialis, refer to this article.
Drug comparison. To learn how Cialis compares with other drugs for erectile dysfunction (ED), read this article.
Dosage. For information about the dosage of Cialis, view this article.
Interactions. To find out about the interactions of Cialis, see this article.
Drug costs. If you want to learn about the cost of Cialis, refer to this article.
A look at ED. For details on ED, see our men’s health hub, as well as this list of articles.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Last medically reviewed on July 4, 2021

How we reviewed this article:

Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Cialis (tadalafil) tablets, for oral use. (2018).
https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021368s030lbl.pdf
Berry, S., et al. (2017). Nonarteritic anterior ischemic optic neuropathy: Cause, effect, and management.
https://doi.org/10.2147/EB.S125311
Viagra – sildenafil citrate tablet, film coated. (2021).
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b0be196-0c62-461c-94f4-9a35339b4501

Medically reviewed by Neal Patel, Pharm.D. — By Alex Brewer, PharmD, MBA — Updated on November 9, 2022

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