Does tadalafil cause itching? Whilst itching (pruritus) is not amongst the most common side effects of tadalafil, it can occur in some individuals taking this phosphodiesterase type 5 (PDE5) inhibitor for erectile dysfunction or benign prostatic hyperplasia. According to the Medicines and Healthcare products Regulatory Agency (MHRA), skin reactions including pruritus are classified as uncommon, affecting fewer than 1 in 100 people. Most patients tolerate tadalafil well, with headache, indigestion, and flushing being more frequently reported. Understanding when itching warrants medical attention and how to manage this side effect can help you make informed decisions about your treatment.

Does Tadalafil Cause Itching?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor commonly prescribed for erectile dysfunction and benign prostatic hyperplasia. Whilst itching (pruritus) is not listed amongst the most common adverse effects of tadalafil, it can occur in some individuals taking this medication.

According to the Summary of Product Characteristics (SmPC) approved by the Medicines and Healthcare products Regulatory Agency (MHRA), skin and subcutaneous tissue reactions including rash and pruritus have been reported with tadalafil use. These reactions are generally classified as uncommon, affecting fewer than 1 in 100 people. The majority of patients tolerate tadalafil well, with the most frequently reported side effects being headache, indigestion, back pain, muscle pain, facial flushing and nasal congestion.

Itching associated with tadalafil may present in various forms. Some patients experience generalised pruritus affecting multiple body areas, whilst others report localised itching. The severity can range from mild, transient discomfort to more persistent symptoms that warrant medical review. It is important to distinguish between simple itching and more serious allergic reactions, which may present with additional symptoms such as widespread rash, swelling, or breathing difficulties. Rarely, severe cutaneous reactions such as angioedema or Stevens-Johnson syndrome can occur.

If you experience itching after starting tadalafil, it does not necessarily mean you must discontinue the medication immediately. However, documenting when the itching began, its location, severity, and any accompanying symptoms will help your GP or prescriber determine the most appropriate course of action. Understanding the potential causes and management strategies can help you make informed decisions about your treatment.

Why Itching May Occur with Tadalafil

The mechanisms underlying tadalafil-related itching are not fully understood, but several pharmacological and immunological factors may potentially contribute to this adverse effect.

Vasodilation effects: Tadalafil works by inhibiting PDE5, which leads to increased levels of cyclic guanosine monophosphate (cGMP) in smooth muscle cells. This causes vasodilation—widening of blood vessels—not only in the intended target areas but throughout the body. The increased blood flow to the skin might contribute to skin reactions in some individuals, though the exact mechanism linking this to itching remains unclear.

Hypersensitivity reactions: Some individuals may develop a hypersensitivity reaction to tadalafil or one of its excipients (inactive ingredients in the tablet formulation). These reactions can range from mild cutaneous responses to more significant allergic phenomena. If you suspect an excipient allergy, consult your pharmacist or prescriber who can check the specific ingredients in your medication.

Drug interactions and metabolic factors: Tadalafil is metabolised primarily by the cytochrome P450 3A4 enzyme system in the liver. Concurrent use of medications that inhibit this pathway—such as ketoconazole, itraconazole, clarithromycin, or ritonavir—may increase tadalafil levels in the body, potentially increasing the likelihood of adverse effects. Conversely, inducers like rifampicin may reduce effectiveness. It's important to note that tadalafil must never be taken with nitrate medications (used for angina) or riociguat (used for pulmonary hypertension) as this combination can cause dangerous drops in blood pressure.

Pre-existing dermatological conditions: Patients with underlying skin conditions such as eczema, psoriasis, or chronic urticaria may find that tadalafil exacerbates their symptoms, though there is no definitive link established in clinical trials.

When to Seek Medical Advice About Itching

Whilst mild itching may not require immediate medical intervention, certain presentations warrant prompt assessment by your GP or healthcare provider.

Seek urgent medical attention (call 999 or attend A&E) if you experience:

• Difficulty breathing, wheezing, or chest tightness

• Swelling of the face, lips, tongue, or throat

• Widespread rash with blistering or peeling skin

• Involvement of mucous membranes (eyes, mouth, genitals)

• Dizziness, fainting, or rapid heartbeat accompanying the itching

• Signs of anaphylaxis (a severe allergic reaction)

Stop taking tadalafil immediately if you develop any of these symptoms. These may indicate a serious allergic reaction requiring immediate treatment with adrenaline and other emergency interventions.

Contact your GP, NHS 111, or pharmacist within 24–48 hours if:

• Itching is severe, persistent, or progressively worsening

• A rash develops alongside the itching, particularly if it spreads or changes appearance

• The itching significantly disrupts your sleep or daily activities

• You develop other new symptoms such as joint pain, fever, or malaise

• Over-the-counter antihistamines provide no relief

Routine GP appointment appropriate for:

• Mild, intermittent itching that is tolerable but concerning

• Itching that you wish to discuss in the context of medication review

• Questions about whether to continue tadalafil or explore alternatives

Your GP will conduct a thorough assessment including medication history, examination of affected skin areas, and consideration of other potential causes of pruritus. They may recommend temporarily discontinuing tadalafil to determine if symptoms resolve, which helps establish causality. Documentation of the temporal relationship between medication use and symptom onset is valuable for diagnosis. In some cases, referral to a dermatologist or allergist may be appropriate for further investigation, particularly if the cause remains unclear or symptoms persist despite initial management.

Managing Itching While Taking Tadalafil

If you experience mild to moderate itching whilst taking tadalafil, several strategies may help alleviate symptoms whilst you discuss the issue with your healthcare provider.

Symptomatic relief measures:

• Antihistamines: Over-the-counter antihistamines such as cetirizine (10 mg once daily) or loratadine (10 mg once daily) may reduce itching by blocking histamine receptors. These non-sedating options are generally well-tolerated. Older antihistamines like chlorphenamine may cause drowsiness and affect your ability to drive or operate machinery. Avoid alcohol if taking sedating antihistamines.

• Emollients and moisturisers: Regular application of unperfumed emollients helps maintain the skin barrier and can reduce irritation. Apply liberally and frequently, particularly after bathing. Products containing colloidal oatmeal may provide additional soothing effects.

• Cool compresses: Applying a clean, cool, damp cloth to itchy areas can provide temporary relief by reducing inflammation and numbing nerve endings.

• Avoid triggers: Hot showers, harsh soaps, and tight clothing can exacerbate itching. Opt for lukewarm water, gentle cleansers, and loose-fitting, breathable fabrics.

Medication adjustments:

Consult your prescriber about potential modifications to your tadalafil regimen. Options may include:

• Dose adjustment: For erectile dysfunction, the licensed on-demand doses are 10-20 mg, while daily dosing options are 2.5-5 mg. For benign prostatic hyperplasia, the dose is 5 mg once daily. Your prescriber may consider adjusting your regimen if side effects occur.

• Formulation change: Different manufacturers use varying excipients. If an excipient allergy is suspected, your pharmacist or prescriber can check the specific ingredients in your medication and potentially recommend an alternative formulation.

Monitoring and documentation:

Keep a symptom diary noting when itching occurs, its severity, location, and any potential triggers. This information will assist your healthcare provider in determining whether the itching is truly medication-related and guide management decisions. If you suspect an allergic reaction, stop taking tadalafil and seek medical advice. Do not restart the medication without consulting your healthcare provider.

You can report suspected side effects to the MHRA through the Yellow Card scheme at yellowcard.mhra.gov.uk or via the Yellow Card app.

Alternative Treatments If Itching Persists

If itching continues despite management strategies or if you cannot tolerate tadalafil, several alternative treatment options are available depending on your underlying condition.

For erectile dysfunction:

Other PDE5 inhibitors: Sildenafil (Viagra), vardenafil (Levitra) and avanafil (Spedra) are alternative PDE5 inhibitors with similar mechanisms of action but different pharmacokinetic profiles. Some patients who experience side effects with one PDE5 inhibitor tolerate another better due to variations in selectivity, half-life, and metabolism. Sildenafil has a shorter duration of action (4–6 hours) compared to tadalafil (up to 36 hours), which may suit some patients better. However, cross-reactivity is possible, and itching may occur with these alternatives as well.

Non-pharmacological approaches: Vacuum erection devices are mechanical aids that can be effective for erectile dysfunction without systemic medication. Psychological interventions, including cognitive behavioural therapy and psychosexual counselling, may be beneficial, particularly when psychological factors contribute to erectile difficulties. NICE guidance recommends considering these approaches as part of a holistic management strategy.

Alprostadil preparations: Alprostadil can be administered as intracavernosal injections directly into the penis or as intraurethral pellets (MUSE). These options produce erections independently of the PDE5 pathway and avoid the systemic side effects associated with oral medications.

For benign prostatic hyperplasia:

Alpha-blockers: Medications such as tamsulosin, alfuzosin, or doxazosin relax smooth muscle in the prostate and bladder neck, improving urinary symptoms. These work via a different mechanism than tadalafil and would not be expected to cause similar side effects.

5-alpha reductase inhibitors: Finasteride and dutasteride reduce prostate size by blocking testosterone conversion. These are particularly useful for larger prostates and can be used alone or in combination with alpha-blockers.

Conservative measures: NICE guidance recommends lifestyle modifications including moderating fluid intake (especially before bedtime), reducing caffeine and alcohol consumption, and bladder training techniques.

Surgical interventions: For severe or refractory symptoms, procedures such as transurethral resection of the prostate (TURP) or newer minimally invasive techniques may be considered.

Your GP or specialist will work with you to identify the most appropriate alternative based on your specific condition, overall health, concurrent medications, and personal preferences. A thorough discussion of the benefits and risks of each option will help ensure you receive effective treatment without compromising your quality of life.

Frequently Asked Questions