Does tadalafil give you heartburn? Yes, tadalafil can cause heartburn in some individuals. Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor prescribed for erectile dysfunction and benign prostatic hyperplasia. Dyspepsia (indigestion) is listed as a very common side effect, whilst gastro-oesophageal reflux is classified as common in the Summary of Product Characteristics approved by the Medicines and Healthcare products Regulatory Agency (MHRA). Understanding this potential adverse effect allows patients and healthcare professionals to anticipate, monitor, and manage symptoms appropriately, ensuring treatment adherence whilst maintaining quality of life. This article explores the frequency, mechanisms, and management strategies for tadalafil-related heartburn.

Does Tadalafil Give You Heartburn?

Yes, tadalafil can cause heartburn in some individuals. Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor primarily prescribed for erectile dysfunction and benign prostatic hyperplasia. Dyspepsia (indigestion) is listed as a very common side effect, while gastro-oesophageal reflux is classified as a common adverse reaction in the Summary of Product Characteristics (SmPC) approved by the Medicines and Healthcare products Regulatory Agency (MHRA). Heartburn is a symptom that can occur with both these conditions.

The mechanism by which tadalafil may trigger heartburn is thought to relate to its pharmacological action. Whilst tadalafil selectively targets PDE5 enzymes found predominantly in vascular smooth muscle, it may also affect smooth muscle in the lower oesophageal sphincter. This sphincter normally prevents stomach acid from flowing back into the oesophagus. It is proposed that when tadalafil causes vasodilation and smooth muscle relaxation throughout the body, it might also relax this sphincter, potentially allowing gastric contents to reflux upwards, producing the characteristic burning sensation in the chest or throat.

Tadalafil's effects on oesophageal motility may also contribute to reflux symptoms in susceptible individuals. It is important to note that not everyone taking tadalafil will experience heartburn, and the severity can vary considerably between patients. Individual factors such as pre-existing gastro-oesophageal reflux disease (GORD), dietary habits, body weight, and concurrent medications all influence whether this side effect occurs.

Understanding that heartburn is a potential consequence of tadalafil therapy allows patients and healthcare professionals to anticipate, monitor, and manage this adverse effect appropriately, ensuring treatment adherence whilst maintaining quality of life.

How Common Is Heartburn When Taking Tadalafil?

According to the MHRA-approved Summary of Product Characteristics (SmPC), dyspepsia is classified as a very common adverse effect (affecting more than 1 in 10 patients), while gastro-oesophageal reflux is listed as common (affecting between 1 and 10 in 100 patients). Heartburn is a symptom that can occur with both these conditions. This frequency classification follows the standardised terminology used by the MHRA and European Medicines Agency (EMA) for reporting adverse drug reactions.

In clinical trials evaluating tadalafil for erectile dysfunction, gastrointestinal side effects were reported with varying frequencies depending on the dose administered. Higher doses of tadalafil, such as the 20 mg strength, appear to be associated with a greater incidence of gastrointestinal side effects compared to lower doses like 2.5 mg or 5 mg used for daily administration. The once-daily regimen for benign prostatic hyperplasia or erectile dysfunction may result in different side effect profiles compared to on-demand dosing.

It is worth noting that the reported frequency of heartburn may be influenced by several factors:

• Baseline prevalence of GORD in the study population

• Concomitant use of other medications that affect gastric acid production or oesophageal function

• Lifestyle factors including diet, alcohol consumption, and smoking

• Individual patient sensitivity to PDE5 inhibitors

Observational data suggest that gastrointestinal adverse effects occur across the PDE5 inhibitor class, including sildenafil and vardenafil. Tadalafil's longer half-life (approximately 17.5 hours) means that any side effects may potentially persist for a longer duration compared to shorter-acting alternatives.

Most cases of tadalafil-associated heartburn are mild to moderate in severity and do not necessitate treatment discontinuation. Nonetheless, understanding the frequency helps set realistic expectations for patients commencing therapy.

Managing Heartburn While Using Tadalafil

Effective management of tadalafil-related heartburn often involves a combination of lifestyle modifications, timing adjustments, and pharmacological interventions when necessary. The goal is to minimise discomfort whilst maintaining the therapeutic benefits of tadalafil.

Lifestyle and dietary modifications form the cornerstone of initial management:

• Avoid trigger foods such as spicy dishes, citrus fruits, tomatoes, chocolate, caffeine, and fatty meals

• Reduce alcohol consumption, as alcohol can exacerbate gastro-oesophageal reflux and interact with tadalafil

• Maintain a healthy body weight, as excess weight increases intra-abdominal pressure and reflux risk

• Eat smaller, more frequent meals rather than large portions that distend the stomach

• Avoid lying down for at least 2–3 hours after eating

• Elevate the head of the bed by 15–20 cm using blocks or a wedge pillow to reduce nocturnal reflux

Timing considerations can also prove beneficial. As a general strategy for managing GORD symptoms, avoiding large or fatty meals around the time of taking medications can be helpful. For patients using on-demand tadalafil, planning sexual activity to avoid periods shortly after large meals may help reduce reflux symptoms.

Pharmacological management may be appropriate for persistent symptoms:

• Over-the-counter antacids containing aluminium hydroxide, magnesium hydroxide, or calcium carbonate can provide rapid, short-term relief

• H2-receptor antagonists such as famotidine may be considered (note that cimetidine can interact with tadalafil and should be used with caution)

• Proton pump inhibitors (PPIs) like omeprazole or lansoprazole offer more sustained acid suppression for frequent or severe symptoms

Patients should consult their GP or pharmacist before starting any new medication. If antacids are needed, check the tadalafil SmPC for specific guidance on timing. For persistent dyspepsia, NICE guidance recommends considering testing for and treating Helicobacter pylori infection where appropriate.

If heartburn persists despite these interventions, dose reduction or switching to an alternative PDE5 inhibitor may be discussed with a prescribing clinician.

When to Seek Medical Advice About Tadalafil Side Effects

Whilst mild heartburn is a recognised and generally manageable side effect of tadalafil, certain symptoms warrant prompt medical evaluation. Patients should be educated about warning signs that may indicate more serious complications or conditions requiring clinical assessment.

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

• Severe chest pain, particularly if crushing, radiating to the arm, jaw, or back, as this may indicate cardiac ischaemia rather than simple heartburn

• Difficulty breathing or swallowing (dysphagia), which could suggest oesophageal obstruction or severe inflammation

• Persistent vomiting, especially if containing blood (haematemesis) or resembling coffee grounds

• Black, tarry stools (melaena) or visible blood in vomit or stool, indicating possible gastrointestinal bleeding

• Sudden, severe abdominal pain that differs from typical heartburn

• Priapism (painful erection lasting more than 4 hours), a rare but serious side effect of tadalafil

• Sudden vision or hearing loss, which requires immediate medical attention

Contact your GP or NHS 111 if:

• Heartburn persists despite lifestyle modifications and over-the-counter remedies

• Symptoms significantly interfere with daily activities or quality of life

• You require regular use of antacids or acid suppressants to manage tadalafil-related heartburn

• You experience dysphagia (difficulty swallowing), which requires investigation

• You experience unintentional weight loss alongside gastrointestinal symptoms

• Heartburn is accompanied by persistent nausea, bloating, or early satiety

It is particularly important to differentiate cardiac chest pain from heartburn, as tadalafil is contraindicated in patients taking nitrates for angina, and the combination can cause life-threatening hypotension. Patients with pre-existing cardiovascular disease should have been assessed for suitability before tadalafil prescription, but any new cardiac symptoms require urgent evaluation.

According to NICE guidance (NG12), patients should be referred for urgent direct access endoscopy within 2 weeks if they have dysphagia at any age, or if they are aged 55 and over with weight loss and upper abdominal pain, reflux or dyspepsia.

If you experience any suspected side effects from tadalafil, you can report them through the MHRA Yellow Card Scheme, which helps monitor the safety of medicines.

Frequently Asked Questions