How long to take tadalafil for erectile dysfunction depends on individual circumstances, underlying causes, and treatment response. Tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor licensed by the MHRA, offers flexible dosing options for men with erectile dysfunction. Some men use it short-term for situational difficulties, whilst others require long-term therapy for chronic conditions such as diabetes or cardiovascular disease. Available as on-demand or daily dosing, tadalafil treatment duration should be determined collaboratively with your GP, with regular reviews to ensure ongoing safety and effectiveness. This article explores treatment duration, dosing regimens, safety considerations, and when to review your therapy.

What Is Tadalafil and How Does It Work for Erectile Dysfunction?

Tadalafil is a prescription medication licensed by the MHRA for the treatment of erectile dysfunction (ED) in adult men. It belongs to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which also includes sildenafil, vardenafil and avanafil. Tadalafil is available under various brand names, including Cialis, and as generic formulations.

The mechanism of action centres on improving blood flow to the penis during sexual stimulation. When a man becomes sexually aroused, nitric oxide is released in the erectile tissue, which activates an enzyme that produces cyclic guanosine monophosphate (cGMP). This chemical messenger relaxes the smooth muscle in the blood vessels of the penis, allowing increased blood flow and facilitating an erection. The enzyme PDE5 normally breaks down cGMP, limiting the duration of the erection. Tadalafil works by inhibiting PDE5 , thereby prolonging the effects of cGMP and making it easier to achieve and maintain an erection sufficient for sexual activity.

It is important to understand that tadalafil does not cause spontaneous erections—sexual stimulation is still required for the medication to be effective. The drug does not increase sexual desire or libido, nor does it cure the underlying causes of erectile dysfunction. Tadalafil is distinguished from other PDE5 inhibitors by its longer duration of action, with effects lasting up to 36 hours after a single dose. This extended window offers greater flexibility in timing sexual activity compared to shorter-acting alternatives.

Tadalafil 5 mg once daily is also licensed for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia (BPH), either alone or in combination with erectile dysfunction.

How Long Should You Take Tadalafil for Erectile Dysfunction?

The duration of tadalafil treatment for erectile dysfunction varies considerably between individuals and depends on several factors, including the underlying cause of ED, treatment response, and personal circumstances. There is no universally prescribed treatment duration—some men may use tadalafil occasionally for specific situations, whilst others may require long-term therapy.

For men whose erectile dysfunction is situational or related to temporary factors such as stress, anxiety, or relationship issues, short-term use may be sufficient. In these cases, tadalafil might be taken on an as-needed basis for weeks or months until the contributing factors resolve. Psychological support or counselling may complement pharmacological treatment during this period.

Conversely, when erectile dysfunction stems from chronic conditions such as diabetes, cardiovascular disease, or neurological disorders, long-term treatment is often necessary. Many men with persistent ED continue taking tadalafil for years, as the underlying causes may not be fully reversible. NICE guidance recognises that ED is frequently a chronic condition requiring ongoing management.

The decision about treatment duration should be made collaboratively between you and your GP or specialist. Initial prescriptions are typically issued for a trial period, with a review within 4-8 weeks to assess effectiveness and tolerability. If tadalafil proves beneficial and is well-tolerated, your doctor may recommend continuing treatment indefinitely, with periodic reviews to monitor your response, assess any side effects, and evaluate whether the medication remains appropriate for your circumstances.

It's important to note that erectile dysfunction, particularly in men over 40, may be an early marker of cardiovascular disease. Your GP may therefore recommend cardiovascular risk assessment and appropriate management of any underlying conditions. Some men find that lifestyle modifications—such as weight loss, increased exercise, smoking cessation, or better diabetes control—may reduce their reliance on medication over time.

Daily vs On-Demand Tadalafil: Which Treatment Duration Suits You?

Tadalafil is available in two distinct dosing regimens, each suited to different patterns of sexual activity and treatment preferences. Understanding these options helps determine the most appropriate duration and frequency of use for your individual situation.

On-demand tadalafil is taken at higher doses (10 mg or 20 mg) at least 30 minutes before anticipated sexual activity. The effects may last up to 36 hours, providing a wide window of opportunity. This regimen suits men who have sexual activity less than twice weekly or who prefer flexibility without daily medication. Treatment duration with on-demand dosing is essentially indefinite—you take the medication only when needed, which could be occasionally or regularly depending on your circumstances.

Daily tadalafil involves taking a lower dose (2.5 mg or 5 mg) once daily, regardless of when sexual activity is planned. This approach maintains a constant level of the drug in your system, allowing for spontaneous sexual activity at any time without planning ahead. Daily dosing is particularly appropriate for men who engage in sexual activity at least twice weekly or who find the need to plan ahead psychologically burdensome. The duration of daily treatment is typically long-term, often continuing for months or years.

With either regimen, you must not take more than one dose in 24 hours.

Both approaches have broadly comparable efficacy and safety profiles, though individual responses may vary. The choice between them depends on your lifestyle, frequency of sexual activity, and personal preference. Some men initially start with on-demand dosing and later switch to daily treatment, or vice versa. Your GP can help you determine which approach best suits your needs and can adjust the regimen if your circumstances change.

Important cautions: Tadalafil must not be taken with nitrate medications (including recreational 'poppers') or riociguat. Caution is needed when taking alpha-blockers (particularly doxazosin, which is not recommended in combination with tadalafil). Daily low-dose tadalafil may also provide additional benefits for men with both ED and lower urinary tract symptoms related to benign prostatic hyperplasia.

When to Review Your Tadalafil Treatment with Your GP

Regular review of tadalafil treatment is essential to ensure ongoing safety, effectiveness, and appropriateness. NICE recommends that men taking PDE5 inhibitors for erectile dysfunction should have their treatment reviewed periodically. You should have an initial review within 4-8 weeks of starting treatment or changing dose, and then at least annually if your treatment is stable.

You should schedule a review with your GP if:

• Tadalafil becomes less effective over time, requiring higher doses or more frequent use

• You experience new or worsening side effects, including headaches, indigestion, back pain, muscle aches, flushing, or nasal congestion

• You develop visual disturbances, such as blurred vision or changes in colour perception

• You experience an erection lasting more than four hours (priapism)—this requires immediate medical attention

• Your cardiovascular health changes, including new chest pain, breathlessness, or diagnosis of heart conditions

• You start taking new medications that might interact with tadalafil, including nitrates, alpha-blockers, riociguat, or certain antifungals and HIV medications

• Your underlying health conditions worsen, particularly diabetes, hypertension, or kidney disease

During routine reviews, your GP will assess treatment effectiveness, discuss any side effects, review your cardiovascular risk factors, and check blood pressure. They may also evaluate whether lifestyle modifications or management of underlying conditions could improve your erectile function.

If chest pain occurs after taking tadalafil, do not take nitrate medications (such as GTN spray or tablets) and seek emergency medical help immediately (call 999).

Additionally, if you have not attempted tadalafil for several months, it may be worth discussing a trial period off medication with your doctor, particularly if you have made significant lifestyle changes or if underlying contributing factors have improved. Some men find that their erectile function improves sufficiently to reduce or discontinue pharmacological treatment. Never stop taking prescribed medication without consulting your healthcare provider first.

If you experience any suspected side effects, you can report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Can You Take Tadalafil Long-Term Safely?

Extensive clinical evidence supports the long-term safety of tadalafil for erectile dysfunction when used appropriately under medical supervision. Studies have followed men taking tadalafil for several years, demonstrating that it remains well-tolerated with a consistent safety profile over extended periods.

The most common side effects include headache, indigestion, back pain, muscle aches, facial flushing, and nasal congestion. These are generally mild to moderate in severity and often diminish with continued use as the body adapts to the medication. Serious adverse effects are rare but include priapism (prolonged erection), sudden vision loss, and sudden hearing loss. If you experience any of these, seek immediate medical attention.

Long-term tadalafil use does not lead to physical dependence or tolerance in the pharmacological sense. However, some men may develop psychological reliance on the medication for sexual confidence. There is no established link between long-term tadalafil use and increased cardiovascular risk in men who are appropriate candidates for the medication. Some observational studies suggest potential cardiovascular benefits, though this remains an area of ongoing investigation and tadalafil is not licensed for cardiovascular risk reduction.

Important safety considerations for long-term use include:

• Tadalafil is contraindicated in men taking nitrates (for angina) or recreational nitrates ('poppers') due to risk of severe hypotension

• Tadalafil must not be used with riociguat (used for pulmonary hypertension)

• Caution is required with alpha-blockers (particularly doxazosin, which is not recommended in combination)

• Caution is required in men with significant cardiovascular disease, recent stroke, or uncontrolled hypertension

• Dose adjustments may be necessary for men with hepatic or renal impairment (daily dosing is not recommended in severe renal impairment)

• Certain medications that affect CYP3A4 enzymes (like ketoconazole, ritonavir, rifampicin) and grapefruit juice can alter tadalafil levels

• Regular monitoring of blood pressure and cardiovascular health is advisable

Your GP will assess your suitability for long-term tadalafil treatment based on your overall health, medication list, and cardiovascular risk profile. Most men can safely continue tadalafil indefinitely provided they remain under appropriate medical supervision and attend regular reviews. The benefits of restored sexual function—including improved quality of life, relationship satisfaction, and psychological wellbeing—generally outweigh the risks for appropriately selected patients taking the medication as prescribed.

Frequently Asked Questions