What does tadalafil feel like? Many men prescribed this erectile dysfunction medication wonder about the physical sensations they might experience. Tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor available in the UK as Cialis and generic formulations, works by enhancing blood flow to facilitate erections during sexual stimulation. Most users report subtle rather than dramatic effects—there is no immediate 'rush' or altered sensation upon taking the tablet. Instead, when aroused, men typically achieve firmer, more sustainable erections with increased confidence. Understanding what to expect can help reduce anxiety and ensure safe, effective use of this widely prescribed treatment.

What Is Tadalafil and How Does It Work?

Tadalafil is a prescription medication primarily used to treat erectile dysfunction (ED) and the urinary symptoms of benign prostatic hyperplasia (BPH). It belongs to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which also includes sildenafil and vardenafil. In the UK, tadalafil is available under brand names such as Cialis, as well as generic formulations approved by the Medicines and Healthcare products Regulatory Agency (MHRA).

The mechanism of action centres on the relaxation of smooth muscle tissue in blood vessels. During sexual stimulation, the body releases nitric oxide in the erectile tissue of the penis. This triggers an enzyme called guanylate cyclase, which increases levels of cyclic guanosine monophosphate (cGMP). The cGMP causes blood vessels to dilate, allowing increased blood flow into the penis and facilitating an erection. Normally, the enzyme PDE5 breaks down cGMP, limiting the duration of the erection. Tadalafil inhibits PDE5, thereby prolonging the presence of cGMP and enhancing erectile function when sexual stimulation occurs.

It is important to understand that tadalafil does not cause spontaneous erections. Sexual arousal is still required for the medication to be effective. Tadalafil is available in different doses and formulations: lower daily doses (2.5 mg or 5 mg) for continuous use in ED, and higher on-demand doses (10 mg or 20 mg) taken before anticipated sexual activity. For BPH, the licensed dose is 5 mg once daily. The choice depends on individual circumstances and should be determined in consultation with a healthcare professional. When used for BPH, tadalafil helps relax smooth muscle in the prostate and bladder, improving urinary flow and reducing symptoms such as difficulty starting urination or frequent nighttime urination.

Tadalafil should not be taken with nitrate medications (used for angina) or guanylate cyclase stimulators such as riociguat, as this combination can cause a dangerous drop in blood pressure. Dose adjustments may be necessary for patients with severe kidney or liver impairment.

Physical Sensations and Effects During Use

Many patients wonder what tadalafil actually feels like when taking it. The experience is generally subtle rather than dramatic. Most men do not report any immediate or unusual physical sensations upon taking the tablet. Tadalafil typically begins to work within 30 to 60 minutes, though it can take up to two hours to reach peak effectiveness. Unlike some medications, it does not produce a noticeable 'rush' or altered state of consciousness.

When sexual stimulation occurs, men using tadalafil often describe achieving erections that feel more natural and sustainable compared to their experience with untreated ED. The erection quality may be firmer, and the ability to maintain it throughout sexual activity is typically improved. Some men report increased confidence during intimacy, which can be as much psychological as physical. It is worth noting that the medication does not increase sexual desire or libido directly—it simply facilitates the physiological response when arousal is already present.

One distinguishing feature of tadalafil compared to other PDE5 inhibitors is its long duration of action. The effects can last up to 36 hours, which allows for greater spontaneity in sexual activity. This does not mean a continuous erection for 36 hours; rather, the ability to achieve erections in response to sexual stimulation remains enhanced during this window. Many men appreciate this extended timeframe as it reduces the pressure of timing sexual activity precisely.

Some individuals may notice mild physical sensations such as facial flushing or warmth, a slight headache, or nasal congestion shortly after taking tadalafil. These are related to the vasodilatory effects of the medication (widening of blood vessels) and are generally mild and transient. Most men find these effects do not interfere significantly with sexual activity or daily functioning.

It is advisable to avoid excessive alcohol consumption (generally 5 units or more) when taking tadalafil, as alcohol can worsen potential side effects like dizziness and headaches, lower blood pressure further, and may reduce the effectiveness of the medication for erectile function.

Common Side Effects You Might Experience

Like all medications, tadalafil can cause side effects, though not everyone experiences them. Understanding what is normal and expected can help reduce anxiety and ensure appropriate management. The most frequently reported side effects are generally mild to moderate and often diminish with continued use as the body adjusts to the medication.

Common side effects include:

• Headache: This is the most frequently reported side effect, occurring in approximately 11–15% of users. It typically results from the vasodilatory effect of tadalafil and usually resolves within a few hours. Staying well-hydrated and taking a simple analgesic such as paracetamol may help.

• Indigestion or dyspepsia: Some men experience mild stomach discomfort, acid reflux, or heartburn. Food does not significantly affect the drug's absorption, and simple self-care measures like staying upright after taking the medication may help.

• Back pain and muscle aches: Approximately 6–12% of users report back pain or generalised muscle discomfort, typically appearing 12–24 hours after taking the medication and resolving within 48 hours. The exact mechanism is not fully understood but may relate to PDE5 inhibition in smooth muscle elsewhere in the body.

• Facial flushing: A sensation of warmth and redness in the face and neck occurs due to increased blood flow in superficial blood vessels. This is usually mild and temporary.

• Nasal congestion: Some men notice a stuffy or runny nose, again due to vasodilation affecting the nasal mucosa.

Less common but notable side effects include dizziness, blurred vision or changes in vision, and palpitations. These warrant discussion with your GP if they persist or cause concern. Serious side effects are rare when tadalafil is used appropriately and under medical supervision. If you experience side effects that significantly impact your quality of life, your doctor may adjust the dose or consider alternative treatments.

Very rarely, serious allergic reactions can occur, with symptoms such as swelling of the face, lips, or throat, or difficulty breathing. These require immediate medical attention.

If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed here. You can also report side effects directly via the Yellow Card Scheme at yellowcard.mhra.gov.uk.

When to Seek Medical Advice About Tadalafil

While tadalafil is generally well-tolerated, certain situations require prompt medical attention. Understanding these warning signs is essential for patient safety and optimal outcomes.

Seek immediate medical help (call 999 or go to A&E) if you experience:

• Priapism: An erection lasting longer than four hours, which is painful and constitutes a medical emergency. Prolonged priapism can cause permanent damage to penile tissue and future erectile function. This is rare but requires urgent treatment.

• Sudden vision loss: Particularly in one eye, which may indicate non-arteritic anterior ischaemic optic neuropathy (NAION). Though the link between PDE5 inhibitors and NAION remains uncertain, any sudden visual change warrants immediate assessment.

• Sudden hearing loss or decrease: Accompanied by tinnitus (ringing in the ears) or dizziness. There have been rare reports of sudden sensorineural hearing loss associated with PDE5 inhibitor use.

• Chest pain or symptoms suggestive of a heart attack: Especially if occurring during or after sexual activity. Tadalafil is absolutely contraindicated with nitrate medications (such as glyceryl trinitrate). In life-threatening situations, nitrates should only be considered at least 48 hours after the last dose of tadalafil and under close medical supervision.

• Allergic reaction: Swelling of the face, lips, tongue or throat, or difficulty breathing may indicate a serious allergic reaction requiring immediate medical attention.

Contact your GP or pharmacist if:

• Side effects persist beyond a few days or worsen over time

• You experience severe or persistent headaches, dizziness, or palpitations

• The medication is not effective after several attempts at different doses

• You develop new symptoms or have concerns about interactions with other medications

• You have underlying health conditions (such as cardiovascular disease, liver or kidney impairment) that may require dose adjustment

According to NICE Clinical Knowledge Summaries, men with ED should receive a comprehensive assessment including cardiovascular risk evaluation before starting treatment. Regular follow-up is recommended to assess treatment efficacy and tolerability. Never exceed the prescribed dose, and always inform healthcare professionals about all medications and supplements you are taking.

Tadalafil interacts with several medications, including nitrates (absolutely contraindicated), riociguat (contraindicated), and alpha-blockers used for high blood pressure or prostate conditions (use with caution; avoid combination with doxazosin). Caution is also needed with certain antibiotics, antifungals, and HIV medications that affect how tadalafil is processed by the body. Tadalafil should be used with caution in patients with recent heart attack, stroke, unstable angina, severe hypotension, or severe liver impairment.

Frequently Asked Questions