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Last updated June 2, 2020. 4 minute read

Cialis not working anymore? Possible next moves

Talk to your healthcare provider about any changes in tadalafil effectiveness as well as other medications you may be taking; some drugs can affect how well tadalafil works. Don’t change your dosing schedule without consulting with your healthcare provider, but a change may be all you need for Cialis to become effective again.

Dr Chimene Richa Md Written by Dr. Chimene Richa, MD
Reviewed by Dr. Mike Bohl, MD, MPH

Erectile dysfunction, more commonly known as ED, occurs when your penis cannot get firm or stay firm enough for sex. Erection difficulties can happen to all men occasionally; however, if it is happening often enough to affect your sex life, then you may have ED. According to the National Institutes of Health (NIH), you may have ED if you experience any of the following (NIH, 2017):

  • You can get an erection sometimes, but not each time you want to have sex.
  • You get an erection during sex, but it does not last long enough for satisfactory sex.
  • You are never able to get an erection.

Vitals

  • Erectile dysfunction (ED) affects over 30 million men.
  • The most common medications used to treat ED are the phosphodiesterase-5 (PDE5) inhibitors, which include sildenafil (brand name Viagra), vardenafil (brand name Levitra), avanafil (brand name Stendra), and tadalafil (brand name Cialis).
  • PDE5 inhibitors work by increasing blood flow to the penis during arousal
  • You can take tadalafil (Cialis) daily or on an as-needed basis.
  • Other treatment options include testosterone therapy, penile injections, vacuum restriction devices, and penile implants.

If you have ED, you are not alone—anywhere from 3% to 76.5% of men worldwide experience erectile dysfunction (Kessler, 2019). The American Urology Association (AUA) estimates that over 30 million men are affected by ED (AUA, 2018). While your risk of ED increases with age, this condition affects younger men as well. One in four men younger than 40 years of age have ED (Capogrosso, 2013).

Your provider may prescribe medication to treat your ED. The most common class of drugs used for this condition are phosphodiesterase 5 (PDE-5) inhibitors. They include sildenafil (brand name Viagra), vardenafil (brand name Levitra), avanafil (brand name Stendra), and tadalafil (brand name Cialis).

What is Cialis and how does it work?

As a PDE-5 inhibitor, tadalafil (brand name Cialis) works by blocking an enzyme called phosphodiesterase type 5 and increasing the amounts of a chemical called cGMP in the penis. This causes relaxation of the blood vessels, leading to more blood flowing into the penis. During arousal, the increased blood flow allows you to get and maintain an erection—it’s important to note that tadalafil will not give you an erection without sexual stimulation (Huang, 2013). You can take tadalafil either as needed (at least 30 minutes before sexual activity) or once a day regardless of sexual activity (and at a lower dose). Tadalafil works up to 36 hours after taking it.

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What to do if tadalafil (Cialis) is not working anymore

Sometimes, men find that tadalafil is not working as well as it has in the past. Be sure to wait at least 30 minutes after taking the medication before trying to have an erection. While studies have not shown that food affects tadalafil, other PDE5 inhibitors may not work as well if taken after a large meal, especially a high-fat meal (Huang, 2013).

Talk to your healthcare provider about any changes in tadalafil effectiveness as well as other medications you may be taking; some drugs can affect how well tadalafil works. The usual dose of tadalafil can range from 2.5 mg to 20 mg and can vary by person depending on individual dosing patterns (daily vs. as needed) and responsiveness (UpToDate, n.d.). Don’t change your dosing schedule without consulting with your healthcare provider, but a change may be all you need for Cialis to become effective again.

Can you drink alcohol with Cialis? Is it safe?

5 minute read

If tadalafil and other PDE5 inhibitors are not working for you, your healthcare provider may suggest other treatment options including (AUA, 2018):

  • Testosterone therapy: Blood testing shows low testosterone levels
  • Injections into the penis: Alprostadil and other medications
  • Vacuum restriction devices: Can keep the penis hard for up to 30 minutes
  • Intraurethral therapy: Alprostadil pill inserted into opening of the penis
  • Penile implants: Surgically placed implants that allow you to control their erection manually
  • Penile vascular surgery: Usually reserved for younger men with a history of trauma to the penis
  • Lifestyle changes: Eat a healthy diet, exercise, stop smoking, decrease stress, avoid drugs and alcohol
  • Natural remedies: DHEA, ginseng, L-arginine, L-carnitine, and yohimbe may help

Emotional issues can also affect ED. Your healthcare provider may suggest addressing them as well. Things like relationship conflicts, stress, or depression/anxiety from past difficulties with ED (performance anxiety) can all play a role in ED. Also, ED can be a sign of an underlying medical condition such as heart disease, high blood pressure, diabetes, etc.

Considerations/side effects of taking tadalafil (Cialis)

Tadalafil and the other ED medications have the potential to interact with other drugs and cause side effects. Be sure to tell your healthcare provider about any medical issues you may have or any other medicines you may be taking.

Common side effects include (UptoDate, n.d.):

  • Flushing
  • Headaches
  • Nausea
  • Muscle aches
  • Back pain
  • Runny nose

Avoid taking tadalafil if you are taking nitrates, are on dialysis for kidney disease, or have severe liver disease.

Several treatment options exist for improving erectile dysfunction. Talk to your healthcare provider about your options. Don’t give up or feel frustrated if one treatment doesn’t work—there are other choices, and your provider can help you find the one that is right for you.