Tadalafil
Cialis / aminotadalafil / nortadalafil (unregulated analogs) · PDE5 inhibitor
What it is
A prescription PDE5 inhibitor developed for erectile dysfunction and BPH, with a much longer half-life (~17.5 h) than sildenafil. Increasingly researched at low daily use for endothelial function and blood-pressure effects, which is why it shows up in biohacking stacks far beyond ED.
What human evidence shows
Strong trial evidence for ED and BPH — this is one of the best-evidenced compounds on this list, with FDA approval and decades of data. Daily low-dose regimens are an approved prescribing pattern. Evidence for gym "pump"/performance use is thin and mostly mechanistic; the endothelial-health signal is real but studied in clinical populations, not healthy young men.
Risks
Headache, flushing, nasal congestion, back pain and muscle aches (more than sildenafil, because of the long half-life). Dangerous interaction with nitrates — the combination can drop blood pressure catastrophically. Priapism is rare but a surgical emergency. New visual or hearing changes warrant prompt medical assessment. Products from outside lawful channels can vary widely in actual content.
Legal status
US: prescription-only (not scheduled). Products offered outside lawful prescription channels may be falsified or mislabeled.
Evidence base
established literature
Large human evidence base: several phase 3 or 4 trial reports, plus multiple meta-analyses or systematic reviews.
- phase 3/4
- 24
- randomised
- 353
- reviews
- 119
- human trials
- 449
Counts are of published papers, not distinct trials, and measure how much research exists — not whether this works or is safe for you.
Research (12)
- Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysisInt Urol Nephrol · 2017
- Tadalafil for the treatment of benign prostatic hyperplasiaExpert Opin Pharmacother · 2019
- Efficacy and safety of long-term tadalafil 5 mg once daily combined with sildenafil 50 mg as needed at the early stage of treatment for patients with erectile dysfunctionAndrologia · 2015
- Benefits of Tadalafil and Sildenafil on Mortality, Cardiovascular Disease, and DementiaAm J Med · 2025
- Tadalafil Alone or in Combination with Tamsulosin for the Management for LUTS/BPH and EDCurr Urol Rep · 2020
- TadalafilProfiles Drug Subst Excip Relat Methodol · 2011
- Tadalafil for Treatment of Fetal Growth Restriction: A Review of Experimental and Clinical StudiesBiomedicines · 2024
- Tadalafil and Steroid Hormones Interactions in Adipose, Bone and Prostate Tissues: Focus on Translational PerspectivesInt J Mol Sci · 2022
- Potential beneficial impacts of tadalafil on cardiovascular diseasesJ Chin Med Assoc · 2025
- Tadalafil Use in Cardiovascular DiseaseCardiol Rev · 2025
- Tadalafil: in pulmonary arterial hypertensionDrugs · 2010
- Tadalafil for the treatment of pulmonary arterial hypertensionExpert Opin Pharmacother · 2010
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