Cialis not working: 6 reasons why

Taking Cialis (tadalafil) for your erectile dysfunction (ED), but still having a hard time getting an erection? It can be very frustrating when the medication doesn’t seem to work in the first place, or it isn’t working as well as it used to.

Keep reading to learn about possible causes for Cialis not working (such as not giving it enough time to work or an ineffective dose), next steps, and safe and effective alternatives to consider.

Whether you’re taking Cialis for the first time and it isn’t working, or if you’ve taken it before and it isn’t working as well as it did, here are some possible reasons the medication isn’t working well for you.

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1. You aren’t aroused 

Cialis requires sexual stimulation to work — it won’t produce an erection on its own.

What to do: Do what you need to do to get aroused and sexually stimulated. Take your time and don’t rush.

2. You haven’t given it enough time to work

Cialis doesn’t work immediately. An as-needed dose can work in as little as 30 minutes, but it could take up to 2 hours for peak effects. If you’re taking a low daily dose of Cialis, it can take about five days for the medication to build up in the system and reach steady levels in the bloodstream.

What to do: Be sure to wait at least 30 minutes after taking the medication before trying to get an erection. If an as-needed dose hasn’t worked by then, give it some extra time and see if anything happens within a couple of hours. Never take Cialis more than once in a 24-hour period. If it still doesn’t work, contact your healthcare provider. If you’re on a low daily dose, wait at least five days. If it still doesn’t work after that, contact your provider.

3. You have performance anxiety

Sexual performance anxiety is a common cause of ED, and Cialis may not be enough to overcome it. 

What to do: Consider trying the medication on your own first (without a partner) to see how it affects you. If it works when you’re alone but not with a partner, and you’re feeling stressed about sexual performance, performance anxiety could be to blame. You can manage sexual performance anxiety by trying relaxation techniques, breathing exercises, or working with a mental health or sex therapist. 

4. You have a new or worsening underlying condition

ED can sometimes signify an underlying medical condition, such as:

• Diabetes

• Obesity

• Heart disease

• High cholesterol

• High blood pressure (hypertension)

• Atherosclerosis (clogged arteries)

• Depression

• Trauma (e.g. pelvic fractures, spinal cord injuries)

• Hypogonadism (low testosterone levels) 

• Peyronie's disease

• Metabolic syndrome

• Sleep apnea 

• Multiple sclerosis (MS)

If you know you have one or more of these diagnoses, this could be to blame. 

What to do: Visit your healthcare provider so they can evaluate any underlying conditions. Cialis treats the symptoms of ED — not the underlying cause. Treating the root cause may improve results over the long term.

5. You’re experiencing medication interactions

Some medications can interact with Cialis in a way that makes it less effective. 

Examples include CYP3A4 inducers such as:

• Carbamazepine

• Phenytoin

• Phenobarbital

• Rifampin

Antacids that contain aluminum or magnesium can also lower the rate of absorption of Cialis, possibly making it slower to start working.

What to do: Talk to your healthcare provider and let them know about all medications you take. They can determine whether you need a dose adjustment or a different medication altogether.

6. You need a higher dose

Cialis is available in multiple strengths: 2.5 mg, 5 mg, 10 mg, and 20 mg. For an as-needed dose for ED, the labeling approved by the US Food and Drug Administration (FDA) recommends an initial dosage of 10 mg. Starting at a lower dose decreases the risk of side effects. However, for some people, 10 mg may not be a high enough dose, and they may need a stronger prescription.

What to do: Contact your healthcare provider if you’ve given the medication plenty of time to work and tried it a few times. They can determine whether you could benefit from a higher dose of Cialis. 

If you’ve tried these methods and the medication still isn’t working, reach out to your healthcare provider. They can evaluate whether you might be a candidate for combined treatment with Cialis and sildenafil (Viagra) or whether a different dosage might be appropriate. 

One option is a combined treatment like Ro Sparks, which contains both sildenafil and tadalafil in a single dissolving tablet, without the wait time associated with other options. Any medication changes should be made with your healthcare provider to ensure you’re taking a safe and effective medication for your situation.

If Cialis and other similar medications are not working, your healthcare provider may suggest other treatment options, including: 

• Testosterone therapy

• Injections into the penis (intracavernosal injections or ICI)

• Vacuum restriction devices (penis pumps)

• Intraurethral therapy (a pill that’s inserted into the opening of the penis)

• Penile implants (surgically placed implants that allow you to control your erection manually)

• Penile vascular surgery (usually reserved for younger people with a history of penile trauma)

• Lifestyle changes, including a healthy eating plan, regular exercise, not smoking, reducing stress, and avoiding drugs and alcohol

• Natural remedies, including DHEA, ginseng, L-arginine, L-carnitine, and yohimbe

Emotional factors can also affect ED. Relationship conflicts, stress, depression, and anxiety can all contribute. There’s often a vicious cycle: the inability to get or maintain an erection can create performance anxiety, which then makes ED worse. For some people, working with a mental health professional or sex therapist can be an essential part of managing ED.

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

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If you’ve tried Cialis and it’s not working, don’t worry. Once you identify why the medication isn’t working for you, you and your healthcare provider can put together a plan for more effective ED treatment.

• Cialis might not be working if you’re not aroused, not giving it enough time to work, not taking a high enough dose, or experiencing other health-related factors, including drug interactions or an underlying health condition.

• If simple fixes — like giving Cialis more time to work or trying it on your own a few times — don’t help, consult your healthcare provider.

• Other ED medications are available if Cialis isn’t the right fit for you, such as Viagra or combined treatment like Ro Sparks.

• You can also try non-medication ED treatments such as penile injections, penis pumps, and healthy lifestyle changes.