Does Cialis (tadalafil) cause heartburn? Causes and 5 ways to manage it

Does Cialis cause heartburn? Yes, Cialis (tadalafil) can cause heartburn in some people because it relaxes smooth muscles throughout the body, including those involved in digestion.

The prescribing information for Cialis lists indigestion as one of the most common side effects. Because Cialis works by relaxing smooth muscles to increase blood flow and support erections in people with erectile dysfunction (ED), it may also affect muscles in the gastrointestinal tract, which could contribute to symptoms like heartburn. 

Here’s a closer look at how Cialis causes heartburn and what you can do about it. 

Cialis may cause heartburn in some people because it relaxes smooth muscles throughout the body, not just those involved in erections. This can affect the muscles of the digestive tract, making symptoms like acid reflux and abdominal discomfort more likely. 

Cialis may cause heartburn by:

• Relaxing the lower esophageal sphincter (LES): Cialis belongs to a class of drugs called PDE5 inhibitors, which increase smooth muscle relaxation throughout the body. This effect can include the LES — the muscle that normally prevents stomach acid from moving back into the esophagus. Research shows a 20 mg dose of tadalafil can significantly reduce LES pressure and esophageal contraction strength for up to 48 hours, and a case report described a patient experiencing burning chest pain after tadalafil use.

• Causing digestive symptoms like dyspepsia: Both the Cialis prescribing information and placebo-controlled studies list dyspepsia (indigestion) and other gastrointestinal symptoms among the most common adverse reactions of Cialis, even at doses as low as 2.5 mg and 5 mg. Dyspepsia can include upper-abdominal discomfort, acid reflux, and heartburn-like symptoms. In head-to-head comparison data from more than 130,000 users of PDE5 inhibitors, reflux symptoms were reported more frequently with tadalafil (8.0%) than with sildenafil (5.3%).

• Having longer-lasting effects on the body: Tadalafil has a longer half-life than other PDE5 inhibitors at about 17–18 hours, meaning its effects can last up to 36 hours. Because the drug stays active longer, its effects on smooth muscle relaxation may also last longer. In one study, a single 20 mg dose of tadalafil lowered LES pressure and reduced esophageal contractions for up to 48 hours, which may make reflux symptoms more likely in some people.

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If you experience heartburn after taking Cialis, a few lifestyle changes and over-the-counter (OTC) remedies may help relieve your symptoms.

Avoid common heartburn triggers

Tadalafil can be taken with or without food, but certain foods and drinks are known to trigger or worsen heartburn. Limiting these around the time you take Cialis may help reduce symptoms:

• Alcohol

• Coffee

• Spicy foods

• Carbonated beverages

• Chocolate

• Fatty or fried foods

Consider taking OTC antacids

Antacids like Tums, Rolaids, and Alka-Seltzer are some of the most common remedies for heartburn, and there are no known significant interactions between antacids and tadalafil. 

The prescribing information for tadalafil does note that taking antacids with the medication may slow the rate at which tadalafil is absorbed, but it doesn’t affect how much of the medication the body absorbs overall. This means Cialis may take a little longer to start working if you take it with an antacid, but it can still help relieve heartburn symptoms.

Stay upright after eating and taking Cialis

Most people with heartburn are advised to stay upright after eating to reduce symptoms. Lying down too soon can make it easier for stomach acid to travel up the esophagus. Because tadalafil can relax smooth muscles involved in digestion, staying upright for a while after eating or taking Cialis may help reduce reflux symptoms.

Maintain a healthy weight

Carrying extra weight can increase pressure on the stomach and make acid reflux more likely. Research shows that weight loss can reduce acid exposure in the esophagus and improve reflux symptoms in people with gastroesophageal reflux disease (GERD). 

Ask your provider about lowering your dose

Clinical trials show that the risk of dyspepsia and other side effects may increase with higher doses of tadalafil. Taking a lower dose may help reduce symptoms, but you should always check with your healthcare provider before changing your dose.

In the case report mentioned previously, the patient experiencing burning chest pain with tadalafil found relief when switching to a lower dose of sildenafil (Viagra).  

Cialis heartburn is usually temporary and often subsides within several hours after taking the medication. However, because tadalafil has a long half-life and stays active in the body longer than many other erectile dysfunction medications, symptoms may sometimes last longer.

There are no clinical studies that measure exactly how long tadalafil-related heartburn lasts. However, there are case reports that suggest symptoms can persist for up to about 24 hours in some people. In the case report of the patient experiencing burning chest pain with tadalafil, this symptom lasted roughly a day after each dose. This long duration may be related to tadalafil’s half-life of about 17–18 hours.

In contrast, heartburn from shorter-acting PDE5 inhibitors like sildenafil typically resolves sooner, generally within five hours.

Gastrointestinal symptoms, including heartburn, are among the most common side effects of Cialis. Clinical trials showed that indigestion occurred in 4% of people who took the 5 mg dose, 8% of people who took the 10 mg dose, and 10% of people who took the 20 mg dose. In comparison, only 1% of people taking a placebo reported indigestion.

Cialis-related heartburn can be uncomfortable, but GI symptoms like indigestion and heartburn are often temporary and can be managed with simple lifestyle changes. 

However, if your symptoms are severe or don’t go away with lifestyle changes or OTC treatments, talk with your healthcare provider. They can help determine whether there’s another condition — such as GERD — that may be contributing to your symptoms and discuss ways to manage them or alternative treatments.

GI symptoms like heartburn and indigestion are among the most common side effects of the medication, but they’re manageable. Here’s what to know:

• Cialis may cause heartburn by relaxing smooth muscles throughout the body. This effect can include the lower esophageal sphincter, which normally prevents stomach acid from moving back into the esophagus.

• Heartburn is a common side effect of Cialis. Clinical trials show indigestion occurs in up to about 10% of people taking higher doses of tadalafil.

• Symptoms usually improve within several hours but can last longer in some cases. Because tadalafil has a long half-life and stays active in the body for up to 36 hours, heartburn may occasionally persist for up to about a day.

• Simple lifestyle changes and OTC remedies may help reduce Cialis-related heartburn. Avoiding trigger foods, staying upright after eating, using antacids, or maintaining a healthy weight may help improve symptoms.

• Talk with a healthcare provider if heartburn is severe or persistent. Your healthcare provider may recommend adjusting your dose, treating reflux symptoms, or switching to another ED medication.