How to get the maximum effect from Cialis

Cialis (generic name tadalafil) is a prescription drug used to treat erectile dysfunction (ED). It is part of a group of medicines called PDE5 inhibitors. This group also includes sildenafil (brand name Viagra). 

PDE5 inhibitor drugs work by increasing blood flow to the penis during arousal, making it easier to get an erection. Cialis doesn’t create spontaneous erections on its own and still depends on you to be in the mood for sex (Smith-Harrison, 2016). One of the benefits of Cialis is how long it lasts. It can be effective for up to 36 hours, allowing for spontaneity in your sex life when you take a smaller dose daily, regardless of when you have sex. 

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There are two ways to take the medication: a lower dose daily, or a higher dose as-needed (Rew, 2016):

• As needed: ideally at least 30 minutes before sexual activity.

• Every day: taken at the same time each day without regard to when you have sex

Research has shown that both regimens are equally effective in treating erectile dysfunction (Brock, 2016). 

You and your healthcare provider can decide what works best for your sex life. With the as-needed regimen, you don’t have to take the medication every day, but it also means planning your sexual activities. The continuous regimen with a lower dose taken daily allows more flexibility and spontaneity in your sex life. You can just take the tablet every day at the same time and not have to worry about when sex is about to happen. 

Cialis is a safe and effective treatment for erectile dysfunction when taken as directed. But there are some drug interactions to be aware of. Talk to your healthcare provider if you have questions about your medications or supplements interacting with one another. 

Nitrates (Nitroglycerin)

When combined with nitrates (such as nitroglycerin), a medication used to treat episodes of chest pain in people with heart disease, PDE5 inhibitors like Cialis can cause your blood pressure to drop to low levels (FDA, 2011). 

Nitrites

For a similar reason, avoid amyl nitrite (more commonly known as "poppers") when taking Cialis and other PDE5 inhibitors. Nitrites—with an "i"—like nitrates—with an "a"—cause muscle relaxation and dilation of blood vessels, which, when combined with Cialis, can cause your blood pressure to drop (Giorgetti, 2017). 

Alcohol

As Shakespeare wrote about booze in Macbeth, "it [alcohol] provokes the desire, but it takes away the performance." While effective at lowering inhibitions, alcohol is a central nervous system depressant, and this can interfere with your ability to get an erection. It shouldn’t come as a surprise that people who drink alcohol regularly or in high amounts are more likely to experience erectile dysfunction (Wang, 2018). 

The makers of Cialis warn that combining the ED drug with “too much” alcohol may cause side effects (Eli Lilly and Company, 2013). They define “too much” as five glasses of wine or five shots of whiskey, which shows you that it’s more about moderation on drinking, not total abstinence. 

When combining alcohol and Cialis, common side effects are headache, facial flushing, and chest pain (Kim, 2019). Also, drinking large quantities of alcohol can lower your blood pressure while taking Cialis (Schwartz, 2010). 

Grapefruit juice

Some studies suggest that grapefruit juice could interact with the way your body metabolizes certain medications, causing higher levels of a drug than intended, including Cialis and other PDE5 inhibitors (Bailey, 2013; Shen, 2020). 

If you’re not satisfied with Cialis, a simple adjustment in dose and timing might be all you need. You should always speak to your healthcare provider before making any changes. Sometimes, the dosage or dosing schedule of a PDE5 inhibitor is not the main issue, especially when underlying health conditions cause or contribute to erectile dysfunction. Some medical conditions that can cause erectile dysfunction include (Rew, 2016):

• Diabetes

• High blood pressure

• High cholesterol

• Depression

• Low testosterone (or low T)

• Cardiovascular disease

• Enlarged prostate 

Treating these underlying health conditions may help improve your erectile dysfunction as well. And for a natural boost to your sexual function, there are some lifestyle changes that can make a difference. 

Men who smoked cigarettes had higher rates of erectile dysfunction; those who quit smoking had improved erectile function (Kovac, 2015). Diet and exercise can also improve sexual function. Vigorous aerobic exercise can help improve erections (Silva, 2017). 

Summary: Cialis is an effective treatment for erectile dysfunction. For the best Cialis effects, it’s crucial to take the drug as directed, avoid substances like alcohol that can interfere with your erection, and incorporate lifestyle changes like smoking cessation and exercise.  

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

April 15, 2021

Written by

Cale Li, MD

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.