Erectile dysfunction (ED) is a common condition that affects men worldwide, often leading to stress and decreased quality of life. One treatment option is tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor, which has been shown to improve erectile function. In this article i will give general information on the use of a 5 mg daily dose of tadalafil over three months, exploring its effectiveness, potential side effects, and considerations for those considering this treatment to enhance sexual health and overall well-being.

Benefits of long term use of 5 mg tadalafil for ED

The literature on the three-month use of 5 mg tadalafil for ED generally reports positive outcomes. Several clinical studies and reviews highlight the following key benefits:

• Improved Erectile Function: Tadalafil enhances the ability to achieve and maintain an erection, leading to a significant improvement in sexual performance.
• Increased Spontaneity: The daily low-dose regimen allows for more spontaneous sexual activity, eliminating the need to plan around medication timing.
• Increased Sexual Confidence and Satisfaction: Men using tadalafil daily report increased confidence in their ability to achieve and maintain an erection, which leads to higher levels of sexual satisfaction. This can also positively impact overall relationship satisfaction.
• Enhanced Sexual Confidence: Men often experience increased confidence in their sexual abilities, which can positively impact overall sexual satisfaction and relationship quality.
• Continuous Efficacy: The steady presence of the drug in the bloodstream ensures consistent therapeutic effects, reducing anxiety related to sexual performance.
• Improvement in Benign Prostatic Hyperplasia (BPH) Symptoms. For men with both ED and BPH, tadalafil can also help alleviate urinary symptoms associated with an enlarged prostate, such as frequent urination.
• Potential Cardiovascular and endothelial Benefits: Long-term use of tadalafil may improve endothelial function, which could contribute to better cardiovascular health, particularly in men with underlying risk factors.
• Convenience and Tolerability: The 5 mg daily dose is convenient and generally well-tolerated, with most side effects being mild and diminishing over time.
• Positive Psychological Impact: Regular use can lead to reduced anxiety related to sexual performance, improving overall mental well-being and quality of life.
• Long-Term Benefits: Some literature suggests that prolonged use beyond three months may continue to provide benefits, including sustained improvements in erectile function and potentially enhanced endothelial health.
• Minimal side effects: Common side effects of 5 mg tadalafil include: Headache, indigestion, back pain, muscle aches, flushing (redness of the face or skin), nasal congestion and dizziness. These side effects are typically mild and diminish with continued use.

Indications

In summary, the three-month use of 5 mg tadalafil is primarily indicated for treating ED but can also be beneficial for men with benign prostatic hyperplasia and potentially for those with endothelial dysfunction or mild pulmonary arterial hypertension, under the guidance of a urologist.

Here’s a detailed overview:

Erectile Dysfunction (ED)

• Primary Indication: The main indication for using 5 mg tadalafil daily is the treatment of ED. Tadalafil helps men achieve and maintain an erection sufficient for sexual activity by enhancing blood flow to the penis.
• Suitability: This regimen is particularly suitable for men who prefer spontaneity in their sexual activity, as it eliminates the need to plan medication use around sexual intercourse.

Psychological Benefits

• Improved Quality of Life: Regular use of tadalafil can reduce anxiety related to sexual performance, leading to enhanced self-esteem and overall quality of life. This can be particularly beneficial for men whose ED has a psychological component, such as performance anxiety or depression.

Benign Prostatic Hyperplasia (BPH)

• Secondary Indication: Tadalafil is also indicated for the treatment of BPH, a condition characterized by an enlarged prostate, which can cause urinary symptoms such as difficulty in urination and increased frequency of urination, particularly at night. The daily use of tadalafil can alleviate these symptoms.
• Dual Benefit: Men who have both ED and BPH may benefit from the daily 5 mg dose, as it can improve both erectile function and urinary symptoms.

Endothelial Dysfunction and Cardiovascular Risk (Potential Cardiovascular Benefits):

Some studies suggest that tadalafil may improve endothelial function, which is the lining of blood vessels. This is particularly relevant for men with ED who are at higher risk of cardiovascular diseases. Regular use may contribute to better vascular health.

Pulmonary Arterial Hypertension (PAH)

• Off-Label Use: Although not the primary indication for the 5 mg dose, tadalafil is also approved in higher doses for the treatment of PAH. In some cases, long-term tadalafil use for ED may offer benefits for patients with mild forms of PAH, but this should be guided by a physician.

Contraindications

The three-month use of 5 mg tadalafil for ED has several contraindications that need to be considered to ensure patient safety. These contraindications include the following:

Use of Nitrates

• Absolute Contraindication: Tadalafil should not be used by men who are taking nitrates, such as nitroglycerin, isosorbide dinitrate, or isosorbide mononitrate, which are commonly prescribed for chest pain (angina). The combination can lead to a severe and potentially life-threatening drop in blood pressure.

Severe Cardiovascular Conditions

• Contraindicated in Certain Patients: Men with severe cardiovascular conditions, such as unstable angina, recent myocardial infarction (within the last 90 days), recent stroke (within the last 6 months), or severe hypotension (low blood pressure), should avoid using tadalafil. The physical exertion related to sexual activity could pose risks, and tadalafil’s effects on blood pressure could exacerbate these conditions.

Severe Hepatic Impairment

• Not Recommended: Tadalafil is metabolized in the liver, so men with severe liver disease (such as cirrhosis) should avoid its use due to the potential for drug accumulation and increased risk of side effects.

Severe Renal Impairment

• Dose Adjustments or Avoidance: In men with severe renal impairment, the clearance of tadalafil is reduced, which can increase the risk of adverse effects. While lower doses may be prescribed with caution, severe cases may require avoiding tadalafil altogether.

Retinitis Pigmentosa

• Inherited Eye Disorder: Tadalafil is contraindicated in men with retinitis pigmentosa, a rare genetic disorder that affects the retina, as PDE5 inhibitors like tadalafil can potentially worsen this condition due to their effects on retinal PDE6 enzymes.

Hypersensitivity to Tadalafil

• Allergic Reactions: Men with a known hypersensitivity or allergy to tadalafil or any of its components should not use the medication. Symptoms of an allergic reaction could include rash, itching, severe dizziness, or difficulty breathing.

Concurrent Use of Other PDE5 Inhibitors

• Avoidance Required: Tadalafil should not be used in combination with other PDE5 inhibitors like sildenafil (Viagra) or vardenafil (Levitra). The combination can lead to an excessive blood pressure drop or other serious side effects.

Caution in Anatomical Deformation of the Penis

• Conditions Like Peyronie’s Disease: Men with anatomical deformations of the penis, such as Peyronie’s disease, should use tadalafil with caution, as it can potentially exacerbate these conditions.

Caution in Patients with Priapism Risk

• Blood Disorders: Men with conditions that predispose them to priapism (prolonged erection), such as sickle cell anemia, multiple myeloma, or leukemia, should use tadalafil cautiously due to the increased risk of this serious condition.

Concurrent Use of Alpha-Blockers

• Potential Interaction: While not an absolute contraindication, caution is advised when using tadalafil with alpha-blockers (used for treating high blood pressure or prostate enlargement), as the combination can lead to symptomatic hypotension.

Summary

The three-month use of 5 mg tadalafil is a common treatment for ED. Tadalafil, a PDE5 inhibitor, works by enhancing blood flow to the penis, helping men achieve and maintain erections. The daily low-dose regimen allows for more spontaneous sexual activity without the need to time the medication. Studies have shown significant improvements in erectile function, sexual confidence, and overall satisfaction with minimal side effects. This treatment is generally well-tolerated, though it is contraindicated in certain conditions such as severe cardiovascular disease and the use of nitrates.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE