Cialis Together side effects: what to expect and when to get help
- The most common side effects and how long they can last
- Which symptoms need urgent medical help
- The medicines and drinks that interact with tadalafil
- Why Cialis Together isn't meant for daily use
- Cialis Together side effects: the short answer
- How common are Cialis Together side effects?
- Why does tadalafil cause back pain and muscle aches?
- Why can side effects last longer than with sildenafil?
- Serious side effects that need urgent help
- Interactions to know about
- Why Cialis Together isn't for daily use
- How do Cialis Together and Viagra Connect side effects compare?
- How to report a side effect
- Final thoughts
Cialis Together side effects: the short answer
The most common side effects are headache, indigestion, back pain, muscle aches, flushing and a blocked nose. The Cialis Together Summary of Product Characteristics (SmPC) describes reported reactions as transient and generally mild or moderate. Tadalafil has an average half-life of 17.5 hours, so some effects may carry into the next day. Get medical help straight away for an erection lasting 4 hours or more, sudden loss of vision or hearing, chest pain or signs of a serious allergic reaction.
How common are Cialis Together side effects?
The SmPC sorts side effects by how often they happen. The most common ones each affect up to 1 in 10 men, and none affect more than that.
| How common (SmPC frequency band) | Side effects |
|---|---|
| Common: up to 1 in 10 men | Headache, indigestion (dyspepsia), back pain, muscle aches (myalgia), pain in the arms or legs, flushing, nasal congestion |
| Uncommon: up to 1 in 100 men | Including dizziness, blurred vision, a fast or pounding heartbeat, nausea, nosebleeds, rash, chest pain and prolonged erections |
| Rare: up to 1 in 1,000 men | Including priapism, sudden loss of vision or hearing, fainting, serious allergic reactions, stroke and heart attack |
Why does tadalafil cause back pain and muscle aches?
The SmPC lists back pain and muscle aches among the most frequently reported reactions to tadalafil, more common at higher doses and generally mild or moderate. It doesn't explain why tadalafil causes them, and the exact mechanism hasn't been confirmed, so it's worth treating explanations you see elsewhere with caution.
Good to know
If back pain or muscle aches are severe or don't settle, speak to a pharmacist, your GP or a UK-registered prescriber.
Why can side effects last longer than with sildenafil?
Tadalafil is cleared slowly. According to the SmPC, its average half-life is 17.5 hours in healthy men, so around half the dose is still in your system nearly a day later. By comparison, the Viagra Connect SmPC gives sildenafil a half-life of 3 to 5 hours.
The NHS explains that tadalafil can help you get an erection from 30 minutes up to 36 hours after taking it, while alternatives such as sildenafil work for up to 4 hours. Because tadalafil stays active for longer, side effects such as headache or muscle aches may also last longer than with a shorter-acting treatment.
Serious side effects that need urgent help
These are rare but need prompt action. Stop taking Cialis Together and get medical help straight away if you have:
- An erection lasting 4 hours or more (priapism). Without prompt treatment, it can damage penile tissue and cause permanent loss of potency.
- Sudden loss of vision or changes to your sight, in one or both eyes.
- Sudden loss of hearing or reduced hearing, which may come with ringing in the ears or dizziness.
- Chest pain during or after sex. Stop sexual activity and get emergency help, and tell the medical team you've taken tadalafil, as nitrates can't be given within 48 hours of a dose.
- Signs of a serious allergic reaction, such as swelling of the face, lips, tongue or throat, or a widespread rash with blistering or peeling skin.
Interactions to know about
The SmPC lists combinations that raise the risk of side effects or a dangerous drop in blood pressure:
- Nitrates and nitric oxide donors: These include angina medicines and amyl nitrite (poppers), and must never be taken with tadalafil. At least 48 hours should pass after your last tadalafil dose before a nitrate is considered, and only under close medical supervision.
- Riociguat: This pulmonary hypertension medicine must not be taken with tadalafil.
- Alpha blockers: Doxazosin isn't recommended with Cialis Together. If you take another alpha blocker, check with your GP or prescriber first.
- CYP3A4 inhibitors: Medicines such as ketoconazole, itraconazole, ritonavir, erythromycin and clarithromycin raise tadalafil levels, making side effects more likely. Check with your GP or prescriber first.
- Alcohol: Avoid large amounts before sex. The NHS says 1 beer or glass of wine is unlikely to affect tadalafil, but heavy drinking can make erections harder.
- Grapefruit juice: It also raises tadalafil levels, and the NHS advises avoiding it.
Why Cialis Together isn't for daily use
The SmPC recommends one tablet at least 30 minutes before sex, with a maximum of one tablet a day. It's not recommended for continuous daily use, and men who use it at least twice a week are advised to speak to a clinician.
Daily tadalafil is a different, lower-dose regimen that needs a prescription, so a UK-registered prescriber has to assess whether it suits you. The MHRA also notes that men with severe heart conditions, a high cardiovascular risk, severe kidney or liver failure, or who take certain interacting medicines need to stay under medical supervision rather than buy tadalafil from a pharmacy.
How do Cialis Together and Viagra Connect side effects compare?
Both are PDE5 inhibitors and share several side effects, including headache, flushing, indigestion and a blocked nose. The official product information shows a few differences:
- Headache: Very common with Viagra Connect, according to its SmPC, and common with Cialis Together.
- Vision: Changes in colour vision and blurred vision are listed as common with Viagra Connect.
- Back pain and muscle aches: Back pain is common with Cialis Together and isn't listed for Viagra Connect, while muscle aches are uncommon with Viagra Connect.
- Duration: Sildenafil is cleared faster than tadalafil, so its effects tend to wear off sooner.
How to report a side effect
If you think you've had a side effect from Cialis Together, you can report it through the MHRA Yellow Card scheme. Anyone can make a report, not only healthcare professionals, and reports help the MHRA identify new safety issues as early as possible.
Final thoughts
Cialis Together side effects are usually mild and short-lived, but tadalafil's long half-life means effects and interactions, particularly with nitrates, can last longer than with sildenafil. If you find you need it often, a UK-registered prescriber can review whether a daily treatment would suit you better.
FAQ
How long do Cialis Together side effects last?
Most are short-lived, but some may last into the next day.
Is back pain from Cialis Together normal?
It's a common side effect. Speak to a pharmacist or prescriber if it's severe or doesn't settle.
Can I drink alcohol with Cialis Together?
A small amount is unlikely to affect it, but avoid drinking heavily before sex.
Can I take Cialis Together every day?
No. Daily tadalafil needs a prescription.
What should I do if I have an erection lasting more than 4 hours?
Get medical help straight away, as prompt treatment can prevent lasting damage.
The DoktorABC medical advisory board
Dr. Roland Ruiken
Medical advisor, Norway
Dr. Viktor Simunovic
Medical advisor, Croatia