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Last updated: Mar 15, 2022
3 min read

Cialis not working anymore? Possible next moves

chimene richa

Medically Reviewed by Chimene Richa, MD

Written by Health Guide Team

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

You’ve done the hard part—you’ve opened up to your healthcare provider about your erectile dysfunction (ED), and they’ve prescribed you Cialis (tadalafil; see Important Safety Information) to treat it. But now, Cialis isn’t working the way it did initially, or maybe it never worked well for you in the first place. What can you do? 

The good news is there are many treatment options for ED, even if Cialis doesn’t do the trick for you. Read on to learn about your options.  

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What to do if Cialis isn’t working anymore 

Sometimes, people find that tadalafil is not working as well as in the past for treating their erectile dysfunction (difficulty getting or maintaining an erection). Here are some steps you can take to troubleshoot (Huang, 2013): 

  • Be sure to wait at least 30 minutes after taking the medication before trying to have an erection. 
  • While studies have not shown that food affects tadalafil, other PDE5 inhibitors may not work as well if taken after a large meal, especially a high-fat meal. So you may want to try taking your Cialis without a high-fat meal. 
  • If you’re taking any new medications, these might affect how well Cialis works for you. Talk to your healthcare provider about any changes. 

Your healthcare provider might also recommend upping your dose. The usual dose of tadalafil can range from 2.5 mg to 20 mg and can vary by person depending on individual dosing patterns (daily vs. as needed) and how well you respond to it (Dhaliwal, 2021). Don’t change your dose without consulting with your healthcare provider, but a dose adjustment may be all you need for Cialis to become effective again.

Other ED treatments

If tadalafil and other drugs like it are not working for you, your healthcare provider may suggest other treatment options, including (Sooriyamoorthy, 2021): 

  • Testosterone replacement therapy
  • Injections into the penis
  • Vacuum restriction devices
  • Intraurethral therapy (a pill that’s inserted into the opening of the penis)
  • Penile implants (surgically placed implants that allow you to control their erection manually)
  • Penile vascular surgery (usually reserved for younger men with a history of trauma to the penis)
  • Lifestyle changes—Eat a healthy diet, exercise, stop smoking, decrease stress, and avoid drugs and alcohol. 
  • Natural remedies, like DHEA, ginseng, L-arginine, L-carnitine, and yohimbe, may help.

Emotional issues can also affect ED. Things like relationship conflicts, stress, depression, or anxiety can contribute to ED, and there’s often a vicious cycle with ED creating performance anxiety. Help from a mental health professional can be an essential part of overcoming ED. 

ED can also signify an underlying medical condition, such as heart disease, high blood pressure, and diabetes, so it’s important to speak with your healthcare provider early. 

How does Cialis work?

Cialis is a type of drug called a PDE-5 inhibitor, which works by relaxing the blood vessels, leading to more blood flowing into the penis. During arousal, the increased blood flow allows you to get and maintain an erection during arousal. It’s important to note that tadalafil will not give you an erection without sexual stimulation (Huang, 2013). 

You can take tadalafil either as needed (at least 30 minutes before sexual activity) or once a day regardless of sexual activity (and at a lower dose). Tadalafil works up to 36 hours after taking it.

Cialis side effects

Tadalafil and other ED medications can interact with other drugs and cause side effects. Be sure to tell your healthcare provider about any medical issues you may have or any other medicines you may be taking.

Common side effects of tadalafil include (Dhaliwal, 2021):

  • Flushing
  • Headaches
  • Nausea
  • Muscle aches
  • Back pain
  • Runny nose

Avoid taking tadalafil if you take nitrates, are on dialysis for kidney disease, or have severe liver disease.

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

References

  1. Capogrosso, P., Colicchia, M., Ventimiglia, E., et al. (2013). One patient out of four with newly diagnosed erectile dysfunction is a young man—worrisome picture from the everyday clinical practice. The Journal of Sexual Medicine, 10(7), 1833-1841. doi:10.1111https://ro.co/jsm.12179. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23651423/
  2. Dhaliwal, A. & Gupta, M. (2021). PDE5 inhibitors. [Updated Jun 25, 2021]. In: StatPearls [Internet]. Retrieved on Mar. 15, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK549843/ 
  3. Huang, S. & Lie, J. (2013). Phosphodiesterase-5 (PDE5) inhibitors in the management of erectile dysfunction. Pharmacy and Therapeutics, 38(7), 407, 414-41. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776492/
  4. Kessler, A., Sollie, S., Challacombe, B., et al. (2019). The global prevalence of erectile dysfunction: a review. BJU International, 124(4), 587–599. doi:10.1111/bju.14813. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31267639/
  5. Sooriyamoorthy, T. & Leslie S. W. (2021). Erectile dysfunction. [Updated Feb 14, 2022]. In: StatPearls [Internet]. Retrieved on Mar. 15, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK562253/.