Tadalafil helps men with ED get and sustain an erection. It relaxes the smooth muscles and arteries in the penis, and it increases blood flow into the penis, trapping it there. Tadalafil only works when you are sexually stimulated. Erections generally last 10 to 30 minutes.

Phentolamine is used to treat erectile dysfunction. It is a non-selective alpha-blocker that is also used to quickly bring down high blood pressure and to diagnose a condition called a pheochromocytoma.

When treating ED, phentolamine used to be given exclusively as an injection, but now it can be taken by mouth.

https://pubmed.ncbi.nlm.nih.gov/10845768/

Sildenafil and tadalafil both come in multiple strengths. Tadalafil has a longer half-life than sildenafil. It lasts about 36 hours, while sildenafil lasts about 4 hours. Tadalafil also works faster than sildenafil. It usually works within about 30 minutes. Another difference is that tadalafil is not affected by food. Though consuming a high-fat meal before taking tadalafil may slow its absorption.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603624/

Phentolamine has serious interactions with the following drugs:

It also has moderate interactions with 93 other medications. If you are taking another medication, talk with your doctor or pharmacist to ensure the combination is safe for you.

Phentolamine can be injected very slowly into the penis. The standard dose is 0.5 to 1 milligram per injection, following your doctor's instructions. Do not exceed one injection per day; do not use phentolamine for more than two days in a row or more than three days in a week.

Phentolamine is also available in capsule form, combined with tadalafil. It comes in two strengths:

To treat erectile dysfunction, phentolamine blocks alpha-adrenergic receptors found on smooth muscle. By blocking these receptors, blood vessels and the corpora cavernosa in the penis widen, allowing them to fill with blood and cause an erection.

Some men may have many erections during the day, while others may not. Nocturnal erections occur regularly during the night as you sleep, with three to six erections each night, most typically happening during REM sleep. Morning wood is a phenomenon in which an erection appears as you wake up. Peak morning testosterone levels and changes in blood flow after REM sleep are thought to be the causes of morning erections.

Phentolamine usually begins to work within 10 minutes of injecting it. It has a half-life of between three and thirteen hours. After injecting phentolamine, men should attempt sexual intercourse within about 2 hours.

Phentolamine injections do not work well for ED, and that is why phentolamine is commonly combined with another ED medication to get a more synergistic effect. For example, phentolamine combined with tadalafil is a capsule taken as needed to treat ED.

Researchers found that phentolamine at doses of 20 mg, 40 mg, and 60 mg had a success rate of 20%, 30%, and 36.7%, respectively.

https://www.sciencedirect.com/referencework/9780080450469/encyclopedia-of-neuroscience

Phentolamine is contraindicated or not recommended for people who have or have had the following conditions:

Tadalafil is contraindicated or not recommended for people who have/had the following conditions:

Tadalafil is a phosphodiesterase-5 (PDE-5) inhibitor, which dilates blood vessels and increases blood flow. It decreases blood pressure. Since tadalafil is the PDE-5 inhibitor with the longest half-life, it has been considered a viable treatment for high blood pressure.

At a 5 mg dose, tadalafil can treat ED and high blood pressure. The study's authors recommend using tadalafil to treat men with ED and high blood pressure, and they are considering using it outside of that population.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8845461/

Tadalafil will not cure ED, at least not for the time being. Researchers are investigating whether a nightly dose of tadalafil may have a long-term effect.

Tadalafil has a once-daily dose and a long half-life. Taking tadalafil daily will keep a steady level of the medication in your body, so you will not need to take a pill before sexual activity.

Talk to your doctor about a tadalafil/phentolamine combination if tadalafil alone isn't enough to treat your ED. This combination is taken 30 to 60 minutes before sexual activity or as directed.

The most common side effects from taking Cialis (tadalafil) are:

These side effects are usually from dilated blood vessels and will resolve in a few hours after taking Cialis. Muscle aches and back pain may last for 24 hours or so. Serious side effects can occur, so it is important to fully understand the risks and benefits of Cialis before taking it.

Unlike most phosphodiesterase-5 inhibitors used to treat ED, tadalafil can be taken with or without meals. If you are using tadalafil with as-needed dosing, consuming a heavy or high-fat meal when taking tadalafil may slow its absorption.

Phentolamine is a non-selective alpha-adrenergic medication that binds to receptors on smooth muscle cells. It dilates blood vessels and smooth muscle. By relaxing smooth muscle in blood vessels and in the penis, phentolamine increases blood flow into the penis.

Phentolamine also increases heart contractility.

https://www.sciencedirect.com/science/article/pii/B9780444537171012634

Yes, you can take tadalafil every night if you were prescribed the once daily dosing option. Tadalafil is available in two dosage forms: as-needed and daily. Tadalafil/phentolamine has an as-needed option.

To maintain a steady level of tadalafil, take your pill at the same time each day. Swallow it with a glass of water. Avoid grapefruit juice or grapefruits, as these will affect how tadalafil is metabolized.

No, phentolamine has not been discontinued. However, several manufacturers have stopped making it. West-Ward discontinued production in January 2015, and Novartis stopped making Regitine in the U.S. in 2000.

Invigor Medical offers phentolamine in both oral and injectable forms to treat ED. Phentolamine/Tadalafil is an oral ED treatment taken as needed, and Trimix is an injectable ED treatment that contains papaverine, phentolamine, and prostaglandin E.

Tadalafil is prescription-only and should be taken as prescribed. The typical starting dose for tadalafil given as needed is 10 mg tablets taken 30 to 60 minutes before sexual activity. Tadalafil also comes in 5-, 10-, and 20-mg tablets.

The typical starting dose for erectile dysfunction using the daily dose is 2.5 mg once a day. Your doctor may increase or decrease your dose depending on how well it works for you and whether you have any other medical conditions.

Priapism is a prolonged, painful erection. To get and keep an erection, blood must flow into the penis and fill the cavernous spaces in the shaft of the penis. As these spaces fill, blood pressure increases in the penis. Pressure on the veins draining the penis causes them to collapse and trap blood in the penis. This causes an erection.

If an erection lasts too long, oxygen levels in the penis will decrease and acidity will increase. Left untreated, this can cause damage to the structure inside the penis.

Your doctor will probably prescribe a decongestant as a “rescue” treatment. Decongestants constrict blood vessels, restoring blood flow to the penis.

Tadalafil is available by prescription only. Follow the dosing instructions on your prescription. The starting dose for tadalafil is 10 mg by mouth 30 to 60 minutes before planned sexual activity. If this is not enough to adequately treat your ED symptoms, your doctor may increase your dose to 20 mg.

If you have severe kidney disease, your doctor will probably recommend a 5 mg dose. If you have mild to moderate liver disease, your tadalafil dose should not exceed 10 mg.

https://www.aafp.org/pubs/afp/issues/2004/0715/p359.html

Cialis (tadalafil) is used to treat erectile dysfunction, benign prostatic hyperplasia, and pulmonary artery hypertension. A 40-mg dose of Cialis is prescribed for pulmonary artery hypertension.

With each medication, you weigh the risks and benefits. While a 40-mg dose has benefits that outweigh the risks when treating pulmonary artery hypertension, this is not likely the case for ED. A high dose of Cialis increases your risk of having low blood pressure and priapism.

If your current ED medication dosage is not working for you, talk to your doctor about a change in medication or dosing.

Cialis (tadalafil) can be dosed daily or as needed. If you take tadalafil on an as-needed basis, it will reach its maximum concentration in about two hours. The effects are expected to last about 36 hours. If you take the dose daily, tadalafil will remain at a steady state.

Talk to your doctor about whether you should take tadalafil daily or as needed. Both options have benefits. Some men do not want to take medications when they don’t need them, so they may opt for the as-needed dosing option. Other men do not want to remember and then take their medication in advance of having sex, so they would prefer the daily dosing option.

One study found that the efficacy rates for tadalafil taken once a day and as needed were very similar.

https://www.karger.com/Article/FullText/477496

A penile erection typically lasts from a few minutes to about half an hour. Factors such as age, medications, and other medical conditions you may have will affect how long you can stay erect.

Many men will notice that the quality of their erections declines as they get older. This may be due to declining hormone levels or lifestyle choices.

Medical conditions such as high blood pressure, high cholesterol, heart disease, alcoholism, obesity, and diabetes can affect your ability to get and keep an erection, as can dietary choices, alcohol use, and smoking.

Men taking tadalafil for ED usually expect to take it for many years. In 2004, a clinical trial followed 1,000 men for two years while they took different doses of tadalafil. The trial investigators found no serious adverse effects from using tadalafil for two years.

Since most men would expect to use tadalafil for longer than two years, a longer clinical trial is needed. There are many trials looking into the short-term effects of a drug, but not many looking into the long-term.

https://pubmed.ncbi.nlm.nih.gov/15036680/

Tadalafil is also used to treat benign prostate hyperplasia (BPH), a condition in which the prostate becomes too large and causes lower urinary tract symptoms.

Men with BPH have urinary urgency, difficulty starting and maintaining a stream, decreased urine flow, and hesitation before starting a urine stream.

In studies, tadalafil was found to be a safe and effective treatment for BPH.

https://pubmed.ncbi.nlm.nih.gov/30901259/

Tadalafil is a phosphodiesterase-5 inhibitor that is FDA-approved to treat erectile dysfunction (ED), but scientists are looking into whether it may also help with premature ejaculation.

PDE-5 inhibitors increase nitric oxide in blood vessels, dilating them to increase blood flow. Scientists are investigating a potential link between nitric oxide and dopamine levels. Dopamine is a chemical messenger in the brain that controls the timing of ejaculation.

There needs to be more research, but tadalafil might be able to help with erectile dysfunction (ED) and early ejaculation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721550/

Cialis is the brand name, and tadalafil is the generic. Tadalafil is the active component in Cialis. Tadalafil is licensed by the Food and Drug Administration (FDA) to treat erectile dysfunction (ED) and benign prostatic hyperplasia (BPH) in men.

Cialis and its generic tadalafil have the same effectiveness, stability, strength, safety, and quality. Generic medications are the same as their brand-named counterparts, with one big exception: their price.

Tadalafil works well for most men, especially the once-a-day dose. The as-needed dosing requires planning. If you take your as-needed Cialis dose with a heavy or high-fat meal, it will take longer to work.

Consuming alcoholic beverages or using recreational drugs will also make tadalafil less effective, and they will affect blood flow into the penis.

If you have given tadalafil a fair trial and it is still not working for you, talk to your doctor. You may need a higher dose or a different medication.

If tadalafil is not working for you, then you may wonder if there is something better. Potential options include switching to another phosphodiesterase-5 inhibitor or a combination medication. Vardenafil is a more specific PDE5 inhibitor that may work better for some men. Tadalafil/ phentolamine and Trimix are combination medications that attack ED from more than one angle. Trimix is an injectable, and tadalafil/phentolamine is a capsule.

Consuming alcoholic beverages while taking tadalafil reduces the likelihood of the medication working and increases the likelihood of side effects. Dizziness, lightheadedness, flushing, headaches, and heart palpitations are all more common when you combine alcohol and tadalafil.

Alcohol will also affect blood flow into the penis, making it less likely that tadalafil will work for you.

Once-a-day tadalafil treats erectile dysfunction (ED) and benign prostatic hyperplasia (BPH). According to the package insert, it doesn't matter when you take tadalafil; it only matters that you only take it once per day and that you try to take it at the same time every day.

In addition to benign prostatic hyperplasia, investigators have tested how well tadalafil works for chronic prostatitis and chronic pelvic pain syndrome. Patients with moderate to severe lower urinary tract symptoms were given 5 mg of tadalafil daily for 12 weeks. Pain scores decreased, leading investigators to conclude that tadalafil was sufficiently effective in treating BPH and severe chronic prostatitis/chronic pelvic pain syndrome.

https://pubmed.ncbi.nlm.nih.gov/31587411/

In an animal study, investigators gave rats with and without diabetes daily tadalafil for 12 weeks. In both groups, testosterone levels had increased by the end of the 12-week treatment. Tadalafil also increased luteinizing hormone (LH) levels and reduced inflammatory cytokines.

More research is needed, as this was an early animal study, but tadalafil may improve testosterone levels and increase LH.

https://drc.bmj.com/content/8/1/e001111

According to the package insert, tadalafil can cause chest pain (angina), low blood pressure, heart attacks, dizziness when standing, palpitations, fainting, and a fast heart rate. The majority of people experiencing these symptoms have risk factors for cardiovascular disease.

https://www.rxlist.com/cialis-side-effects-drug-center.htm

Tadalafil has many positive effects, not the least of which is its long 17.5-hour half-life, which allows for daily dosing to maintain steady medication levels. Tadalafil has been shown in clinical trials to be both safe and effective. The daily dose makes it possible to treat ED without planning ahead. The dose can be taken between meals to enhance its absorption. Tadalafil is preferred by many patients and their partners.

In a clinical trial that spanned two years, men were given 5, 10, or 20 mg once-daily doses of tadalafil. No serious side effects were seen, which suggests that long-term use of tadalafil is safe and effective.

https://pubmed.ncbi.nlm.nih.gov/15036680/

According to a study, men with lower urinary tract symptoms and erectile dysfunction who took Tadalafil 5 mg once a day had much better ejaculation, orgasm, sexual activity, and general enjoyment. It also helped them get and keep an erection. Findings support the effects of tadalafil on sexual pleasure.

https://pubmed.ncbi.nlm.nih.gov/23346990/

Tadalafil (Cialis) is an effective treatment for erectile dysfunction and the symptoms of benign prostatic hyperplasia. However, it does not cure either condition. Symptoms are expected to return once tadalafil is stopped and the medication is cleared from the body.

The following are the most prevalent Cialis side effects:

Though rare, Cialis has the potential to cause serious side effects, such as:

At this time, it is not known if Cialis or other drugs that block phosphodiesterase-5 affect testosterone or other androgens. However, some small animal studies have shown there is a possibility that Cialis may increase testosterone levels. More research is needed.

Cialis can increase erectile function and confidence. It may also have an effect on ejaculation timing, but more research is also needed here.

Cialis (tadalafil) tablets are not scored and are essentially insoluble in water, so splitting or crushing the pills will likely result in an inaccurate dose. According to the manufacturer, Cialis tablets should not be split or crushed.

https://www.lillymedical.com/en-us/answers/can-cialis-tadalafil-tablets-be-crushed-or-split-26428

Cialis can cause side effects like headaches, upset stomach, back pain, muscle aches, flushing, and a stuffy or runny nose. These side effects are usually gone after a few hours. Men who experience back pain and muscle aches usually do so 12 to 24 hours after using Cialis.

Yes, phentolamine is used to treat erectile dysfunction. To improve its efficacy, phentolamine is frequently combined with other ED medications. For example, a combination of tadalafil and phentolamine is available in capsule form to be taken as needed for ED. Trimix is a combination of phentolamine, papaverine, and alprostadil that is injected into the penis as needed to treat ED.

Phentolamine can be injected into the penis alone or with papaverine and alprostadil as part of Trimix, or it can be taken orally with tadalafil.

Phentolamine is an alpha-adrenergic antagonist that relaxes smooth muscle and dilates blood vessels. It is a vasodilator and can be used to treat high blood pressure.

With a small insulin needle, inject medicines for erectile dysfunction into the side of the penis about halfway down the shaft.

After wiping the medication vial with an alcohol wipe, draw up your dose of ED medication. Clean the midshaft of the penis, insert the needle, and gently and slowly inject the medication. Withdraw the needle and hold pressure on the penis for about 5 minutes.

Tadalafil does not help you sleep unless you are awake through the night, getting up to urinate (pee). Men with benign prostatic hyperplasia have difficulty urinating and commonly wake up through the night to urinate. Tadalafil improves nocturia (nighttime urinating) and, therefore, can improve sleep quality.

https://www.karger.com/Article/FullText/506489#

Yes, after penetrative sex, most men only last between three and eight minutes before ejaculating. Most men hold an erection up to an average of 30 minutes.