Cialis 20 mg: Uses, Benefits, Side Effects & More
You might have encountered Cialis® — the well-known erectile dysfunction (ED) medication — offered in various doses ranging from 2.5 mg to 20 mg. You may wonder, is a higher dose always better? While Cialis 20 mg is indeed a potent treatment for erectile dysfunction, lower doses can also be quite effective for many users.
In this article, we will dive into what Cialis 20 mg is used for, explore its benefits, discuss possible side effects, and compare it to other available strengths to help you make an informed decision.
Cialis is recognized by its brand name, which represents tadalafil, a medication categorized as a phosphodiesterase type 5 inhibitor, commonly abbreviated as a PDE5 inhibitor. This classification denotes its primary action mechanism that helps in managing erectile dysfunction.
The FDA has officially approved Cialis for the treatment of:
Erectile dysfunction, a condition affecting many men’s ability to achieve or maintain an erection suitable for sexual intercourse.
Benign prostatic hyperplasia (BPH), which refers to the non-cancerous enlargement of the prostate gland, causing various urinary symptoms.
Cialis is available in multiple dosages, including 2.5 mg, 5 mg, 10 mg, and 20 mg. The flexibility in dosages allows for personalized treatment plans. You can opt to take Cialis on an as-needed basis, consuming a pill prior to sexual activity, or you may choose a daily regimen, which keeps you ready for intimacy at any moment.
When prescribed for as-needed use, a healthcare provider will typically start patients on 5 mg, 10 mg, or 20 mg, with 10 mg being a common starting point that can be adjusted based on its effectiveness and any side effects experienced. It’s important to note that the 20 mg daily regimen is not recommended; instead, daily doses are generally limited to the lower options of 2.5 mg and 5 mg to ensure safety and minimize side effects.
How does Cialis work? For those experiencing erectile dysfunction—a condition characterized by the difficulty in achieving or sustaining an erection—Cialis works by facilitating the relaxation of muscles and dilation of blood vessels in the penis, resulting in improved blood flow and, consequently, a firmer erection.
It’s worth mentioning that Cialis (regardless of the dose) does not provide an erection by itself; sexual arousal and stimulation are still necessary to trigger the erectile response.
Cialis 20 mg may prove to be a more effective option for erectile dysfunction compared to the 10 mg version. Clinical studies have indicated that 68% to 77% of men taking 10 mg Cialis reported being able to engage in penetrative sexual activity with their partner, while those using 20 mg exhibited success rates ranging from 76% to 85%. However, not all research supports the necessity of higher doses, as studies suggest that smaller daily doses can be just as effective as the as-needed variant of Cialis.
A recent systematic review and meta-analysis evaluated data from six randomized controlled trials involving over 1,500 participants. It compared the effectiveness of as-needed tadalafil treatments with once-a-day doses, concluding that both methods yielded comparable results, emphasizing the versatility of tadalafil in treatment.
In addition to its application in treating erectile dysfunction, tadalafil is also utilized for managing pulmonary arterial hypertension (PAH), a severe form of high blood pressure that primarily affects the blood vessels in the lungs. A 20 mg dose can be particularly beneficial for these patients, as evidenced by a 2006 study demonstrating that a single 20 mg dose of tadalafil effectively lowered average blood pressure for up to 26 hours in patients with uncontrolled hypertension.
Explore our guide on tadalafil uses for more detailed information on the various applications of this powerful medication.
Cialis boasts several key benefits:
Cialis boasts an extended effect duration. Compared to similar medications like Viagra, Cialis 20 mg remains effective in the body for a much longer duration, often referred to as the “weekend pill.” This enables you to take one pill and enjoy sexual activity at any time over the next 36 hours, promoting a spontaneous sex life. In contrast, medications like avanafil last for about six hours and Viagra® typically lasts up to four hours.
Cialis is clinically proven to be effective. Numerous clinical trials have demonstrated that Cialis is effective for a range of ED severities and can be appealing for men who struggle with difficult-to-treat erectile dysfunction. If you find that 10 mg does not sufficiently address your needs, switching to a 20 mg dose might enhance your experience significantly.
Flexibility in daily medication intake. Depending on your personal preferences and lifestyle, daily use of Cialis may not be the best fit for you. The 20 mg dosage is typically reserved for as-needed usage. This opens up a world of freedom, as you can engage in sexual activities without the obligation of daily medication.
Mild side effects. Side effects associated with Cialis tend to be mild in nature, often resolving on their own. However, these effects may become more pronounced with higher doses. For instance, clinical research indicates that 11% of patients taking tadalafil 10 mg experienced headaches, whereas 15% of those on a 20 mg dose reported similar symptoms. Other side effects, such as flushing and limb pain, may occur at similar rates regardless of the dosage. If the side effects from Cialis 20 mg prove to be uncomfortable, a healthcare provider can suggest a lower dosage.
Reduced flushing sensation. For individuals who experience bothersome flushing as a side effect of ED medications, switching to Cialis may alleviate this issue. A 2017 systematic review and meta-analysis showed that tadalafil presents lower rates of flushing than sildenafil. However, it’s worth noting that muscle aches and back pain were reported more frequently in those taking tadalafil compared to sildenafil. Overall, the effectiveness and safety profiles of tadalafil and sildenafil are comparable, with many men and their partners expressing a preference for tadalafil. For further insights, check our comprehensive guide on Cialis vs. Viagra.
While Cialis provides numerous advantages, it’s essential to acknowledge the potential side effects.
The most commonly reported Cialis side effects include:
Headache
Dyspepsia (indigestion)
Back pain
Myalgia (muscle aches and pain)
Nasal congestion
Flushing
Limb pain
These side effects can affect a small percentage of users, potentially occurring in as few as three percent of individuals taking either Cialis 10 mg or 20 mg. Clinical trials suggest that most side effects are dose-dependent, indicating a higher likelihood of occurrence with increased dosages—hence, taking Cialis 20 mg may elevate the risk of experiencing these effects.
Allergic reactions to Cialis, while rare, are possible. Signs of an allergic reaction can manifest as:
Rash
Hives
Swelling of the lips, tongue, or throat
Difficulty breathing or swallowing
Furthermore, there’s the risk of experiencing priapism, which describes painful, prolonged erections lasting several hours. While this may sound appealing for those struggling with ED, extended erections can be painful and might lead to irreversible damage. If you experience an erection lasting more than four hours, seek immediate medical attention.
Individuals with specific medical conditions, such as:
Sickle cell anemia
Multiple myeloma
Leukemia
Anatomical deformities of the penis (e.g., Peyronie’s disease)
are typically at a higher risk of developing priapism. For more information about this condition, refer to our extensive guide on priapism.
Vision loss is another serious side effect you should be aware of. Should you find yourself experiencing any degree of vision loss in one or both eyes, discontinue use of Cialis immediately and consult a healthcare provider, as this might indicate a condition known as non-arteritic anterior ischemic optic neuropathy (NAION), resulting from insufficient blood flow to the optic nerve.
You should also be cautious of sudden hearing loss or a decrease in hearing ability, as these issues warrant prompt attention from a medical professional.
In addition to potential side effects, it’s crucial to be aware of drug interactions when considering Cialis.
If you are currently taking nitrates, avoid using Cialis entirely. The combination of these two substances can cause a significant drop in blood pressure, leading to dizziness, loss of consciousness, or severe health emergencies such as heart attacks or strokes. Nitrates can be found in medications like isosorbide dinitrate and isosorbide mononitrate.
Recreational drugs containing nitrates, commonly referred to as “poppers,” should also be avoided in conjunction with Cialis.
Additionally, Cialis should not be used with guanylate cyclase stimulators, such as riociguat.
For individuals taking alpha-blockers (for instance, doxazosin, tamsulosin, or alfuzosin) or CYP3A4 inhibitors (like the antibiotics erythromycin and the antifungal medication ketoconazole), a healthcare provider may prescribe a lower dosage of Cialis, likely not the maximum 20 mg dose.
Regarding the safety of using Cialis alongside other PDE5 inhibitors like:
Viagra (sildenafil)
Levitra® (vardenafil)
Stendra® (avanafil)
it remains unclear, so ensure to inform your prescribing healthcare provider of all medications and supplements you are currently taking prior to starting Cialis therapy.
Beyond medication interactions, be mindful of your alcohol consumption while taking Cialis. Drinking five or more units of alcohol can lead to:
Increased heart rate
Decreased standing blood pressure
Dizziness
Headaches
An unexpected interaction to consider is the effect of grapefruit on Cialis. A 2020 study involving rats found that grapefruit juice inhibits the metabolism of tadalafil, the active ingredient in Cialis. This can potentially result in elevated levels of tadalafil in your system, thereby increasing the risk of adverse side effects.
For a comprehensive understanding of what to avoid while using Cialis, refer to our detailed guide on tadalafil interactions.
Finally, it’s essential to disclose any and all underlying medical conditions to your healthcare provider before initiating treatment with Cialis. Such conditions include, but are not limited to:
Cardiac issues, including angina (chest pain due to reduced blood flow), heart disease, or irregular heartbeat patterns
Hypotension (low blood pressure)
Stomach ulcers
Retinitis pigmentosa (a genetic retinal disease)
Cialis comes in different dosages, each tailored for specific treatment scenarios:
Cialis 2.5 mg. It’s common to prescribe 2.5 mg for daily intake if you are using Cialis regularly. This dose may be increased to 5 mg if additional efficacy is desired without significant side effects.
Cialis 5 mg. This dosage is frequently prescribed for BPH treatment. If you experience both BPH and ED, a 5 mg daily dosage may address the symptoms associated with both conditions.
Cialis 10 mg. For on-demand ED treatment, 10 mg is typically the initial prescription. Depending on your response to the medication, this may be adjusted to 20 mg or reduced to 5 mg.
Cialis 20 mg. Considered the highest strength, Cialis 20 mg is generally prescribed for as-needed use if you tolerate the 10 mg dose but feel it is insufficient in managing your symptoms effectively.
Each tadalafil dosage option—whether you’re opting for Cialis 20 mg or a lower dose—comes with its distinct advantages and disadvantages. The typical starting point for daily use is 2.5 mg, which may be increased to 5 mg if necessary.
One benefit of the smaller daily dose of Cialis is the continuous readiness for sexual activity without needing to remember to take a pill consistently. However, this can lead to persistent side effects. For more information, check our guide on daily-use Cialis.
If you choose a higher-dose, as-needed treatment, the advantage is the freedom from daily medication, reducing the chance of missed doses. Studies have shown that higher doses usually yield better results. However, be advised that greater dosages may also lead to a heightened incidence of side effects.
Your healthcare provider is best equipped to recommend the most appropriate Cialis dosage and regimen tailored to your individual needs.
Keep in mind that Cialis cannot be purchased over the counter. You will need to consult a healthcare professional to receive a prescription for this ED medication.
As enticing as they might appear, it’s crucial to avoid non-prescription Cialis alternatives. Such products lack FDA approval, and reports indicate that counterfeit PDE5 inhibitors have been found to
containpotentially harmful contaminants. Moreover, these counterfeit products have been shown to have anywhere from zero percent to over 200 percent of the labeled active ingredient dosage, risking severe health complications.
A glance at the FDA’s database of tainted sexual enhancement products highlights that many contain hidden, dangerous ingredients. It’s imperative to be cautious about where you source your medications.
If you plan on utilizing Cialis before engaging in sexual activity, ensure to ingest your prescribed dosage—whether that is a 20 mg or a lower strength—at least 30 minutes to two hours prior to sexual contact, allowing sufficient time for the medication to take effect. Cialis can be taken without regard to meals, providing further convenience.
Remember to limit your intake to one dose of Cialis per day; this means that if you intend to have sexual relations multiple times a day—*high five*—Cialis offers support for that, as its efficacy has been demonstrated for up to 36 hours.
For more details on how long Cialis lasts, check out our informative guide.
If you are taking daily Cialis, whether for erectile dysfunction or BPH, it is prudent to take your dose at approximately the same time every day, relieving you from the stress of predicting the timing of your sexual encounters.
Your healthcare provider will be able to guide you on the most effective approach to take Cialis that suits your unique circumstances.
Cialis 20 mg serves as a viable treatment option for erectile dysfunction. It could be ideal for you if you find success with the 10 mg dose but require a little extra boost to achieve satisfactory results.
Consult with a healthcare provider to determine whether Cialis 20 mg is the right choice for your specific situation.
To summarize:
Cialis 20 mg is prescribed for as-needed treatment of erectile dysfunction. You’ll take this medication prior to engaging in sexual activity when you require it, and it should provide relief from ED symptoms for up to 36 hours, allowing you the flexibility to enjoy intimacy when the mood strikes.
Side effects tend to be mild. Common side effects might include headaches, indigestion, or backaches. While these symptoms are not ideal during intimate moments, they remain relatively mild. If side effects become bothersome, speak with a healthcare provider regarding possible adjustments to your dosage.
Explore other treatment options. Cialis 20 mg isn’t your sole option for treating ED. Alternatives include Viagra (sildenafil), Stendra, and our hard mints that contain the active ingredients found in Cialis, Levitra, and Staxyn. Exploring and discussing these options with your healthcare provider can help you find the best solution for your needs.
Before initiating treatment with Cialis 20 mg, you’ll need to obtain a prescription—this applies to all PDE5 inhibitors. This doesn’t necessarily require leaving your home. Through online consultations, you can connect with licensed healthcare professionals who can guide you on the best ED treatment options and, when appropriate, prescribe Cialis or alternative medications directly to you.
To understand the financial aspects of using Cialis or generic tadalafil for treating erectile dysfunction, explore our comprehensive guide on Cialis pricing.
16 Sources
- Highlights of Prescribing Information. (n.d.). https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021368s030lbl.pdf
- Dhaliwal, A., Gupta, M. (2023, April 10). PDE5 Inhibitors - StatPearls. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK549843/
- Definition & Facts for Erectile Dysfunction. (n.d.). https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts
- Peng, Z., Yang, L., Dong, Q., Wei, Q., Liu, L., & Yang, B. (2017). Efficacy and Safety of Tadalafil Once-a-Day versus Tadalafil On-Demand in Patients with Erectile Dysfunction: A Systematic Review and Meta-Analyses. Urologia internationalis, 99(3), 343–352. https://karger.com/uin/article-pdf/99/3/343/3603031/000477496.pdf
- Patterson, D., McInnes, G. T., Webster, J., Mitchell, M. M., & Macdonald, T. M. (2006). Influence of a single dose of 20 mg tadalafil, a phosphodiesterase 5 inhibitor, on ambulatory blood pressure in subjects with hypertension. British journal of clinical pharmacology, 62(3), 280–287. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1885145/
- Questions and Answers for Cialis (tadalafil). (n.d.). https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-cialis-tadalafil
- Huang, S. A., & Lie, J. D. (2013). Phosphodiesterase-5 (PDE5) Inhibitors In the Management of Erectile Dysfunction. P & T : a peer-reviewed journal for formulary management, 38(7), 407–419. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776492/
- Katz, E. G., Tan, R. B., Rittenberg, D., & Hellstrom, W. J. (2014). Avanafil for erectile dysfunction in elderly and younger adults: differential pharmacology and clinical utility. Therapeutics and clinical risk management, 10, 701–711. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155803/
- Viagra (sildenafil citrate) tablets. (n.d.). https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/20895s039s042lbl.pdf
- Coward, R. M., & Carson, C. C. (2008). Tadalafil in the treatment of erectile dysfunction. Therapeutics and clinical risk management, 4(6), 1315–1330. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2643112/
- Gong, B., Ma, M., Xie, W., Yang, X., Huang, Y., Sun, T., Luo, Y., & Huang, J. (2017). Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis. International urology and nephrology, 49(10), 1731–1740. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603624/
- Frajese, G. V., Pozzi, F., & Frajese, G. (2006). Tadalafil in the treatment of erectile dysfunction; an overview of the clinical evidence. Clinical interventions in aging, 1(4), 439–449. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699638/
- Shen, X., Chen, F., Wang, F., Huang, P., & Luo, W. (2020). The Effect of Grapefruit Juice on the Pharmacokinetics of Tadalafil in Rats. BioMed research international, 2020, 1631735. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003282/
- Hatzimouratidis K. (2014). A review of the use of tadalafil in the treatment of benign prostatic hyperplasia in men with and without erectile dysfunction. Therapeutic advances in urology, 6(4), 135–147. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4054509/
- Jackson, G., Arver, S., Banks, I., & Stecher, V. J. (2010). Counterfeit phosphodiesterase type 5 inhibitors pose significant safety risks. International journal of clinical practice, 64(4), 497–504. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069491/
- Tainted Sexual Enhancement and Energy Products. (n.d.) https://www.fda.gov/drugs/medication-health-fraud/tainted-sexual-enhancement-and-energy-products
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