Cialis 20 mg: Uses, Benefits, Side Effects & More

You might have encountered Cialis® — the well-known erectile dysfunction (ED) medication — offered in various doses, which typically range from 2.5 mg to 20 mg. The notion that larger doses equate to superior results is a common thought, but is it truly accurate?

In actual fact, while Cialis 20 mg is indeed a potent option for treating erectile dysfunction, the lower dosages also provide effective solutions. This article delves into the specific uses, advantages, and potential side effects associated with Cialis 20 mg, and how it compares to other available doses.

Cialis is marketed under the name tadalafil. Tadalafil functions as a phosphodiesterase type 5 inhibitor, or, to keep it simple, a PDE5 inhibitor. 

The FDA has granted approval for Cialis to manage the following conditions: 

• Erectile dysfunction 

• Benign prostatic hyperplasia (BPH), which involves an enlarged prostate 

Cialis is available in several dosages, including 2.5 mg, 5 mg, 10 mg, and 20 mg. 

Patients have the flexibility of taking Cialis either as needed — which means taking a tablet prior to sexual activity — or on a daily basis, ensuring they are always prepared. If opting for the as-needed route, your healthcare provider may prescribe dosages of 5mg, 10mg, or 20mg. Generally, 10mg serves as the standard initial dosage, which can be fine-tuned based on effectiveness and side effects experienced.

It’s important to note, however, that you wouldn’t be recommended a 20 mg Cialis dosage for daily use. For routine administration, the lower doses of 2.5 mg and 5 mg are typically prescribed.

How does Cialis work? When it comes to erectile dysfunction — characterized by the inability to achieve or sustain an erection — Cialis functions by relaxing the blood vessels in the penis, subsequently leading to a firmer and more reliable erection. 

It’s worth mentioning that Cialis — whether at 20 mg or otherwise — does not independently induce an erection; some level of sexual stimulation is still necessary to achieve arousal.

Cialis 20 mg might be a more efficacious treatment for erectile dysfunction in comparison to the 10 mg formulation. Clinical trials have indicated that between 68 percent to 77 percent of men utilizing 10 mg Cialis could successfully engage in penetrative intercourse. In contrast, 76 percent to 85 percent of participants taking 20 mg Cialis were able to achieve the same success rate. 

However, it’s crucial to note that not all studies reach a consensus; a lower daily dosage may prove equally effective when weighed against the as-needed Cialis treatment. A systematic review encompassing six randomized controlled trials with more than 1,500 participants found that both the as-needed tadalafil treatment and a once-daily dosage exhibited similar effectiveness.

Tadalafil is also applicable for addressing pulmonary arterial hypertension, a variant of elevated blood pressure that influences the blood vessels within the lungs. 

In this instance, a 20 mg dose could be highly beneficial. A 2006 study presented evidence that a single 20 mg dose of tadalafil effectively decreased average blood pressure for an impressive 26 hours in subjects with uncontrolled hypertension.

For further information, refer to our guide focusing on tadalafil uses. 

The benefits associated with Cialis include: 

• Cialis provides an extended duration of action. While Cialis boasts efficacy comparable to Viagra, the 20mg formulation remains in your system longer and has earned the nickname “weekend pill” for a valid reason. With just one tablet, you can engage in sexual activity at your leisure for the subsequent 36 hours (give or take a few hours), facilitating greater spontaneity in your intimate moments.

  In contrast, avanafil lasts up to six hours, while Viagra® only maintains effectiveness for approximately four hours.

• Cialis is clinically proven to be effective. Numerous clinical trials confirm that Cialis remains effective across all severities and types of erectile dysfunction, even in challenging cases. If you find that 10 mg Cialis isn’t meeting your needs, attempting the 20 mg tablet might yield better outcomes.

• Everyday use is not a necessity. Depending on your personal choices and lifestyle, you may prefer not to consume Cialis on a daily basis. In fact, the 20 mg dosage should only be ingested as needed.

• Typically, side effects are mild. For the most part, side effects associated with Cialis are generally mild and tend to resolve on their own — although they could be intensified with higher dosages. For instance, studies show that 11 percent of individuals taking tadalafil 10 mg experienced headaches, while 15 percent of those on 20 mg reported similar issues. Some side effects maintain similar frequencies across both dosages, including flushing and limb pain. Should the side effects of Cialis 20 mg prove too bothersome, your healthcare provider may suggest a dosage reduction.

• Reduced flushing incidence. If you find flushing to be an especially bothersome side effect from erectile dysfunction treatments, transitioning to Cialis may be the key. A 2017 systematic review and meta-analysis directly compared sildenafil (the generic equivalent of Viagra) and tadalafil. The findings revealed that tadalafil resulted in fewer instances of flushing.

  While muscle aches and back pain were reported more frequently with tadalafil compared to sildenafil, the overall efficacy and safety profiles were similar, leading many men and their partners to favor tadalafil. More information about the comparisons between the two ED treatments can be found in our Cialis vs. Viagra comparison article.

As with any medication, Cialis may present certain side effects. 

The most frequently reported Cialis side effects include: 

• Headache

• Dyspepsia (indigestion) 

• Back pain 

• Myalgia (muscle discomfort and pain)

• Nasal congestion 

• Flushing 

• Limb pain 

Depending on the side effect experienced, these adverse reactions can occur in as few as three percent of individuals taking either Cialis 10 mg or 20 mg. 

Research from clinical trials suggests that most side effects are dose-dependent, indicating you’re more likely to experience them at higher dosages — such as with Cialis 20 mg.

In addition, allergic reactions to Cialis are not out of the question and may manifest as: 

• Rash

• Hives 

• Swelling in the lips, tongue, or throat

• Difficulty in breathing or swallowing

Moreover, the risk of priapism, characterized by excessively prolonged erections, exists — we’re talking about a duration lasting several hours. While it may sound appealing for those grappling with ED, these prolonged erections can lead to pain and potentially cause irreversible damage to the penis. 

If your erection persists beyond four hours, it’s imperative to seek medical attention. 

Individuals diagnosed with certain conditions may have a heightened likelihood of experiencing prolonged erections when using Cialis, including: 

• Sickle cell anemia

• Multiple myeloma 

• Leukemia 

• Anatomical deformities of the penis (such as Peyronie’s disease)

To better understand this side effect and what to do if it occurs, consult our comprehensive guide on priapism.

There is also a minor risk of vision loss. Should you experience any loss of vision in one or both eyes, discontinue Cialis usage immediately and seek medical assistance, as it may indicate a condition known as non-arteritic anterior ischemic optic neuropathy (NAION), which is caused by insufficient blood flow to the optic nerve. 

Another grave side effect to watch for includes sudden hearing loss or a decrease in hearing acuity. It’s vital to seek medical guidance promptly if you detect any changes.

Several drug interactions are key to note. 

Using Cialis is contraindicated if you are currently on nitrates, as this combination can cause a dangerous drop in blood pressure, leading to dizziness, loss of consciousness, or even a heart attack or stroke. Nitrates may be found in medications like isosorbide dinitrate or isosorbide mononitrate. 

Caution is advised with recreational drugs that also contain nitrates, often referred to as “poppers.” 

Additionally, Cialis should not be prescribed to individuals taking medications classified as guanylate cyclase stimulators, including riociguat. 

Those on alpha-blockers (including doxazosin, tamsulosin, or alfuzosin) or CYP3A4 inhibitors (such as the antibiotic erythromycin or antifungal medications like ketoconazole) may be advised a lower Cialis dose — likely not the 20 mg strength — to minimize any potential interaction risks.

The safety of combining Cialis with other PDE5 inhibitors is still uncertain. The medications to be cautious of include: 

• Viagra (sildenafil) 

• Levitra® (vardenafil) 

• Stendra® (avanafil) 

It’s essential to inform your prescribing healthcare provider about all medications and supplements you are currently taking before initiating Cialis therapy.

In addition to medication considerations, monitoring alcohol consumption while utilizing Cialis is crucial.

Ingesting five or more units of alcohol could lead to: 

• Increased heart rate

• Reduced standing blood pressure

• Dizziness

• Headaches

A more surprising interaction to be wary of involves grapefruit and Cialis. 

A 2020 study conducted on rats revealed that grapefruit juice inhibits the metabolism of tadalafil, Cialis’s active ingredient. This inhibition can result in elevated tadalafil levels in your system, thereby increasing the potential for side effects.

To uncover more about what to avoid, head over to our guide on tadalafil interactions. 

Lastly, do ensure that you discuss any and all existing medical conditions with your healthcare provider prior to embarking on Cialis treatment to determine safety and suitability. 

It’s imperative to consider the following conditions: 

• Cardiac issues, such as angina (chest pain arising from decreased blood flow to the heart), heart disease, or irregular heart rhythms 

• Hypotension (low blood pressure)

• Gastric ulcers 

• Retinitis pigmentosa (a hereditary eye disorder)

Cialis is accessible in a spectrum of doses, typically prescribed for varied conditions:  

• Cialis 2.5 mg. This dosage is normally prescribed for those opting for daily Cialis administration. Should 2.5 mg prove ineffective, it may be increased to 5 mg.

• Cialis 5mg. For benign prostatic hyperplasia (BPH), a daily dosage of 5 mg may be indicated. If you have concurrent BPH and ED (a link exists between the two), a 5 mg daily dose of Cialis might also be appropriate.

• Cialis 10 mg. For on-demand ED treatment, the majority of patients will start at a 10 mg Cialis dosage. This dosage can then be adjusted to 20 mg or lower to cater to individual responses to the medication.

• Cialis 20 mg. This is typically the highest dosage prescribed and is generally reserved for those who find the lower 10 mg dose ineffective.

Each tadalafil dosage presents both advantages and drawbacks, regardless of whether you're using 20 mg Cialis or a lesser amount. The recommended daily starting dose is 2.5 mg, which can be increased to 5 mg if necessary.

For example, one of the benefits of choosing a smaller daily Cialis dosage is being prepared for spontaneous intimacy at any given moment. However, the trade-offs involve the need for consistent daily consumption and potential for enduring side effects. Explore our guide on daily-use Cialis for comprehensive insights.

On the other hand, the upside of a higher-dose, as-needed treatment is that you won’t have to worry about daily administration, consequently reducing the risk of missed doses. Moreover, higher dosages tend to demonstrate greater effectiveness. Nevertheless, the trade-off remains that greater doses come with an increased likelihood of side effects. 

Your healthcare provider is best suited to determine the most appropriate Cialis dosage based on your unique needs.

Just a reminder: Cialis is not available over the counter. A discussion with a healthcare professional is essential to obtain a prescription for this ED medication. 

When taking Cialis prior to engaging in sexual activity, consume your designated dosage — whether it’s the 20 mg or a lower option — approximately 30 minutes to two hours before anticipated intercourse. Cialis can be taken without food.

Limit usage to once per day. If planning on sexual activity more than once—*high five!*—Cialis has you covered; it’s been demonstrated to enhance erectile function for up to 36 hours.

Further information is available in our guide on how long Cialis lasts.

For those opting for daily Cialis, whether for erectile dysfunction or BPH treatment, try to take your dose at the same time every day to maintain consistency without having to plan around sexual activity.

A healthcare provider is equipped to offer guidance on the best method for taking Cialis tailored to your particular needs.

Cialis 20 mg serves as a viable treatment option for erectile dysfunction. It may be suitable for you if you have been taking the 10 mg tablets but haven’t achieved the desired effectiveness.

It’s advisable to consult with a healthcare provider to assess whether Cialis 20 mg aligns with your health profile. 

In summary: 

• Cialis 20 mg is intended for on-demand ED treatment. This dosage will be taken right before sexual activity when needed, providing up to 36 hours of erectile dysfunction relief, thereby granting you the flexibility to enjoy your intimate life.

• Side effects are generally mild. Common side effects might include headaches, indigestion, or backaches. While not ideal when you’re aiming for romantic moments, these side effects are often mild. If any side effects become bothersome, consult your healthcare provider, who may suggest a lower Cialis dosage.

• Other ED medications are accessible. Remember, Cialis 20 mg isn’t your sole remedy. Alternatives such as Viagra or sildenafil, Stendra, and our hard mints, which feature the active ingredients in Cialis, Levitra, and Staxyn are also available.

To obtain Cialis 20 mg — or any other PDE5 inhibitor — a prescription is mandatory. Fortunately, this doesn’t necessitate leaving your house.

You can connect with one of our licensed healthcare professionals online to explore which erectile dysfunction treatments might be suitable for you, and you can even arrange for Cialis or other ED medications to be delivered directly to your door if indicated.

For detailed insights into the costs associated with Cialis or generic tadalafil as treatments for erectile dysfunction, check out our comprehensive guide on Cialis pricing.