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

You might have seen Cialis® — the erectile dysfunction (ED) drug — available in doses ranging from 2.5 mg to 20 mg. While a higher dose may seem appealing, it’s essential to understand that "more" isn't always "better." The effectiveness of Cialis 20 mg as an ED treatment is notable, but lower doses can also be beneficial for many users.

In the following sections, we’ll explore the specific uses of Cialis 20 mg, the various benefits it offers, potential side effects, and how this particular dosage compares with other available strengths.

Cialis is the brand name for tadalafil, which is categorized as a phosphodiesterase type 5 inhibitor, or more succinctly, a PDE5 inhibitor. This classification is significant because it provides insight into how the medication functions within the body to improve erectile function.

The FDA has approved Cialis for the treatment of several conditions, including: 

• Erectile dysfunction (ED)

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

The available dosages for Cialis range from 2.5 mg to 20 mg, allowing for flexibility depending on individual needs and responses. For those considering Cialis, it can be administered on an as-needed basis prior to sexual activity or consumed as a daily medication to ensure readiness whenever the moment arises.

If you're using it as needed, your healthcare provider will likely prescribe a dosage of 5mg, 10mg, or 20mg, with 10mg serving as a common starting point. Adjustments may occur based on your response, with the possibility of moving up or down in dosage based on effectiveness and any side effects experienced.

It's important to note that daily usage typically does not involve the 20 mg dose, as the lower 2.5 mg and 5 mg dosages are recommended for maintaining consistent levels of tadalafil within the body.

Understanding how Cialis works is key for anyone considering treatment. For individuals experiencing erectile dysfunction—characterized by difficulty achieving or maintaining an erection—Cialis works by relaxing the blood vessels in the penis, which enhances blood flow and supports the ability to achieve a firmer erection during times of sexual arousal.

However, it’s critical to acknowledge that Cialis—regardless of the dosage—does not automatically induce an erection. Some level of sexual stimulation is necessary for the drug to be effective.

Cialis 20 mg could possibly offer enhanced performance in treating ED compared to the 10 mg version. Clinical studies indicate that 68% to 77% of men administered the 10 mg dose could engage in penetrative sex with their partners, whereas those taking the 20 mg dosage achieved success rates of approximately 76% to 85%. This data suggests that a higher dose may improve outcomes for some users.

Research is varied on this topic, however, as some studies propose that lower daily doses can provide similar efficiency to as-needed treatment with Cialis. A detailed analysis involving six randomized controlled trials and over 1,500 participants demonstrated that both as-needed tadalafil and once-daily doses had comparable effectiveness. 

Interestingly, tadalafil is also applied in treating pulmonary arterial hypertension, a serious condition characterized by elevated blood pressure in the lungs. In this context, the 20 mg dose of tadalafil may prove useful. A study performed in 2006 revealed that a single 20 mg dose of tadalafil effectively reduced average blood pressure in patients suffering from uncontrolled hypertension over a 26-hour period.

For individuals seeking more information, our comprehensive guide to tadalafil uses expands on the various applications of this medication.

Among the many benefits of Cialis, you will discover: 

• Long-lasting effects: Cialis is renowned for its extended duration of action. Compared to other ED treatments like Viagra, Cialis can remain effective in the body for 36 hours, making it a popular choice known as the “weekend pill.” This prolonged effect allows for significant spontaneity in intimate situations, as users can take a single dose and be ready for action throughout the weekend. In contrast, avanafil has a shorter action time, lasting only about six hours, while Viagra has a maximum effect of around four hours.

• Demonstrated effectiveness: Clinical research endorses Cialis as a viable option for various levels and types of ED, even those cases that are difficult to treat. For those who find the 10 mg dose lacking in effectiveness, the 20 mg option may provide the necessary enhancement.

• Flexibility in usage: Depending on your lifestyle and preference, you might prefer not to take Cialis every day. The 20 mg dosage is intended for as-needed use, making it a suitable choice for those who prefer targeted treatment.

• Mild side effects: The side effects associated with Cialis are generally mild and transient. However, higher doses may exacerbate these effects. For instance, headaches have been reported in 11% of individuals taking tadalafil 10 mg, compared to 15% for those on the 20 mg dose. Some side effects, such as flushing and limb pain, appear to have similar frequencies across both dosages. If the side effects associated with Cialis 20 mg become problematic, your healthcare provider may suggest lowering your dosage.

• Reduced incidence of flushing: For individuals sensitive to flushing—a common side effect of many ED medications—Cialis may offer a favorable alternative. A 2017 systematic review indicated that tadalafil tends to cause lower rates of flushing compared to sildenafil. However, muscle aches and back pain were found to be more common in tadalafil users than in those taking sildenafil, illustrating the mixed experience patients may have. Overall, both tadalafil and sildenafil showed similar efficacy and safety profiles, though many men and their partners tend to express a preference for tadalafil. More information can be found in our comparison of Cialis vs. Viagra.

As with any prescription medication, Cialis is accompanied by potential side effects that users should be aware of. 

The most frequently reported Cialis side effects include: 

• Headaches

• Dyspepsia (indigestion)

• Back pain

• Myalgia (muscle aches)

• Nasal congestion

• Flushing

• Limb pain

These side effects can occur in as few as three percent of users, regardless of whether they are taking Cialis 10 mg or 20 mg. 

Clinical trials reveal that side effects can be dose-dependent, meaning the likelihood of experiencing adverse effects increases with higher dosages—such as with Cialis 20 mg. 

It is also possible to experience an allergic reaction to Cialis. In such cases, the following symptoms may arise: 

• Rash

• Hives

• Swelling of the lips, tongue, or throat

• Difficulty breathing or swallowing

Moreover, there exists a risk of priapism—a prolonged and often painful erection lasting several hours, which can result in permanent damage if left untreated. Should an erection persist for more than four hours, it is crucial to seek immediate medical assistance.

Certain conditions may increase the likelihood of developing priapism when using Cialis, including: 

• Sickle cell anemia

• Multiple myeloma

• Leukemia

• Anatomical abnormalities of the penis, such as Peyronie’s disease

For additional details regarding priapism, please refer to our dedicated guide on the subject.

Vision loss is also a minimal risk associated with the use of Cialis. If you notice any instances of vision impairment in one or both eyes, discontinue the medication and seek medical attention immediately, as this could indicate the onset of non-arteritic anterior ischemic optic neuropathy (NAION), a condition tied to decreased blood flow to the optic nerve.

A sudden decrease in hearing or hearing loss represents another serious side effect that warrants prompt medical consultation.

When it comes to drug interactions, there are important precautions to be aware of.

Cialis should not be taken alongside nitrates, as the combination can trigger a dangerous drop in blood pressure, resulting in symptoms such as dizziness, syncope, or even catastrophic events like heart attacks or strokes. Nitrates are often found in prescriptions like isosorbide dinitrate or isosorbide mononitrate.

Additionally, recreational drugs containing nitrates, commonly known as “poppers,” should be avoided. 

Individuals taking guanylate cyclase stimulators, such as riociguat, should also refrain from using Cialis. If you are prescribed alpha-blockers or CYP3A4 inhibitors—which include certain antibiotics and antifungals—your healthcare provider may suggest a lower Cialis dosage instead of the 20 mg variant.

The safety of concurrently using Cialis with other PDE5 inhibitors, including: 

• Viagra (sildenafil)

• Levitra® (vardenafil)

• Stendra® (avanafil)

remains unclear. It’s crucial to discuss all medications and supplements you are taking with your prescribing healthcare provider before initiating treatment with Cialis.

It’s equally important to consider your alcohol consumption when taking Cialis.

Consuming five or more alcoholic beverages may elevate the risk of experiencing: 

• An increased heart rate

• A decrease in standing blood pressure

• Dizziness

• Headaches

One unexpected interaction to be cautious about involves grapefruit and Cialis. A study conducted in 2020 revealed that grapefruit juice can inhibit the metabolism of tadalafil, potentially leading to elevated levels in the bloodstream and an amplified risk of adverse effects.

For further information concerning interactions, please explore our guide on tadalafil interactions.

Prior to initiating Cialis therapy, it’s crucial to inform your healthcare provider about any pre-existing medical conditions, as this knowledge enables them to assess whether treatment is appropriate for you. 

This includes conditions such as: 

• Heart issues like angina, heart disease, or arrhythmias

• Lowered blood pressure

• Stomach ulcers

• Retinitis pigmentosa, a genetic eye disorder

In terms of dosing, Cialis is available in several options, typically prescribed based on individual needs:  

• Cialis 2.5 mg: Ideal for daily use, starting with 2.5 mg may allow for adjustment to 5 mg if necessary, depending on effectiveness and tolerability.

• Cialis 5mg: When treating BPH, a daily regimen of 5 mg may be prescribed. If both BPH and ED are present, a 5 mg daily dosage could be recommended as well.

• Cialis 10 mg: Often the initial dose for as-needed ED treatment, healthcare providers may subsequently adjust the dosage based on response, with possible movements to the 20 mg or down to 5 mg as required.

• Cialis 20 mg: Generally reserved for patients who have previously responded well to the 10 mg dose but seek improved results. This higher dose is only recommended as an as-needed treatment.

Each tadalafil dosage presents its own set of advantages and drawbacks, whether utilizing the 20 mg Cialis or opting for a lower dose. The daily recommended starting dose is 2.5 mg, which can be increased to 5 mg if needed.

For instance, one advantage of lower daily doses is the convenience of being prepared for spontaneous intimacy at any moment. The downside, however, includes the necessity of daily medication along with the possibility of more persistent side effects. For more details, refer to our guide on daily-use Cialis. 

The higher-dose as-needed treatment provides the benefit of not requiring daily intake, alleviating concerns about missed doses, and higher doses have been correlated with better effectiveness. However, as dosage increases, so does the potential for side effects. 

A healthcare provider can assist in determining the most suitable Cialis dosage tailored to your needs.

It's crucial to note that Cialis is not available over the counter, necessitating a conversation with a healthcare professional for a prescription.

The FDA’s database highlights numerous tainted sexual enhancement products that may include hidden ingredients, which is a cause for concern.

When preparing to take Cialis for sexual engagement, it’s advised to consume your prescribed dosage—whether that’s 20 mg or a smaller amount—at least 30 minutes to two hours before your planned sexual activity. Notably, Cialis can be taken without regard to meals.

It is vital to limit Cialis intake to once per day at most. Should you find yourself engaging in sexual activity multiple times within a short period, rest assured that Cialis remains effective for up to 36 hours following ingestion.

For additional information regarding the duration of Cialis’s effectiveness, consult our guide on how long Cialis lasts.

If utilizing daily Cialis for either ED or BPH treatment, aim to take the medication at approximately the same time every day without needing to plan around sexual activity.

Your healthcare provider will be able to recommend the optimal method for utilizing Cialis based on your unique circumstances.

Cialis 20 mg functions as a viable treatment option for erectile dysfunction. If you tolerate the 10 mg tablets but haven’t experienced desired results, Cialis 20 mg may be an appropriate alternative.

Your healthcare provider can help determine whether Cialis 20 mg is a suitable choice for your individual needs.

Here is a quick summary: 

• Cialis 20 mg is intended for as-needed use for ED. Taken prior to sexual activity, it can offer relief from erectile dysfunction for up to 36 hours, providing flexibility and spontaneity in your love life.

• Mild side effects may occur. Potential side effects include headaches, indigestion, or back pain. Although these effects can be bothersome during intimate moments, they are usually mild. Consult your healthcare provider if any side effects are concerning, as they may recommend lowering your dosage of Cialis.

• Alternative ED treatments are accessible. Beyond Cialis 20 mg, other options such as Viagra, sildenafil, Stendra, and even our hard mints containing active ingredients from various ED medications are available.

Remember, a prescription is necessary to obtain Cialis 20 mg or any other PDE5 inhibitor. Fortunately, it doesn’t always require an in-person visit to a clinician.

You can connect with licensed healthcare providers online to explore effective

Additionally, to get more information about the costs associated with Cialis or generic tadalafil for ED treatment, consult our comprehensive guide on Cialis pricing.