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  • Semi-rigid implants – can be appropriate for older men who don’t have regular sex
  • Inflatable implants – made up of two or three parts that are inflated to maintain a more natural erection. They are often very expensive.

About 5% of men who have penile implants experience mechanical issues with the implants within five years.

Side Effects and Warnings

Men who have cardiovascular disease including conditions like coronary heart disease, should use PDE-5 inhibitors with caution. Speak to your doctor if this applies to you. Sex can be a good way to improve your cardiovascular health, but you need to ensure that you are fit enough to take the medication safely.

If you have an anatomical issue with your penis, like Peyronie’s Disease, again you need to consult your doctor to see if it is safe for you to take an erectile dysfunction treatment. 

If you are taking medicines (for example, to treat angina) or using recreational drugs (such as butyl nitrate, also known as poppers) that contain nitrates, then you must not take PDE-5 inhibitors. Using the two drugs together can be very dangerous for your heart. 

If you suffer from priapism (a painful erection that lasts several hours), or if you are taking long-lasting alpha-blockers (a type of medication used to treat high blood pressure), then, again, you need to be very cautious about taking any erectile dysfunction treatment, so speak to your doctor first. 

Unless your doctor has said you can, do not take PDE-5 inhibitors if you:

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  • Everyday
  • Skin Care
  • Facial Hair Removal Cream
  • Hormone Replacement Therapy
  • Sexual health
  • Skin Care
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    • They are taking other erectile dysfunction drugs such as Viagra/sildenafil, Levitra, or Spedra
    • They are currently taking nitrates for angina, including isosorbide mononitrate, isosorbide dinitrate, nicorandil, and glyceryl trinitrate - serious reactions possible
    • They are taking medications to treat HIV, including Indinavir and Ritonavir
    • They are using anti-fungal treatments like Itraconazole or Ketoconazole
    • They are using recreational drugs such as amyl nitrate (poppers)
    • They are taking alpha-blockers often used in the treatment of prostate enlargement and high blood pressure such as Doxazosin, Prazosin, Alfuzosin, Terazosin, Indoramin and Tamsulosin

    Dr Fox cannot supply Cialis to men where the above are present.

    Cialis should not be taken at the same time or within 36 hours of taking Viagra/sildenafil, Levitra, or Spedra.

    Patient leaflet

    The 'Patient Information Leaflet' supplied with medication must be read before taking tablets.

    Cialis 2.5mg Patient Leaflet
    Cialis 5mg Patient Leaflet
    Cialis 10mg Patient Leaflet
    Cialis 20mg Patient Leaflet

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    Cialis FAQs

    Why should I see a doctor face-to-face before starting ED treatment?

    ED can be a sign of an underlying medical condition such as diabetes, raised blood pressure, or high cholesterol. An examination is required and tests may be needed. These cannot be carried out online. It is fine to obtain repeat supplies of Cialis online, but only after an initial diagnosis and assessment.

    Is Cialis suitable for all men?

    Cialis, along with the other commonly used ED medicines Viagra/sildenafil and Levitra are usually effective and well tolerated treatments. Most men are able to take them and they usually work well. However, men taking some prescription medicines, most notably drugs called nitrates used to treat heart disease, but also some other prescription medicines, should not take Cialis. Men who have some medical conditions, particularly those effecting exercise tolerance should also not take Cialis. Always consult your regular doctor before starting ED treatment. Online doctors carry out checks through online questionnaires, but this does not replace and initial face-to-face assessments and regular medical check-ups are necessary.

    What is the difference between Cialis and Viagra?

    They are similar in that they treat ED in the same way by altering blood flow in the penis and are both classed medically as PDE5 inhibitors. They differ in their duration of action. Viagra remains active for about 4 hours after taking a tablet and Cialis for about 36 hours.

    Why is Cialis sometimes called the 'weekend pill'?

    A Cialis tablet taken on Friday evening will usually remain active through a whole weekend until Sunday evening, hence the name.

    Why do some men take Cialis every day?

    Most men take Cialis occasionally up to a maximum of 2 or 3 tablets per week. They take a tablet if they expect to be sexually active in the following 36 hours. Men who regularly require Cialis more than twice a week sometimes prefer to take a lower dose 2.5mg or 5mg tablet each day, at the same time of day. These low dose tablets are specifically for daily use and provide a continuous level of treatment.

    Is Cialis stronger than Viagra and Levitra?

    No, the duration of action is longer, 36 hours for Cialis compared with 4-5 hours for Levitra and 4 hours for Viagra, however most men find that during this active period the treatments are equally effective when equivalent strength tablets are used. The lower strength of each is Cialis 10mg, Levitra 5mg, and Viagra 25mg and the upper doses 20mg, 20mg, and 100mg respectively. Some men find one type of tablet works better for them than another, but this is not usually the case.

    Is there a lower cost generic version of Cialis?

    Yes. Cialis was under patent by the drug company which developed it, Eli Lilly until 14 November 2017. Dr Fox can now offer UK licensed generic Cialis (tadalafil) at significantly lower cost.

    Who can legally supply Cialis in the UK?

    Only registered pharmacies are allowed to supply Cialis. It is a prescription only medicine. In most cases doctors write the prescriptions and pharmacies dispense the tablets. Some specialist pharmacists can also prescribe Cialis or supply it using a 'patient group direction'. In all cases only registered pharmacies can supply it.

    Why do the prices of Cialis vary?

    The amount pharmacies pay for Cialis is the wholesale price set by the drug company Eli Lilly. The amount pharmacies charge patients will depend on their business models. Some supply Cialis with a small profit margin and others with bigger profit margins. It is usually worth shopping around for the lowest cost supplier, but always use a registered pharmacy to avoid fake medicines.

    Can I get Cialis on the NHS?

    This depends, there are strict criteria in the NHS for the supply of Cialis and limits on the amounts which can be prescribed. NHS prescription fees apply.

    Can I get Cialis on a private prescription from my doctor?

    Some doctors, particularly private doctors, but also some GPs, will write private prescriptions for Cialis. NHS doctors usually charge in the region of £25.00 to write private prescriptions, and private doctors usually quite a lot more. A private prescription can be taken to or posted to a pharmacy for dispensing. The cost of the medicine is in addition to the prescription fee. When medicines are supplied online an electronic private prescription from a doctor is usually involved and costs are usually quite a lot lower.

    Can Cialis tablets be divided and taken in parts?

    No, Cialis tablets are film coated and are intended to be swallowed whole. Cutting up the tablets will reduce their effectiveness.

    Why should Cialis not be taken with recreational or illegal drugs?

    People who take illegal drugs are likely to engage in risky sexual practices and this likelihood is increased when ED treatments are taken at the same time. There is also an increase in side effects, such as changes in vision and changes in blood pressure. The combination of Cialis and cocaine and other recreational drugs may lead to the rare but dangerous condition of priapism in which a prolonged erection of more than an hour or two can cause permanent damage to the erectile tissues. See Beware club drugs and Viagra.

    Is ED counselling better than tablets?

    This depends - ED increases with age, effecting up to 40% of men by the age of 50. In many men there is no significant psychological cause and counselling is likely to be ineffective. In other men stress, relationship difficulties, and psychosexual factors play a role and for these men counselling may be preferable. Sometimes a combination of tablet treatments and counselling works best.

    See also erectile dysfunction FAQs page.

    Authored 7 December 2012
    by Dr Tony Steele

    Reviewed 30 July 2017 by Dr B. Babor, Dr A. Wood, Dr P. Hunt

    Last updated 3 October 2018

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