Tadalafil / Cialis

ID: tadalafil

Aliases: Cialis, tadalafil, tadafil, tadalifil, Adcirca, daily Cialis, PDE5 inhibitor

Type: compound

Route/form: oral prescription tablet; daily and as-needed patterns are distinct

Status: approved

Evidence level: approved / labelled

Best data tier: approved label + human controlled/review

Support scope: human

Source types: human_rct, human_trial, label, meta_analysis

Linked sources: 8

Broad outcomes: Cardiovascular / lipids / blood pressure, Fat loss / metabolic health, Hormones / fertility / sexual health, Muscle growth / performance / recovery

Reading note: These are curation notes anchored to linked sources, not a clinical recommendation or protocol.

Targets / mechanism

• PDE5 inhibition
• NO/cGMP signaling preservation
• corpus cavernosum smooth-muscle relaxation
• longer half-life PDE5 inhibitor profile

Optimization domains

• erectile
• sexual
• vascular
• endothelial
• blood pressure
• cardiovascular
• exercise performance
• pump
• metabolic
• type 2 diabetes
• nitric oxide

Research basis

• Tadalafil has label-level human evidence for erectile dysfunction and BPH contexts, with the practical distinction that daily and as-needed use are different clinical patterns.
• Human trials support endothelial-function and metabolic-adjacent hypotheses in selected populations, including increased cardiovascular-risk men and type 2 diabetes/ED studies.
• The performance-community rationale is plausible through NO/cGMP preservation, vasodilation, endothelial function, and possibly pump perception, but the direct performance and lean-mass evidence is far smaller than ED evidence.

Limits, risks, and missing evidence

• The often-cited lean-mass/endothelial tadalafil paper is not the same as proof of hypertrophy, strength gain, or PED-level body recomposition in healthy lifters.
• Tadalafil can lower blood pressure and has important interactions with nitrates, riociguat/GC stimulators, alpha-blockers, antihypertensives, alcohol, and CYP3A4 inhibitors.
• Back pain, myalgia, dyspepsia, flushing, nasal congestion, headache, ocular/hearing warnings, renal/hepatic adjustment, and cardiovascular suitability make this a medical-context drug rather than a harmless pump supplement.

Risk flags

• prescription only
• nitrate contraindication
• blood pressure interactions
• cyp3a4 interactions
• ocular hearing warnings
• not hypertrophy proven

Linked papers, labels, and reviews

1. Tadalafil tablet, film coated - Prescribing Information
   label / dailymed_tadalafil_label
   DailyMed label for oral tadalafil, including ED/BPH dosing, nitrate/riociguat contraindications, alpha-blocker/antihypertensive cautions, and common adverse effects.
2. Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis
   meta_analysis / pubmed_tadalafil_sildenafil_meta_2017
   Head-to-head tadalafil versus sildenafil systematic review/meta-analysis; useful for duration/tolerability preference framing without implying one is universally superior.
3. Chronic treatment with tadalafil improves endothelial function in men with increased cardiovascular risk
   human_rct / pubmed_tadalafil_endothelial_cvrisk_2005
   Randomized trial of tadalafil and endothelial function in men with increased cardiovascular risk; useful vascular-function context beyond ED symptom scores.
4. Effects of tadalafil administration on plasma markers of exercise-induced muscle damage, IL6 and antioxidant status capacity
   human_trial / pubmed_tadalafil_exercise_muscle_damage_2014
   Double-blind crossover healthy-male trial around exhaustive exercise, oxidative status, IL-6, and muscle-damage markers; mechanistic recovery-adjacent but not hypertrophy proof.
5. Tadalafil improves lean mass and endothelial function in nonobese men with mild ED/LUTS: in vivo and in vitro characterization
   human_trial / pubmed_tadalafil_lean_mass_endothelial_2017
   Human and in vitro tadalafil paper often cited in performance communities for lean mass/endothelial-function claims; population and endpoint limits should be preserved.
6. Effect of low-dose tadalafil once daily on glycemic control in patients with type 2 diabetes and erectile dysfunction: a randomized, double-blind, placebo-controlled pilot study
   human_rct / pubmed_tadalafil_t2d_glycemic_pilot_2022
   Pilot RCT of tadalafil 5 mg daily in type 2 diabetes with ED; useful for NO/cGMP-metabolic hypothesis but too small for general metabolic-drug claims.
7. Feasibility of high-dose tadalafil and effects on insulin resistance in well-controlled patients with type 2 diabetes (MAKROTAD): a single-centre, double-blind, randomised, placebo-controlled, cross-over phase 2 trial
   human_rct / pubmed_tadalafil_makrotad_2023
   Phase 2 crossover trial in type 2 diabetes; adds insulin-resistance/metabolic context at high-dose tadalafil with tolerability caveats.
8. Long-term effects of phosphodiesterase-5 inhibitors on cardiovascular outcomes and death: a systematic review and meta-analysis
   meta_analysis / pubmed_pde5_cvd_outcomes_meta_2024
   Long-term cardiovascular-outcome meta-analysis; mostly observational/heterogeneous evidence, useful as hypothesis-generating rather than proof of mortality benefit.