We understand this is an initial step in your journey to improve your erectile dysfunction (ED) and general wellness, and we want to be here to support you through the whole process. Any worries, concerns, questions – we are here for you.

As a first step it’s important for you to take the time to read the manufacturer’s patient information leaflet (PIL) enclosed in your box. This gives you a lot of information about how to take the medication, what to avoid, side-effects and potential interactions with other medications.

Causes of ED

Now your Tadalafil is being freshly packed for you and it’s a good start, but we also advise exploring if there are any underlying causes that may need more specific treatment.

So broadly speaking there are two main causes of ED: physical (organic) and psychological causes. In most men it’s usually due to a combination of factors. Typically those over 40 years of age are more likely to have more physical elements limiting their ability to get erections, and those under 40 have a tendency to be impacted by more psychological factors. Now this is a generalisation, and so it’s always advisable to look a bit deeper into the causes.

Morning erections are also a good indication of the cause. They are the body’s way of providing oxygen to preserve the penis. Loss of night-time/morning erections strongly suggests a more physical (organic) cause.

When we say physical (organic) causes this covers a spectrum of issues that include high blood pressure, diabetes, high cholesterol, thyroid conditions, prostate problems, abnormal hormone levels, and anatomical issues such as a tight foreskin.

Psychological causes range from new relationship anxiety, depression, stress, porn-addiction. Typically this ED is improved during holidays or reduced stress. Often you still have morning erections with these causes.

As part of a full assessment of your ED, if you haven’t had these tests before (or in the last year), we advise arranging to see your regular GP/doctor for a number of checks which include:

• Cardiovascular health: Blood pressure measurements and a cholesterol blood test. There is now overwhelming evidence that ED is strongly associated with cardiovascular disease. The penile blood vessels gradually get narrower over time, and this limits the blood flow needed to sustain an erection.
• Diabetes: A blood sugar level test also known as HbA1c. Diabetes is a cause of ED.
• Hormone imbalance: Check your testosterone, prolactin and thyroid levels. Hormonal imbalances may contribute to ED.
• Prostate assessment: This may be advised in your case, especially if you have prostate symptoms (such as poor urinary stream, frequency of urinating etc.). This can involve a blood test and physical examination of your prostate gland.
• Depression/Anxiety/Psychosexual issues: If you believe you may have underlying problems that could be leading to a psychological cause for your ED, its best to explore this further with your GP or seek psychosexual counselling. It’s good to talk.
• Smoking: May cause damage to your blood vessels, affecting blood flow and hence contributing to ED. If you are a smoker, it is worth trying to quit to improve your overall health too. Joining a smoking cessation service has been shown to be a more effective way to quit smoking.
• Alcohol: Drink within limits! The combination of excessive alcohol and sildenafil may cause a drop in blood pressure, lowering testosterone and impacting your erections.
• BMI: A healthy BMI (Body Mass Index) not only helps improve ED but your overall health. Having a healthy weight reduces risks of developing diabetes, high blood pressure and high cholesterol. As outlined above, all these factors may contribute to the physical causes of ED. It is important to maintain a healthy weight by eating a balanced diet and exercising regularly!

What is Tadalafil DAILY?

Tadalafil belongs to the family, known as phosphodiesterase-5 (PDE5) inhibitors, which work to relax the smooth muscle in the penis and increase blood flow in order to promote and sustain an erection. The original brand named version is called Cialis, and it was only available as an “as required” on-demand medication – that you take just before you want to have sex. It became known as the “weekend pill” as it lasts for up to 36hrs.

In 2007, Tadalafil once-daily use was approved for the treatment of ED, and became available in the UK. Prior to this, the ED treatment repertoire consisted mostly of on-demand conventional PDE5 inhibitors which didn’t suit the needs of men who are frequently sexually active (twice a week or more) and wanted to be ready for action at any time.

Its benefits are:

• Enables spontaneous erections with no “sex planning” needed around your medication.
• Side effects are less likely as you take a lower dose, with less peaks in dosing.
• A simple once daily dose, giving routine to your treatment regime.

Tadalafil and Erections

It’s hard to get hard: your brain, heart, hormones and a few other bits and bobs all need to come together – which can be tricky at any age. Sometimes this all breaks down and you can’t get or stay hard long enough to have satisfactory sexual intercourse – a condition known as erectile dysfunction. This is where we can help! So the Tadalafil we have prescribed you is one of the most popular tablets that is given to men who need help with ED. By being both a safe and effective treatment, its use is commonly approved in a countless number of men across the globe, who experience different degrees and causes of ED.

Get back to enjoying sex, and reducing your worries about not getting an erection!

How Tadalafil works?

It works by inhibiting an enzyme known as phosphodiesterase inhibitor (PDE5) associated with muscle contraction in penile tissue. Tadalafil allows the blood vessels to relax and expand, leading to increased blood flow into the penis and Voila you have an erection! Don’t forget it works only when you are sexually stimulated and there is some “va va voom”.

Be aware Tadalafil does not protect you from sexually transmitted diseases (STDs), a condom does.

How do I take it?

• Take one Tadalafil 5mg tablet once a day, at approx. the same time each day.
• Unlike Sildenafil, its onset of effectiveness is not delayed by food, and it can be taken at a spontaneous time in your daily routine!
• Drink within limits (14 units per week). More than 2 units of alcohol will make Tadalafil less effective.
• Do not take more than one tablet within 24 hours, if Tadalafil is not effective after sexual stimulation, please speak to our clinicians.
• Tadalafil should not be taken within 24 hours of taking other ED medication, such as Viagra, Levitra or Spedra.
• It is important that you are aware that certain ‘street drugs’ may interact with Tadalafil. If you are using illicit drugs e.g. ‘Aromas, Poppers or Odorisers’, please make sure the clinicians are aware as the combination could be dangerously fatal!

How effective is Tadalafil?

Tadalafil is known to be the faster and longer acting brother of Sildenafil. The effectiveness of the once daily regimen is comparable to that of the on-demand variants of tadalafil (e.g. the 10mg and 20mg strengths), it just allows you to engage in sex, without having to worry about taking your tablet at least 30 mins before sex.

If Tadalafil DAILY does not work for you, please do not give up and get in contact with our clinicians who are happy to help.

What are the side-effects?

Phosphodiesterase inhibitors are generally safe and well tolerated, however all medicines have the potential for causing side-effects. The good news is, the majority of these are mild and not all men get them and in fact, research data has indicated Tadalafil to have the lowest rate of adverse effects, showcasing it as having the highest tolerability profile.

Side effects include lightheadedness, headaches, ringing in the ear (tinnitus), indigestion, muscle aches, facial flushing and nasal congestion. Symptoms could last longer in some individuals, owing to the longer duration of action of Tadalafil in comparison to Sildenafil. However, these are usually mild and not every patient experiences these symptoms.

More serious side-effects, which are rare include; breathing difficulties, visual disturbances, kidney or liver dysfunction, widespread rashes, agitation, chest pain, anaphylaxis (a severe allergic reaction) and priapism (a painful and persistent erection that lasts for > 4 hours). If any of the rare but serious side-effects happen please go to your local Accident and Emergency immediately or call 999. If you have any concerns regarding the side-effects, please stop taking the medication and contact us.

What if I am taking other medicines?

It is important that you are completely honest with us when completing the questionnaire as some medicines are not safe to take with Tadalafil.

Interactions include:

Alpha blockers (such as tamsulosin, alfuzosin, doxazosin or terazosin). This could result to your blood pressure dropping dangerously low. Tadalafil should NOT be taken with alpha blockers.

Nitrates (such as GTN (Glyceryl trinitrate) commonly used to manage chest pain associated with angina, or rectal GTN ointment used for anal fissures). The combination of nitrates with Tadalafil may cause your blood pressure to drop dangerously low. DO NOT TAKE Tadalafil if you have been prescribed Nitrates.

Please remember to inform our clinicians via your personal patient account: if you start taking any new medicines or if there are any significant changes to your medical history. Also if you experience any significant side-effects or want further advice on your treatment.

It is important that you inform your GP about the medicines you take to ensure they have an accurate medication history. If you do not share this information with your GP it could result in the healthcare professional not having enough information to make informed clinical decisions about your care, increasing your risk of injuries or side effects. On your account page, you can download a letter to share with your GP that contains all the relevant information about your treatment plan.

Until then, we hope to see you back again!