Side Effects Of Taking Cialis And Viagra Together

Can you take Cialis in the morning, Viagra at night?

Cialis and Viagra are drugs used to treat erectile dysfunction (ED). In general, it’s not recommended to take Viagra within 36 hours of a dose of Cialis, but there might be certain situations in which your healthcare provider has given you a prescription for both.

Written by Cale Li, MD

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Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Cialis (generic name tadalafil; see Important Safety Information) and Viagra (generic name sildenafil; see Important Safety Information) are drugs for erectile dysfunction. They both belong to the same family of drugs called PDE5 inhibitors. PDE5 inhibitors work by increasing blood flow to the penis during arousal leading to a harder erection (Smith-Harrison, 2016).

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“In general, it’s not recommended to take both Cialis and Viagra within a 36 hour period, because that’s how long Cialis can stay in your system,” says Dr. Michael Reitano, an expert in sexual health and Physician in Residence at Roman. “They both work on the same mechanism […] there isn’t any support in the literature for going above the maximum dose.”

You and your healthcare provider might find an individual schedule that works for your personal needs. Viagra and Cialis both belong to the same family of drugs and combining them could increase your risk of side effects. In general, if you’ve taken a dose of Viagra for ED, it’s not recommended to take Cialis within 24 hours after that. Or, if you’re taking Cialis, you shouldn’t take Viagra within the next 36 hours, Dr. Reitano says.

Some common side effects of PDE5 inhibitors include (Smith-Harrison, 2016):

There might be some situations in which someone has both Cialis and Viagra in their medicine cabinet. “If you had a patient switching from one drug to the other drug, you would just give them a washout period,” says Dr. Reitano. “So there’s no reason why a person couldn’t be given two prescriptions over time and have two medications on hand, even if it’s just switching from one to the other.”

What are the main differences between Cialis and Viagra?

Cialis and Viagra are drugs called PDE5 inhibitors that work by increasing blood flow to the penis during arousal, leading to harder erections. PDE5 inhibitors don’t create erections on their own, but make it easier for you to get hard over the course of its action.

One of the main differences between Cialis and Viagra is the duration of action. Cialis can cover you for up to 36 hours, allowing for spontaneity in your sex life. There are two ways to take Cialis: either as-needed, at least 30 to 60 minutes prior to sexual activity or once a day at the same time every day without regard for the timing of sexual activity (Smith-Harrison, 2016).

What dosing schedule you prefer depends on your personal preferences, which you can discuss with your healthcare provider. If you don’t like taking medications every day, the as-needed Cialis may be more attractive. On the flip side, if you’d like more spontaneity without worrying about planning your sexual activity, the once-a-day way to take Cialis could be better for you. There’s only one way to take Viagra for erectile dysfunction: as needed around one hour prior to sexual activity.

Which is better for you: Viagra or Cialis?

“It depends on your lifestyle, sexual needs, side effect profile, how they last in your system, and how well they work,” says Dr. Reitano. “Let’s say a person has side effects with one—with the sildenafil—and it causes nasal stuffiness. They might say, well I’m only going to have a single sexual experience, I’d rather have a drug that covers me for 8 hours, even though it causes me this stuffiness and discomfort because I’m not going to need the effects of the drug beyond that.”

“This same person may be going away for the weekend and they don’t know when they’ll be having sex. They want the effects for 36 hours […] and they might say ‘I’d like to take Cialis for this 36 hour period, even if it causes some nasal congestion.’”

One study comparing Cialis and Viagra showed that the two drugs were equally effective in treating erectile dysfunction. However, men and their partners preferred Cialis over Viagra, citing less time pressure, reduced sense of urgency and less planning before and during sexual encounters (Gong, 2017). In the end, it’s up to you and your healthcare provider to decide what works best for you.

How long does Viagra last and when does it start to work?

What if Cialis or Viagra isn’t working for me?

If you’re still experiencing erectile dysfunction after having tried Cialis or Viagra, there are other options.

Addressing underlying health conditions

Certain health conditions can impede your body’s ability to get an erection, even when taking drugs like Cialis. Common health conditions associated with erectile dysfunction include high blood pressure, heart disease, diabetes, depression, low testosterone, and enlarged prostate. Improving these underlying conditions may help improve your overall sexual health (Rew, 2016).

Lifestyle changes

Cigarette smoking is associated with higher rates of erectile dysfunction (Kovac, 2015). Quitting smoking can help improve your sexual health. In addition, alcohol dependency was associated with more sexual dysfunction, including problems with desire, arousal, and erectile function (Pendharkar, 2016).

Other treatments for ED

Beyond PDE5 inhibitors, there are other treatment options for erectile dysfunction (Rew, 2016):

  • Testosterone therapy for men with erectile dysfunction caused by low levels of testosterone, a condition called hypogonadism.
  • Injectable medications like alprostadil directly stimulate the penis to get hard. placed over the penis can maintain erections up to 30 minutes.

References

  1. Food and Drug Administration (FDA). (2015). ADCIRCA (tadalafil) tablets for oral administration. FDA. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022332s007lbl.pdf
  2. Gong, B., Ma, M., Xie, W., Yang, X., Huang, Y., Sun, T., Luo, Y., & Huang, J. (2017). Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis. International Urology and Nephrology, 49(10), 1731–1740. doi: 10.1007/s11255-017-1644-5. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603624/
  3. Kovac, J. R., Labbate, C., Ramasamy, R., Tang, D., & Lipshultz, L. I. (2015). Effects of cigarette smoking on erectile dysfunction. Andrologia, 47(10), 1087–1092. doi: 10.1111/and.12393. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25557907/
  4. Pendharkar, S., Mattoo, S. K., & Grover, S. (2016). Sexual dysfunctions in alcohol-dependent men: A study from north India. The Indian Journal of Medical Research, 144(3), 393–399. doi: 10.4103/0971-5916.198681. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5320845/
  5. Rew, K. T., & Heidelbaugh, J. J. (2016). Erectile Dysfunction. American Family Physician, 94(10), 820–827. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27929275/
  6. Smith-Harrison, L. I., Patel, A., & Smith, R. P. (2016). The devil is in the details: an analysis of the subtleties between phosphodiesterase inhibitors for erectile dysfunction. Translational Andrology and Urology, 5(2), 181–186. doi: 10.21037/tau.2016.03.01. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837309/

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Important Safety Information for Tadalafil (Cialis)

What Is The Most Important Information I Should Know About CIALIS® (tadalafil) and generic CIALIS®?

  • CIALIS® and generic CIALIS® can cause serious side effects. Serious, but rare, side effects include:
    • An erection that won’t go away (priapism). If you get an erection that lasts more than 4 hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis, including the inability to have erections.
    • Changes in vision. Color vision changes, such as seeing a blue tinge (shade) to objects or having difficulty telling the difference between the colors blue and green.
    • Sudden decrease or loss of vision. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including CIALIS® and generic CIALIS®) reported a sudden decrease or loss of vision in one or both eyes. It is uncertain whether PDE5 inhibitors directly cause the vision loss. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including CIALIS® and generic CIALIS®, and call a healthcare provider right away.
    • Sudden loss or decrease in hearing. Sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness, has been rarely reported in people taking PDE5 inhibitors, including CIALIS® and generic CIALIS®. It is not possible to determine whether these events are related directly to the PDE5 inhibitors, to other diseases or medications, to other factors, or to a combination of factors. If you experience these symptoms, stop taking CIALIS® and generic CIALIS® and contact a healthcare provider right away.
    • ED is a condition where the penis does not fill with enough blood to harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his healthcare provider for help if the condition bothers him.
    • CIALIS® and generic CIALIS® help increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away. Some form of sexual stimulation is needed for an erection to happen with CIALIS® or generic CIALIS®.
    • CIALIS® and generic CIALIS® do not:
      • Cure ED
      • Increase a man’s sexual desire
      • Protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your healthcare provider about ways to guard against sexually transmitted diseases.
      • Serve as a male form of birth control
      • Take CIALIS® or generic CIALIS® exactly as your healthcare provider prescribes it. Your healthcare provider will prescribe the dose that is right for you. Do not change your dose or the way you take CIALIS® or generic CIALIS® without talking to your healthcare provider.

      Who Should Not Take CIALIS® or generic CIALIS®?

      Do not take CIALIS® or generic CIALIS® if you:

      • Have severe liver disease. Tell your doctor if you have mild to moderate liver disease as you may need dosage reductions.
      • Have severe kidney disease. Tell your doctor if you have mild to moderate kidney disease as you may need dosage reductions
      • Take any medicines called “nitrates”
      • Use recreational drugs called “poppers” like amyl nitrite and butyl nitrite
      • Take any medicines called guanylate cyclase stimulators, such as riociguat
      • Are allergic to CIALIS®, tadalafil or ADCIRCA®, or any of its ingredients

      When should I call my primary provider?

      Call your primary provider right away if you:

      • Have an erection that lasts longer than 4 hours
      • Experience a sudden loss of vision in one or both of your eyes
      • Experience a sudden decrease or loss hearing
      • Take too much CIALIS® or generic CIALIS®
      • Have an allergic reaction to CIALIS® or generic CIALIS®
      • Symptoms of an allergic reaction may include:
      • Rash
      • Hives
      • Swelling of the lips, tongue, or throat
      • Difficulty breathing or swallowing

      Call your healthcare provider or get help right away if you have any of the symptoms of an allergic reaction listed above.

      If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

      What Should I Tell My Roman-affiliated Provider Before Taking CIALIS® and generic CIALIS®?

      Tell your Roman-affiliated provider about all your medical problems, including if you:

      • Have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. Ask your healthcare provider if it is safe for you to have sexual activity. You should not take CIALIS® and generic CIALIS® if your healthcare provider has told you not to have sexual activity because of your health problems.
      • Have pulmonary hypertension
      • Have low blood pressure or have high blood pressure that is not controlled
      • Have had a stroke
      • Have liver problems
      • Have kidney problems or require dialysis
      • Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
      • Have ever had severe vision loss, including a condition called NAION
      • Have stomach or intestinal ulcers
      • Have a bleeding problem
      • Have a deformed penis shape or Peyronie’s disease
      • Have had an erection that lasted more than 4 hours
      • Have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia

      Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

      Especially tell your healthcare provider if you take any of the following:

      • Medicines called nitrates
      • Medicines called guanylate cyclase stimulators, such as riociguat (Adempas®), used to treat pulmonary hypertension
      • Medicines called alpha blockers. These include Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), 4 Jalyn® (dutasteride and tamsulosin HCl) or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. If CIALIS® or generic CIALIS® is taken with certain alpha blockers, your blood pressure could suddenly drop. You could get dizzy or faint.
      • Other medicines to treat high blood pressure (hypertension)
      • Medicines called HIV protease inhibitors, such as ritonavir (Norvir® , Kaletra® )
      • Oral antifungals such as ketoconazole (Nizoral® ), itraconazole (Sporanox® )
      • Antibiotics such as clarithromycin (Biaxin® ), telithromycin (Ketek® ), erythromycin (several brand names exist. Please consult your healthcare provider to determine if you are taking this medicine).
      • Other medicines or treatments for ED.
      • Tadalafil is also marketed as ADCIRCA® for the treatment of pulmonary arterial hypertension. Do not take both CIALIS® or generic CIALIS® and ADCIRCA®. Do not take sildenafil citrate (Revatio®, Viagra®) with CIALIS® or generic CIALIS®.

      Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

      What are the most common side effects of CIALIS® or generic CIALIS®?

      The most common side effects with CIALIS® and generic CIALIS® are:

      • Headache
      • Indigestion
      • Back pain
      • Muscle aches
      • Flushing
      • Stuffy or runny nose

      What is the FDA-approved Use of CIALIS® and generic CIALIS®?

      CIALIS® and generic CIALIS® are prescription medicines used to treat erectile dysfunction (ED), symptoms of benign prostatic hyperplasia (BPH), or both.

      Roman-affiliated doctors may prescribe CIALIS® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment.

      You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

      Please see the full Prescribing Information for complete safety information.

      Important Safety Information for Sildenafil (Viagra)

      What are the most important things I need to know about VIAGRA® (sildenafil citrate) 25 mg, 50 mg, and 100 mg tablets and generic VIAGRA®?

      Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate emergency medical attention.

      • VIAGRA® and generic VIAGRA® can cause serious side effects. Serious, but rare, side effects include:
        • an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, seek emergency medical attention right away. If it is not treated right away, priapism can permanently damage your penis.
        • sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking VIAGRA and call your healthcare provider right away if you have any sudden vision loss
        • sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking VIAGRA and contact a doctor right away

        Who should not take VIAGRA® or generic VIAGRA®?

        Do not take VIAGRA® or generic VIAGRA® if you:

        • Take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
        • Are allergic to sildenafil, as contained in VIAGRA® and REVATIO®, or any of the ingredients in VIAGRA® or generic VIAGRA® tablets.
        • Are a women or a child

        When should I call my primary provider?

        Call your primary provider right away if you:

        • Have an erection that lasts longer than 4 hours
        • Experience a sudden loss of vision in one or both eyes
        • Experience a sudden decrease in or loss of hearing
        • Experience chest pain, dizziness, or nausea during sex
        • Take too much Viagra or sildenafil citrate

        If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

        What are the most common side effects of VIAGRA® and generic VIAGRA®?

        The most common side effects are:

        • headache
        • flushing
        • upset stomach
        • abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision
        • stuffy or runny nose
        • back pain
        • muscle pain
        • nausea
        • dizziness
        • rash

        What should I tell my Roman-affiliated provider before taking VIAGRA® and generic VIAGRA®?

        Before you take VIAGRA® or generic VIAGRA® , tell your healthcare provider if you:

        • Have or have had heart problems such as a heart attack,irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
        • Have had heart surgery within the last 6 months
        • Have pulmonary hypertension
        • Have had a stroke
        • Have low blood pressure, or high blood pressure that is not controlled
        • Have a deformed penis shape
        • Have had an erection that lasted for more than 4 hours
        • Have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia
        • Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
        • Have ever had severe vision loss, including an eye problem called NAION
        • Have bleeding problems
        • Have or have had stomach or intestinal ulcers
        • Have liver problems
        • Have kidney problems or are having kidney dialysis
        • Have any other medical conditions

        Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

        VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works, causing side effects.

        Especially tell your healthcare provider if you take any of the following:

        • Medicines called nitrates
        • Medicines called guanylate cyclase stimulators such as Adempas® (riociguat)
        • Medicines called alpha-blockers such as Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), Jalyn® (dutasteride and tamsulosin HCl), or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of VIAGRA® with alpha-blockers can lead to a drop in blood pressure or to fainting
        • Medicines called HIV protease inhibitors, such as ritonavir (Norvir®), indinavir sulfate (Crixivan®), saquinavir (Fortovase® or Invirase®), or atazanavir sulfate (Reyataz®)
        • Oral antifungal medicines, such as ketoconazole (Nizoral®) and itraconazole (Sporanox®)
        • Antibiotics, such as clarithromycin (Biaxin®), telithromycin (Ketek®), or erythromycin
        • Other medicines that treat high blood pressure
        • Other medicines or treatments for ED
        • VIAGRA® contains sildenafil, which is the same medicine found in another drug called REVATIO®. REVATIO® is used to treat a rare disease called pulmonary arterial hypertension (PAH). VIAGRA® should not be used with REVATIO® or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil])

        Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

        What is the FDA-approved use of VIAGRA® and generic VIAGRA®?

        VIAGRA® (sildenafil citrate) is prescription medicine used to treat erectile dysfunction (ED).

        Roman-affiliated doctors may prescribe VIAGRA® or generic VIAGRA® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment. While this is not an FDA-approved use of the drug, the American Urological Association has included the use of sildenafil citrate in the treatment of PE in its Guideline on the Pharmacologic Management of Premature Ejaculation.

        You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

        Please see the full Prescribing Information for complete safety information.

        Product names referenced herein are trademarks of their respective owners.