Tadalafil (Cialis) Refill Online — Discreet Board-Certified MD Review

Tadalafil is the long-acting PDE5 inhibitor, and that half-life is the whole reason people prefer it. If you are already established on a stable dose and simply need the prescription renewed, this is a refill, not a new consultation.

How tadalafil differs from sildenafil

Both are PDE5 inhibitors and both work by the same mechanism, but the pharmacokinetics are not comparable. Sildenafil has a half-life of about four hours and is taken as needed roughly an hour before activity. Tadalafil's half-life is around 17.5 hours, which is why it is sometimes described as the weekend drug and why it is the only PDE5 inhibitor with an approved once-daily low-dose regimen.

That difference matters for a refill. A patient on daily 5 mg tadalafil and a patient on as-needed 20 mg tadalafil are on two different regimens with the same drug, and the quantity dispensed is very different. Be specific about which one you are on.

The dosing patterns we see

Two established regimens, and refills continue whichever you are already on:

• As needed: 10 mg or 20 mg, taken before activity. Effect can persist up to 36 hours.
• Once daily: 2.5 mg or 5 mg, taken at the same time each day, for men who prefer not to plan around dosing. The 5 mg daily dose is also used for benign prostatic hyperplasia, sometimes alongside ED.

We continue your current dose. We do not move you from as-needed to daily, or from 10 mg to 20 mg — that is a decision for the prescriber managing your care.

Nitrates are an absolute contraindication

This is the screening question that matters most, and it is not a formality. Taking any nitrate with a PDE5 inhibitor can cause a profound, sometimes fatal drop in blood pressure. With tadalafil the concern lasts longer than with sildenafil because the drug lasts longer — guidance generally suggests a 48-hour gap after a tadalafil dose before a nitrate can be given.

That has a practical consequence people do not think about: if you develop chest pain and go to an emergency department, the treating clinician needs to know you take tadalafil and when you last took it. Nitroglycerin is a first-line treatment for cardiac chest pain and it will be withheld if you have recently taken tadalafil.

Nitrates include nitroglycerin in any form, isosorbide mononitrate, isosorbide dinitrate, and recreational amyl nitrite or ‘poppers’. A request that discloses nitrate use is declined, and you are not charged.

Alpha-blockers and blood pressure

Tadalafil is also commonly taken by men on tamsulosin or another alpha-blocker for prostate symptoms. That combination is not prohibited, but it does lower blood pressure additively, and both drugs are often started at reduced doses when used together. If you are established on both at stable doses, a refill is straightforward. If you have recently started an alpha-blocker, or your dose changed, that is a reason for review rather than an automatic renewal.

We also screen for a cardiac event in the past six months, uncontrolled hypertension or hypotension, and significant hepatic or renal impairment, which affect appropriate dosing.

What to do about priapism

An erection lasting more than four hours is a urological emergency, not something to wait out. Untreated priapism can cause permanent tissue damage. Go to an emergency department. This is uncommon, more likely with sickle cell disease, multiple myeloma or leukemia, and anatomical deformity of the penis, and we screen for those conditions.

Frequently Asked Questions About Tadalafil Refills