Tadalafil: Every Day or Only Before Intercourse? What T… — Transcript

Dr. Tiago Guirro explains tadalafil use for erectile dysfunction, comparing daily low doses vs. higher doses before intercourse.

Key Takeaways

Tadalafil can be taken daily or on-demand with similar short-term effectiveness.
Daily low-dose tadalafil may offer better long-term vascular benefits.
Tadalafil's long half-life provides dosing flexibility and less food interaction.
Contraindicated with nitrate medications due to risk of severe hypotension.
Erectile dysfunction may signal underlying cardiovascular disease.

Summary

Tadalafil (Cialis) was approved in 2003 as a treatment for erectile dysfunction with a longer duration than Viagra.
It works by inhibiting phosphodiesterase type 5, allowing nitric oxide to increase blood flow in the penis.
Tadalafil reaches peak concentration in 2 hours and has a half-life of about 17 hours, lasting up to 36 hours in the body.
Unlike Viagra, tadalafil does not interact with food or alcohol and offers more flexibility in dosing.
Both daily 5 mg and on-demand 20 mg doses are similarly effective short-term for achieving erections.
Long-term use of daily 5 mg may improve endothelial function and penile blood vessel health better than on-demand dosing.
Dosing should be individualized based on frequency of sexual activity and patient preference.
Tadalafil is safe for most patients except those taking nitrates for heart conditions due to risk of blood pressure drop.
Erectile dysfunction can be an early sign of systemic atherosclerosis, which also affects heart and brain vessels.
Patients with cardiovascular risk factors should have cardiac evaluation before using tadalafil.

Chapters

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Speaker A

On March 27th, 1998, the FDA approved the first oral medication for the treatment of male sexual impotence, Viagra. From there, industries around the world began research to launch new medications, and in November 2003, tadalafil, commercially known as Cialis,

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emerged, earning the nickname "weekend pill" due to its duration of effect. But what is the best way to take it? Five milligrams every day or 20 milligrams before intercourse? Is there any method that is better than the other? Hello, I am Doctor Thiago, and I

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am a urologist here in São Paulo. Tadalafil is a medication that inhibits an enzyme in our body called phosphodiesterase type 5. The mechanism of action is exactly the same as that of Viagra and Levitra, the other medications we have for erectile

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dysfunction. But what does phosphodiesterase have to do with erection? Inside the penis, there is a kind of competition between nitric oxide and phosphodiesterase. Nitric oxide releases a substance called cyclic GMP, which is responsible for dilating blood vessels, increasing blood flow, and the

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phosphodiesterase goes in and removes this cyclic GMP, causing vasoconstriction, reducing blood flow to the penis. Most of the time, phosphodiesterase wins this competition. After all, the state of a flaccid penis is much more common than

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that of an erect one. When there is a stimulus and excitation, the body increases the amount of nitric oxide inside the penis, and this allows nitric oxide to win the competition, resulting in an erection. Where does tadalafil fit into

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this? Tadalafil goes in and inhibits the action of phosphodiesterase, so tadalafil facilitates the process of nitric oxide, thereby facilitating erection. Now that you understand the mechanism of action of tadalafil, let's delve into the more peculiar characteristics of this drug. Tadalafil, when

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you take it, will reach its peak concentration in your body in about two hours, and its half-life is around 17 hours. What is half-life? It is the time that our body takes to reduce the concentration of the drug in our blood

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by half. That is why when you take a 20 mg tadalafil, it can last up to 36 hours in our body. Every 17 hours, it reduces by half; therefore, doses of up to 20 mg are sufficient to cause an erection. That is

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why we recommend taking tadalafil 20 mg every two or three days. Another very peculiar characteristic of tadalafil is its longer duration of action and also the fact that it does not interact with food and alcohol. For Viagra to have a good

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effect and proper absorption, it is ideal to take it on an empty stomach one hour before intercourse, and its effect lasts for only four hours. We know that taking this type of medication on an empty stomach is more

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complex. After all, you're not going to take it in the morning right after you wake up. You will have to take it close to your sexual activity, and this can often interfere with the absorption of the medication. But what is the best way

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to take tadalafil? Five milligrams every day or 20 milligrams only when having intercourse? We have both of these presentations at the pharmacy. First point, in the short term, in matters of effectiveness in a relationship, what is that? When a person

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takes it, what is the percentage that this person can achieve an erection sufficient to achieve vaginal penetration? The effectiveness of both five milligrams taken daily and 20 milligrams taken on demand, which we refer to, is very similar. This is in the short term. When we look

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at the long term, it seems that the five milligrams taken daily has a slightly better effect on blood vessel function, particularly in improving endothelial function, which is the inner part of the blood vessels in the penis that is responsible for releasing nitric

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oxide. So, in the long term, it does seem that five milligrams tadalafil taken daily has a better effect. The data is still scarce for this type of statement, but there is indeed a direction in that sense. Agreed, doctor? Does that mean that taking it

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every day is always better than taking 20 milligrams sporadically? The 20 milligrams sporadically? Calm down. Every time we generalize, we end up taking the risk of being wrong. Taking tadalafil, for example, may not make sense for someone who has a relationship with their spouse

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every 15 days. It might not be necessary to take five milligrams of tadalafil every day. If he takes 20 milligrams only during that period, it might be better for him. I really like the five milligram presentation. Why? Because it allows us to

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have greater flexibility, precisely because of its prolonged effect. When we choose to undergo this treatment of five milligrams within three to four days, there is a stabilization of the concentration in our blood. So you are taking it, and the body is

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eliminating it. You are taking it, and our body is eliminating it. Since the elimination rate is low, it takes time. We can achieve a relatively short steady state dose, which is three or four days. Therefore, it is very worthwhile to

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individualize. What do you mean? For example, patients who have a mild degree of erectile dysfunction. He is able to have an erection, but he sometimes likes to improve his sexual potency a little. A five milligram tablet taken on alternate

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days is sometimes enough for us to achieve an improvement in performance and enhancement of the erection without the need to take it every day. Another thing is that there are patients who say, doctor, I only have relations on the

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weekends. What we sometimes advise is to start taking the five milligrams tadalafil on Wednesday. You start on Wednesday, Thursday, Friday, and Saturday, and by then, you already have good concentrations in the blood to have the drug circulating at the time of the erection, eliminating

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the need to take a medication for an erection one or two hours beforehand. Sometimes we know that many patients do not like to have this association, and they sometimes feel embarrassed to take the medication in front of the person, and sometimes he

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ends up having to choose this type of treatment, taking it on Wednesday, Thursday, Friday, Saturday, and Sunday, while he doesn't take it on Monday and Tuesday. Do you understand? Then the five milligram tadalafil allows us much greater treatment

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flexibility. When I talk about taking it every day, many people have the question, doctor, but doesn't this medication harm the heart? It is said that those who take this type of medication can have a heart attack or cardiovascular problems.

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This is completely a myth. Where does this myth come from? There is a single contraindication for taking both tadalafil, Viagra, and Levitra, which is for patients who have already had a heart attack and are taking a medication called

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nitrate, commercially known as Isordil or Monoket. When you take tadalafil while using Monoket or Isordil, you may experience a very abrupt drop in your blood pressure, which can lead to a deficiency in vascularization in the heart, potentially

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resulting in a heart attack. In general, why do reports of heart attacks occurring while taking tadalafil, Viagra, or similar medications arise? You see, the main disease that causes erectile dysfunction in patients over 40, 50, and 60 years of age is

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arterial occlusion, a systemic disease that affects the entire body called atherosclerosis, which is the deposition of fat within the vessels. Atherosclerosis affects the penile vessel, which is much thinner than the cardiac vessel. The penile vessel has an average diameter of 1 mm, while the

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cardiac vessel has three. Therefore, it is the first to become clogged. If you block the penis, you cause erectile dysfunction. If you block the heart, it causes a heart attack. If you block the vessel in the head, it is commonly known as a

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stroke. Why does erectile dysfunction appear first? Because the vessel is thinner. In fact, there are studies showing that patients with erectile dysfunction have an increased chance of having a heart attack because the disease causing the problem is the

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same. It is the blockage of blood vessels. So that person who is sedentary, has atherosclerosis, has erectile dysfunction, and probably also has a small blockage in the coronary. However, this obstruction does not cause any issues in his daily life. Then he goes

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takes Viagra, takes tadalafil, takes these other medications, and he is a...

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activity with this increase in cardiac workload that vessel which was partially obstructed is unable to deliver the blood that the heart needs then this person has a heart attack but they did not have a heart attack because of the

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medication they had a heart attack because of the sexual relationship if that person tried to run two blocks they would also have a heart attack do you understand that is why patients who have heart diseases patients who are sedentary and those who

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have risk factors for atherosclerosis such as obesity sedentary lifestyle smoking diabetes and high blood pressure they should undergo this cardiac evaluation to determine if everything is fine with the coronary arteries and if they can engage in physical activity just like a patient

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who is 40 or 50 years old needs to undergo a cardiac evaluation to join a gym if it has been a long time since he last engaged in physical activity he also needs a cardiac evaluation to be able to take tadalafil or Viagra to

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determine if his coronary vessel can handle sexual intercourse not whether he can tolerate the medication right so the medication does not cause problems for the heart if you have erectile dysfunction and need to take the medication but you engage in

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physical activity you can handle running a very interesting measure we used to know if everything is fine is can you climb two flights of stairs without stopping in between if you can everything is probably okay but again I want to emphasize here

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do not forget to have a cardiac evaluation because this is very important okay erectile dysfunction is sometimes the first sign that a heart attack may be occurring indicating a blockage in the blood vessel of your heart as well combined then tadalafil is

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indeed a very important medication a great Ally in the treatment of erectile dysfunction we achieve many results EXC ENT results with the use of the medication both on demand and with daily use I particularly prefer the daily doses precisely because of this

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flexibility and the long-term Improvement in penile function and vascularization anyway I hope you enjoyed it below in the description there is a link to my website where you can find various articles about health please share in the comments what type

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you use what medication you take every day if you take it on demand if you have any side effects related to it and I hope you enjoyed it

Topics:tadalafilCialiserectile dysfunctionViagraphosphodiesterase type 5daily tadalafilon-demand tadalafilsexual healthcardiovascular riskendothelial function

Frequently Asked Questions

Is it better to take tadalafil daily or only before intercourse?

Both daily 5 mg and on-demand 20 mg tadalafil doses are similarly effective short-term, but daily dosing may improve long-term penile blood vessel health.

Can tadalafil be taken with food or alcohol?

Yes, tadalafil does not interact with food or alcohol, unlike Viagra, which is best taken on an empty stomach.

Is tadalafil safe for patients with heart conditions?

Tadalafil is safe except for patients taking nitrate medications like Isordil or Monoket, as this combination can cause dangerous drops in blood pressure.

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