Can I get it?
Yes, if a doctor decides it is right for you. Tadalafil 10/20mg is authorised in the EU and can be prescribed after a medical review.
Tadalafil 10/20mgPrescription only
Online medical consultation for Tadalafil 10/20mg.
An EU-licensed doctor reviews your case and, if eligible, issues an electronic prescription valid at any EU pharmacy under Directive 2011/24/EU.
- Effect window of up to 36 hours
- A low-dose daily option exists
- More spontaneity, less planning
Start consultationStart consultation · €35
Full refund if a review is not approved · Medication, if prescribed, is dispensed and paid for separately at a pharmacy.
IN PLAIN TERMS
What Tadalafil 10/20mg is, and how to get treatment
Tadalafil is a prescription tablet for erectile dysfunction, authorised across the EU since 2002. Like sildenafil it relaxes the blood vessels in the penis so blood can flow in, and sexual arousal is still needed for it to work. Its distinguishing feature is how long the effect lasts: the EU product information reports a measurable effect up to 36 hours after a dose. It also comes as a low-dose tablet taken once a day rather than before sex, and it cannot be combined with nitrate heart medicines.
Tadalafil 10/20mg has been authorised for use in the EU since 12 November 2002, so a licensed doctor can prescribe it when it is clinically appropriate for you.
What can I take instead?
Our doctors review every Sexual health option and recommend what fits your history and goals.
See all Sexual health optionsWhat do the studies show?
Every trial behind Tadalafil 10/20mg is listed below with how many people took part and whether the results are peer-reviewed or a company announcement.
Jump to the studiesVERIFIED EVIDENCE
Tadalafil 10/20mg: evidence and regulatory guide.
WHAT IT IS
How it works
Tadalafil blocks the PDE5 enzyme that normally ends an erection, keeping the blood vessels in the penis relaxed so blood can flow in when a man is sexually aroused.
- PDE5
DEVELOPMENT STAGE
EU-authorised medicine
Trial register2 registered trials
Every NCT identifier links to its ClinicalTrials.gov record. A readout is not the same as peer-reviewed publication.
| TRIAL / NCT | POPULATION | PARTICIPANTS | STATUS | READOUT / COMPLETION |
|---|---|---|---|---|
| Integrated analysis of five randomised, double-blind, placebo-controlled 12-week trials | Men aged 22-82 (mean 59) with mild to severe erectile dysfunction of various causes | 1,112 | Read out | 2002-10-01 |
| Three at-home period-of-responsiveness studies | Men with erectile dysfunction | 1,054 | Read out | — |
What the studies reported
Results are grouped by source and evidence grade so journal data and manufacturer announcements cannot be confused.
Peer-reviewed
Brock GB, McMahon CG, Chen KK, Costigan T, Shen W, Watkins V, Anglin G, Whitaker S. Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol 2002;168(4 Pt 1):1332-1336. doi:10.1016/S0022-5347(05)64442-4 (PMID 12352386)| DOSE OR GROUP | MEAN WEIGHT CHANGE | WEEKS |
|---|---|---|
| 20 mg | Mean improvement of 7.9 points from baseline on the IIEF erectile function domain (p<0.001 vs placebo) | 12 |
| 20 mg | 75% of intercourse attempts completed (SEP question 3), p<0.001 vs placebo | 12 |
| 20 mg | 81% reported improved erections vs 35% on placebo (Global Assessment Question), p<0.001 | 12 |
This pooled five 12-week manufacturer-run trials, and the 7.9-point IIEF change is the within-group change from baseline rather than the difference from placebo.
NAMED SAFETY SIGNALS
What has been reported with Tadalafil 10/20mg.
Headache
Listed as common in the EU product information — between 1 in 100 and 1 in 10 men. Frequency rises with higher doses. With once-daily dosing, most headaches occur in the first 10 to 30 days of treatment.
Back pain
Listed as common in the EU product information — between 1 in 100 and 1 in 10 men. Named alongside headache, dyspepsia and myalgia as one of the most frequently reported reactions, with frequency rising at higher doses.
Myalgia (muscle pain)
Listed as common in the EU product information — between 1 in 100 and 1 in 10 men, with frequency rising at higher doses.
Dyspepsia (indigestion)
Listed as common in the EU product information — between 1 in 100 and 1 in 10 men.
Flushing and nasal congestion
Both listed as common in the EU product information — between 1 in 100 and 1 in 10 men.
Non-arteritic anterior ischaemic optic neuropathy (NAION)
Contraindicated in men who have lost vision in one eye because of NAION, whether or not the episode was linked to a PDE5 inhibitor.
Use with nitrates
Contraindicated with nitrate medicines and with guanylate cyclase stimulators, and after a recent heart attack (within 3 months) or stroke (within 6 months).
€35 one-offStart a medical consultation
FormOral tablet
FrequencyOn demand or daily
ResultsWindow of up to 36 hours
What you pay Hi-Doctor€35 one-off
IN 60 SECONDS
Tadalafil 10/20mg at a glance
- A PDE5-inhibitor tablet taken by mouth
- Adult men with erectile dysfunction; a daily dose also eases prostate symptoms
- One tablet at least 30 minutes before sex, or a low dose once every day
- Nitrates and poppers are contraindicated: blood pressure can fall dangerously
- Hi-Doctor consultation fee; the medicine is paid separately at a pharmacy
About
What is Tadalafil 10/20mg?
Also sold as Cialis.
Active ingredient: Tadalafil · Dosages: 10 / 20 mg on demand · 5 mg daily
Tadalafil is a PDE5 inhibitor whose long half-life sets it apart — up to 36 hours of therapeutic window. That allows spontaneity, and a low-dose daily regimen is available for continuous use when clinically appropriate.
It also suits people who respond better to sustained action, and it's considered in cases with lower urinary tract symptoms (BPH), where tadalafil is indicated. The doctor weighs the on-demand versus daily approach with you.
HOW IT WORKS
What Tadalafil 10/20mg does in your body
Like other PDE5 inhibitors it improves blood flow in response to stimulation — but its effect persists far longer. The on-demand dose acts in 30–60 minutes; the low daily dose reaches a steady effect in a few days.
Arousal releases nitric oxide
Sexual stimulation is what starts the process. Nerves and the lining of the blood vessels in the penis release nitric oxide, which triggers a messenger chemical called cyclic guanosine monophosphate, usually shortened to cGMP. Without arousal, tadalafil does nothing at all.
Tadalafil blocks the PDE5 enzyme
Tadalafil is a selective, reversible blocker of an enzyme called phosphodiesterase type 5, or PDE5, whose normal job is to break cGMP back down. With PDE5 blocked, cGMP builds up in the erectile tissue instead of being cleared away as fast as it appears.
Blood flows in, erection follows
Higher cGMP relaxes the smooth muscle in the arteries of the corpus cavernosum, so blood flows into the penis and an erection can form. The same relaxation happens in the prostate and bladder, which is why a daily dose can also ease urinary symptoms.
How it helps
How it helps.
The 36-hour window
One on-demand dose covers a much longer period than other PDE5s.
Daily option
A low daily dose allows sexual activity without planning, when appropriate.
Doctor-screened
Cardiovascular health and interactions are reviewed before any prescription.
What to expect
How to take it.
On demand or as a low daily dose — your doctor recommends the regimen that fits your frequency and preferences.
- On demand · 30–60 minutes before activity
- Effect window · Up to 36 hours
- Daily option · Low dose reaches steady effect in days
- Message your doctor to adjust the regimen if needed
Doses your doctor can prescribe
- On demand10 / 20 mg
- Daily (when appropriate)low dose, typically 5 mg
Your schedule is personal
These are typical steps only. Your doctor adjusts the plan to how you respond and tolerate it — and you can message them at any point.
DAY TO DAY
Taking Tadalafil 10/20mg day to day
Agree which regimen first
There are two routes. On demand means one tablet before sex. Once daily means a small tablet every day, so dosing and sex are no longer linked. Your prescriber chooses with you, mainly based on how often sex is expected.
Take it 30 minutes ahead
On the on-demand route, swallow the tablet whole at least 30 minutes before sexual activity. Peak blood levels are reached at around two hours. Never take more than one dose in any 24-hour period.
Food does not matter
Tadalafil can be taken with or without food, because the rate and extent of absorption are not influenced by meals. Dosing in the morning versus the evening also makes no clinically relevant difference to absorption.
Arousal is still required
The tablet does not produce an erection on its own. Sexual stimulation is required for it to work. If nothing happens without arousal, that is expected behaviour rather than a sign the dose is too low.
Same time each day if daily
On the once-daily route, take the tablet at roughly the same time every day. Steady levels in the blood are reached within five days of daily dosing, so judge the effect after that point, not on day one.
Go easy on alcohol
Tadalafil did not increase the average blood-pressure drop caused by alcohol in studies, but some people had postural dizziness and a drop in blood pressure on standing. Heavy drinking also makes erections harder to achieve.
List everything else you take
Grapefruit juice and medicines such as ritonavir, ketoconazole, itraconazole, erythromycin and clarithromycin raise tadalafil levels. Rifampicin, phenytoin and carbamazepine lower them. Include recreational drugs, especially poppers.
Keep the review booked
Whether continued daily use still suits you should be reassessed periodically. Report side effects, and tell any doctor treating you for chest pain that you take tadalafil, before nitrates are given.
Safety first
Safety, in full.
Tadalafil 10/20mg is an effective medicine — and like any medicine it carries risks. Your doctor screens for all of this before prescribing. Here's the honest picture, not just reassurance.
Side effects, by how often they happen
Stop and get urgent medical help if
seek medical help immediately
these need urgent attention, whatever the frequency
- An erection lasting four hours or more, which is a medical emergency
- Sudden loss of vision, blurred vision or visual distortion in either eye
- Sudden decrease or loss of hearing, with or without ringing in the ears
- Chest pain during or after sex, and tell staff you have taken tadalafil
- Swelling of the face, lips, tongue or throat, or difficulty breathing
- Fainting, a seizure, sudden weakness or slurred speech
- A severe rash that blisters or peels
Common
common (≥1/100 to <1/10)
somewhere between 1 in 100 and 1 in 10 people
- Headache, the most frequently reported effect, usually mild and short-lived
- Indigestion or heartburn, known medically as dyspepsia
- Back pain
- Muscle aches, known medically as myalgia
- Pain in an arm or a leg
- Flushing, a warm red feeling in the face and neck
- A blocked or stuffy nose
- On daily dosing most headaches appear in the first 10 to 30 days
Uncommon
uncommon (≥1/1,000 to <1/100)
somewhere between 1 in 1,000 and 1 in 100 people
- Dizziness
- Blurred vision, or sensations described as eye pain
- Ringing in the ears, known medically as tinnitus
- A fast heartbeat, or palpitations
- Low blood pressure, or raised blood pressure
- Shortness of breath, or nosebleeds
- Abdominal pain, nausea, vomiting or acid reflux
- Skin rash, prolonged erections, or blood in the urine
Rare
rare (≥1/10,000 to <1/1,000)
somewhere between 1 in 10,000 and 1 in 1,000 people
- Stroke, transient ischaemic attack, fainting, seizures or transient amnesia
- Migraine
- Non-arteritic anterior ischaemic optic neuropathy, a sudden optic nerve injury
- Visual field defect, swollen eyelids, red eyes or retinal vascular occlusion
- Sudden hearing loss
- Heart attack, unstable angina or ventricular arrhythmia
- Priapism, penile bleeding or blood in the semen
- Hives, Stevens-Johnson syndrome, exfoliative dermatitis or heavy sweating
Prescribed for adult men with erectile dysfunction in two regimens.
- On-demand: 10 mg taken at least 30 minutes before sexual activity. Adjustable to 20 mg or 5 mg by the doctor.
- Daily low-dose: 2.5 mg or 5 mg once a day for men with frequent activity or co-existing benign prostatic hyperplasia (BPH).
- Effect window of up to 36 hours from a single dose; food and alcohol have minimal impact compared with sildenafil.
WHO SHOULD NOT TAKE IT, AND WHO NEEDS EXTRA CARE
- You are allergic to tadalafil or to any other ingredient in the tablet
- You take any form of organic nitrate, such as a nitroglycerin spray or tablet
- You use riociguat or another guanylate cyclase stimulator
- You use amyl nitrite or nitrate poppers, including recreationally
- You are already taking another PDE5 inhibitor, because of severe low blood pressure and priapism risk
- Your doctor has advised that sexual activity is inadvisable for your heart
- You had a heart attack within the last 90 days, or a stroke within the last 6 months
- You have unstable angina, or angina that comes on during sexual intercourse
- You have had New York Heart Association class 2 or worse heart failure in the last 6 months
- You have uncontrolled arrhythmia, uncontrolled high blood pressure, blood pressure below 90/50 mmHg, or past vision loss in one eye from NAION
When to seek urgent care
For severe, sudden or unexpected symptoms, call your local emergency number or go to the nearest emergency department. Then let your doctor know through your account chat.
Medicines and substances that interact
| MEDICINE OR SUBSTANCE | WHAT CAN HAPPEN | WHAT THE DOCTOR DOES |
|---|---|---|
| Nitrates (e.g. GTN spray, isosorbide) | Tadalafil amplifies the blood-pressure drop from nitrates, which can be large and unpredictable | Absolute bar to prescribing; at least 48 hours must pass before emergency nitrates |
| Riociguat and other guanylate cyclase stimulators | Adds to the blood-pressure-lowering effect and can cause symptomatic low blood pressure | Contraindicated, so the prescriber selects a different treatment entirely |
| Doxazosin (an alpha-blocker) | Significantly increases doxazosin's blood-pressure drop for at least twelve hours, sometimes causing fainting | Combination not recommended; prescriber may change the alpha-blocker or avoid tadalafil |
| Other alpha-blockers (alfuzosin, tamsulosin) | Both are blood-vessel relaxants, so blood pressure can fall further, especially in older men | Start at the minimum dose and adjust gradually, with extra caution in the elderly |
| Ritonavir, ketoconazole, itraconazole, erythromycin, grapefruit juice | Block the CYP3A4 enzyme; ketoconazole 400 mg daily quadrupled tadalafil exposure in a study | Prescribe with caution, and a lower tadalafil dose may be chosen |
| Rifampicin, phenytoin, carbamazepine, phenobarbital | Speed up tadalafil breakdown; rifampicin cut tadalafil exposure by 88% in a study | Expect a weaker effect; the prescriber reviews whether tadalafil still suits you |
| Blood-pressure medicines (ACE inhibitors, beta-blockers, diuretics, calcium blockers) | A small extra fall in blood pressure, generally minor and not likely to be clinically relevant | Usually allowed, with advice about dizziness and a possible review of doses |
| Other erectile dysfunction treatments | Combining tadalafil with other ED treatments has not been studied for safety or effectiveness | Do not combine; the prescriber keeps you on one treatment at a time |
Have a doctor review your caseThis is exactly what the doctor screens for before prescribing anything.
Read the full Tadalafil 10/20mg safety summaryEVIDENCE
What the clinical trials found
In the tadalafil registration trials, both the on-demand and the once-daily regimens improved erectile function and the share of successful intercourse attempts compared with placebo, and one dedicated trial found the effect was still measurable 36 hours after a single dose.
1,112 men with erectile dysfunction · 12 weeks
Integrated analysis of five placebo-controlled trials, p<0.001 versus placebo
Source: Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses1,112 men with erectile dysfunction · 12 weeks
Sexual Encounter Profile question 3 in the same integrated analysis, p<0.001 versus placebo
Source: Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses348 men with erectile dysfunction in Europe and the United States · Single dose, assessed at 36 hours
Randomised to tadalafil 20 mg or placebo, p<0.001
Source: Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: a randomized controlled trialMen with erectile dysfunction · 12 weeks
Dose-response study; 35% of men on placebo also reported improved erections
Source: EAU Guidelines on Sexual and Reproductive Health, limited update March 2025217 treatment-naive men with erectile dysfunction
Randomised to tadalafil 5 mg daily or placebo, mean per-subject proportion
Source: Cialis (tadalafil): Summary of Product Characteristics, Annex IThese figures are group averages, not promises. In the trials a typical man on tadalafil completed a clear majority of intercourse attempts, while a meaningful share of men on dummy tablets also improved, which is why the comparison against placebo matters more than the headline number. Your own response may be better or worse than the average, and the only way to know is to try the dose your prescriber recommends and report back.
ALTERNATIVES
Tadalafil vs the other EU-approved ED tablets
| MEDICINE | HOW IT IS TAKEN | HOW OFTEN | TYPICAL DOSE RANGE | EU-AUTHORISED INDICATION | KEY EVIDENCE |
|---|---|---|---|---|---|
| Sildenafil | Tablet by mouth | As needed, maximum once a day | 25–100 mg | Erectile dysfunction in adult men; sexual stimulation is required | Dose-response study: improved erections 56%, 77%, 84% vs 25% placebo |
| Vardenafil | Tablet by mouth | As needed, maximum once a day | 5–20 mg | Erectile dysfunction in adult men; sexual stimulation is required | Dose-response study: improved erections 66%, 76%, 80% vs 30% placebo |
| Avanafil | Tablet by mouth | As needed, maximum once a day | 50–200 mg | Erectile dysfunction in adult men; sexual stimulation is required | Successful attempts 47%, 58%, 59% vs 28% placebo across the three doses |
Not sure which one fits your case? The doctor reviews your history and tells you.
Start consultation · €35ACCESS AND COST
Getting Tadalafil 10/20mg, and what it costs
This describes how tadalafil is legally supplied in each country and whether the public health system pays, not what any consultation costs. Rows say "See national criteria" where the reimbursement position could not be confirmed from an official national source, rather than guessing.
What you pay Hi-Doctor
€35 one-off
Answer a few questions and a licensed EU doctor reviews your case in less than 2 hours on average. Refunded in full if it's not right for you.
What the pharmacy charges
Hi-Doctor does not sell, stock or dispense medicines and does not set their price. The medicine is paid for separately at the pharmacy, and the amount depends on the country, the pack size, whether a generic is available and whether your health system covers it. The official national database linked in the table publishes the current authorised price.
| COUNTRY | HOW IT IS SUPPLIED | COVERED BY THE HEALTH SYSTEM? | OFFICIAL SOURCE |
|---|---|---|---|
| Spain | Prescription-only | See national criteria | AEMPS CIMA |
Show the other countries
| Germany | Prescription-only | Excluded from statutory health insurance | PharmNet.Bund AMIce |
|---|---|---|---|
| France | Prescription-only (liste I) | Not reimbursable | Base de données publique des médicaments |
| Italy | Prescription-only (repeatable prescription) | Restricted — AIFA Nota 75 criteria only | AIFA Medicinali |
| Netherlands | Prescription-only | Not reimbursed for erectile dysfunction | CBG-MEB Geneesmiddeleninformatiebank |
| Portugal | Prescription-only (MSRM) | Reimbursement rate 0% | INFARMED Infomed |
| Belgium | Prescription-only | See national criteria | FAGG-AFMPS medicines database |
| Ireland | Prescription-only, plus one 10 mg pharmacy product | See national criteria | HPRA Find a Medicine |
| Austria | Prescription-only (Rp) | See national criteria | BASG Medikamente Info Austria |
| Poland | Prescription-only, plus one 10 mg product sold OTC | See national criteria | Rejestr Produktów Leczniczych |
PRICING
You only pay if treatment is approved.
€35 for one sexual-health consultation. Paid once, with no recurring charge.
Sexual health
ONE-OFF
€35 one-off
One consultation, one doctor, one decision.
Nothing stored publicly, ever
Start consultation
Full refund if a review is not approved
WHAT'S INCLUDED
- Consultation reviewed by an EU-licensed doctor
- Electronic prescription if approved
- Full refund if not approved
Full refund if a review is not approved
If a review is not approved, we refund the €35 consultation fee in full.
Note: The medication, if the doctor prescribes it, is paid separately at the pharmacy at the price it sets. Hi-Doctor does not sell medications.
HOW THE DOCTOR DECIDES
A licensed doctor reviews your case, not an algorithm
An EU-licensed doctor reads your questionnaire and answers in less than 2 hours on average.
If the doctor decides it is not safe to prescribe, the consultation fee is refunded in full.
Follow-up happens in the private chat inside your account, under GDPR. No WhatsApp, no SMS.
FREQUENTLY ASKED QUESTIONS
Questions about Tadalafil 10/20mg.
OTHER SEXUAL HEALTH TREATMENTS
Explore related treatments.
SOURCES
Where this information comes from
- 01
Cialis (tadalafil): Summary of Product Characteristics, Annex I — European Medicines Agency, 2025
- 02
Cialis: EPAR medicine overview — European Medicines Agency, 2002
- 03
Cialis 20 mg film-coated tablets: Summary of Product Characteristics — electronic medicines compendium (emc), 2026
- 04
Tadalafil: NHS medicines A to Z — National Health Service (UK), 2026
- 05
Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses — The Journal of Urology 168(4 Pt 1):1332-6, 2002
- 06
Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: a randomized controlled trial — Urology 62(1):121-5, 2003
- 07
EAU Guidelines on Sexual and Reproductive Health, limited update March 2025 — European Association of Urology, 2025
- 08
Viagra (sildenafil): Summary of Product Characteristics, Annex I — European Medicines Agency, 2025
- 09
Levitra (vardenafil): Summary of Product Characteristics, Annex I — European Medicines Agency, 2024
- 10
Spedra (avanafil): Summary of Product Characteristics, Annex I — European Medicines Agency, 2025
- 11
Tadalafilo: authorised medicines register (99 entries, prescription-only) — AEMPS CIMA, Spain, 2026
- 12
CIALIS 20 mg comprimé pelliculé: liste I, non remboursable, prix libre — Base de données publique des médicaments, France, 2026
- 13
§ 34 SGB V: medicines excluded from statutory health insurance, including erectile dysfunction — Bundesministerium der Justiz, Germany, 2026
- 14
Nota 75: PDE5 inhibitor reimbursement limited to neurogenic erectile dysfunction — AIFA, Gazzetta Ufficiale della Repubblica Italiana n. 7, 2017
- 15
Tadalafil: not reimbursed by basic health insurance — Medicijnkosten.nl, Zorginstituut Nederland, 2026
- 16
Lista de medicamentos genéricos disponíveis no mercado: tadalafil, taxa de comparticipação 0% — INFARMED, Portugal, 2026
- 17
Public assessment report: Cialis for men 10 mg film-coated tablets, a non-prescription tadalafil medicine — Health Products Regulatory Authority, Ireland, 2024
- 18
Tadalafil Mensil 10 mg: availability category OTC, medicine supplied without a doctor's prescription — Rejestr Produktów Leczniczych, Poland, 2026
- 19
Tadalafil 5 mg oral tablet: Cialis and seven generics listed under erectile dysfunction — CBIP/BCFI Répertoire Commenté des Médicaments, Belgium, 2026
- 20
Arzneispezialitätenregister: authorised medicines register — BASG, Austria, 2026
Reviewed by Hi-Doctor's medical team · Last reviewed 2026-07-27 · Next review due 2027-07-27
This page is educational information about a medicine, not a recommendation to take it and not a substitute for a medical consultation. Only a licensed doctor who has reviewed your history can decide whether a treatment is appropriate for you.
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