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Erectile dysfunction (ED) isn’t always easy to talk about, but it’s a common condition affecting 30 million men* ^[1] National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts for Erectile Dysfunction. in the United States.

Despite being easily treatable, over 50% of respondents from our January 2024 survey said they lived with ED for years before they sought medical help. Untreated ED ^[1] National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts for Erectile Dysfunction. can lead to strained relationships, depression, anxiety, and low self-esteem.

“Remember that sexual health is essential to overall well-being, and seeking help for ED is a positive step toward improving your quality of life,” says Rhiannon John, certified sexologistⓘ A specialist who studies human sexual behavior. . 

If your doctor prescribes Cialis (tadalafil) for erectile dysfunction, you may want to consider generic Cialis, since it’s the same medication at a much lower price. The medication can be taken daily or as needed, and it lasts longer than Viagra. The FDA ensures that generic drugs meet the same rigorous standards as their brand-name counterparts, guaranteeing equivalent effectiveness. So, whether you opt for Cialis or generic tadalafil, you can expect comparable results in treating erectile dysfunction.

We spoke with urologists and sexual health experts to get a comprehensive understanding of tadalafil, including how it works and where you can get it. While not all generic tadalafil is FDA-approved, we only recommend platforms that offer FDA-approved Cialis or tadalafil to ensure safety and efficacy.

*For brevity, we refer to all people assigned male at birth as men throughout this guide.

Best for generic Cialis: Hims

What is tadalafil?

Tadalafil is a type of medicine called a PDE5 inhibitor used to treat erectile dysfunction, symptoms of benign prostatic hyperplasia (BPH), and the ability to exercise in people with pulmonary arterial hypertension (PAH). Tadalafil helps increase blood flow to the penis to cause an erection. ^[5] MedlinePlus. Tadalafil.

Tadalafil is the active ingredient in Cialis. Generic tadalafil and brand-name Cialis are the same medication, but different pharmaceutical companies make them. “Regarding safety, efficacy, and quality, generic tadalafil should be equivalent to Cialis when it meets regulatory standards and is obtained from a reputable source,” says Michael Green, MD, chief medical officer at Winona, Inc., based in Lake Arrowhead, California. 

Tadalafil can be taken at any time of the day, with or without food. It comes in five-, 10-, and 20-milligram doses. 

What is a PDE5 inhibitor?
In those with erectile dysfunction, PDE5 inhibitors improve erections by increasing blood flow to the penis.

PDE5 inhibitors work by inhibiting the PDE5 enzyme. When PDE5 is blocked, cGMP levels increase, leading to the relaxation of smooth muscle cells in blood vessels. This increases blood flow, which can help treat conditions like erectile dysfunction and pulmonary hypertension.

Is generic tadalafil as effective as Cialis?

Yes, generic tadalafil is just as effective as Cialis. Both medications contain the same active ingredient, tadalafil, and are used to treat erectile dysfunction. The only significant difference between the two is the price. Since generic tadalafil is typically more affordable than Cialis, it offers the same benefits at a lower cost. Like Cialis, generic tadalafil works by increasing blood flow to achieve and maintain erections during sexual activity.

The FDA holds generic drugs to the same standards as name brands, ensuring they are equally effective. Whether you choose Cialis or generic tadalafil, you can expect similar results in treating ED.

How is generic Cialis different from Viagra?

Cialis has a longer half-life than Viagra, meaning it is effective as needed for a longer time. Cialis is effective for roughly 18 hours, while Viagra is only effective for four hours. You could take Cialis in the afternoon, and it should be effective that evening, any time overnight, and the next morning. 

However, Cialis has a slower onset than Viagra. The effectiveness peaks around two to three hours after taking it, so it may be more beneficial for people who can plan sexual activities ahead of time. Viagra takes effect in 45 minutes to one hour, so it may be a good choice for those who engage in more spontaneous sex. 

Cialis can be taken daily or as needed; Viagra is only taken as needed. If you’re interested in Cialis but still want room for spontaneous sexual activities, you can take Cialis as a daily dose. At a low dose, Cialis daily can build up in your system over time so that you don’t have to schedule sex around the time you take the medication.

Special considerations: erectile dysfunction medication for older adults

Viagra and Cialis may be ineffective or dangerous based on your health history and current medications.

Some of the most common chronic conditions affecting older adults—including high blood pressure, high cholesterol, heart disease, and diabetes—can damage penile blood vessels and nerves, ^[3] Defeudis G, et al. Diabetes/Metabolism Research and Reviews. 2022. Erectile Dysfunction and Diabetes: A Melting Pot of Circumstances and Treatments. leading to new or worsening ED that doesn’t respond to Viagra or Cialis. Fortunately, several other ED treatments are available, including penile injections, vacuum erection devices, and a discreet penile prosthesis.  ^[4] McMahon CN, et al. BMJ. 2006. Treating Erectile Dysfunction When PDE5 Inhibitors Fail.

ED can also appear as one of the first symptoms of cardiovascular disease, hypertension, anxiety, and other chronic health concerns. If you haven’t had a physical exam within the last year, don’t try to get ED medication online. Visit your doctor in person first to ensure underlying conditions are diagnosed and treated alongside ED before using an online platform.

Who shouldn’t take Viagra or Cialis

Viagra and Cialis shouldn’t be taken with some of the medications used to treat chest pain, high blood pressure, or lower urinary tract symptoms. Viagra should also be avoided in men taking protease inhibitors—a specific class of medications used to treat HIV. 

Combining nitrates or alpha-blockers with ED pills may cause a severe, life-threatening drop in blood pressure, which can be associated with feeling dizzy, fainting, falling, and even death.  This is not a complete list of medications that can interact with Viagra and Cialis. Talk to your provider about everything you take—including recreational drugs—when discussing potential ED treatments. 

Cialis and Viagra also shouldn’t be taken by people with low resting blood pressure, uncontrolled high blood pressure, inherited disorders of the eye or retina, recent heart attack or stroke, or uncontrolled heart disease. Cialis and Viagra may worsen abdominal pain in men with stomach ulcers. 

Where can you find generic Cialis?

Hims for generic Cialis

Sesame for generic Cialis

Optum Store for generic Cialis

Generic Cialis (tadalafil) information

Generic Cialis cost

Generic tadalafil costs less than name-brand Cialis, and it is usually the most affordable erectile dysfunction treatment option. In this review, the cost of generic Cialis ranges from $0.17–$9 per dose. Depending on your insurance coverage and other factors, you may end up paying more through a telehealth platform like the Optum Store. If you do not plan to use insurance, platforms like Hims or Sesame can be more affordable. In general, Cialis is more affordable than other ED medications like Viagra.

If you already have a prescription from a health care provider, you can also use platforms like GoodRx or CostPlus Drugs to find affordable ED medications, including tadalafil. GoodRx provides coupons you can use at your local pharmacy, while CostPlusDrugs is an online pharmacy where you can purchase affordable medications.

PDE5 inhibitors: how do they work?

PDE5 inhibitors are the first line of treatment for erectile dysfunction, according to the American Urological Association (AUA) Guidelines for ED treatment. ^[6] American Urological Association. Erectile Dysfunction: AUA Guideline (2018).

Four oral PDE5 inhibitors are FDA-approved for ED in the United States: 

• Tadalafil 
• Sildenafil
• Vardenafil
• Avanafil

When sexual stimulation occurs, nerve impulses release neurotransmitters, which cause the blood vessels of the penis to relax and widen so that more blood can flow into the penis. 

PDE5 inhibitors help to maintain an erection, but they don’t cause the erection. They work by blocking the breakdown of a substance that strengthens the erection. For the medication to work, you still need sexual stimulation, limited stress, healthy hormone levels, and relatively normal blood vessels that can allow for increased blood flow. If the medication doesn’t work, talk to your doctor about alternative or additional treatment options. 

In addition to PDE5 inhibitors, the AUA also recommends patients see a mental health professional and make lifestyle changes such as increased physical activity or dietary changes. These might improve your erectile function and overall health.

Tadalafil side effects

With any medication, there is a risk of side effects. The risk of side effects is slightly higher for people who take on-demand dosing rather than daily dosing. The PDE5 enzyme is located in multiple tissues in the body. Because of that, side effects may include headache, facial flushing, muscle aches, and diarrhea due to an increase in blood flow in those different tissues. 

Here are some potential tadalafil side effects ^[5] MedlinePlus. Tadalafil you should discuss with your doctor:  

• Headache
• Heartburn
• Nausea
• Diarrhea
• Flushing
• Stomach, back, arm, leg, or muscle pain
• Cough

You should also be on the lookout for more severe tadalafil side effects. If you experience any of the following symptoms, you should seek emergency medical treatment:

• Changes in vision (changes in color, decrease or loss of vision, blurred vision)
• Ringing in ears
• Erection lasting longer than four hours
• Dizziness
• Chest pain
• Hives
• Rash
• Difficulty breathing or swallowing
• Swelling (around the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs)
• Blistering or peeling skin

Erectile dysfunction can be an early sign of heart disease. If you suspect you have erectile dysfunction, you should talk to your health care provider to be referred to a cardiologist. A cardiologist can help you prevent the development of heart disease.

Before taking tadalafil, consult with your doctor about your specific health conditions and medications. “ED in the older population should be treated carefully, and treatment should be individualized. Online platforms can be beneficial to patients experiencing ED. However, prior to utilizing them, I would recommend a comprehensive history taking and thorough exam by your care provider prior to any treatment,” says Christian Reutter, DO, an osteopathic physician at Pelvic Rehabilitation Medicine. 

How we research and evaluate erectile dysfunction platforms

Based on our expert consultations, research, and testing, we determined the following factors to be essential for our readers when signing up for an erectile dysfunction medication platform:

• Costs for medications and consultations
• Ability to conduct live calls (video or phone) with prescriber
• Users must complete a health questionnaire when signing up
• Name-brand and generic prescriptions available
• Ability to message prescriber through the platform
• Ability to get an ED diagnosis through the platform
• Shipping options and costs
• Customer service

We have all our articles medically reviewed by an expert in the field to ensure the information is appropriate for NCOA readers’ needs. Read more on our methodology here.

Compare generic tadalafil providers

Bottom line

Generic Cialis, tadalafil, is an affordable treatment of erectile dysfunction. After receiving a prescription from your health care provider, you can purchase generic Cialis through an online platform like Hims or the Optum Store, or you can see a health care provider virtually and purchase your prescription in one visit through Sesame. Before you shop online for generic Cialis, talk to your health care provider to make sure it’s the right medication for you. 

Frequently asked questions

Is tadalafil the same as Cialis?

Yes, tadalafil is the same as Cialis. They contain the same ingredients, but different pharmaceutical companies make them.

How long does tadalafil take to work?

Tadalafil usually starts to work two to three hours after taking it.

Is tadalafil stronger than Viagra?

The effects of tadalafil last longer than Viagra does. Tadalafil can last up to 36 hours, while Viagra lasts up to four hours.

How long does tadalafil last?

After taking tadalafil, the effects will last 30 minutes to 18 hours. If you participate in sexual activities within this time, it will be easier to have and maintain an erection. You should not take more than one tadalafil in 24 hours.

How can I get generic Cialis?

You can get generic Cialis through your health care provider or an online platform like Hims, Sesame, or the Optum Store.

Have questions about this review? Email us at reviewsteam@ncoa.org.

Sources

1. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts for Erectile Dysfunction. Found on the internet at https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts
2. NCOA Adviser Erectile Dysfunction Survey. 300 respondents. Conducted using Pollfish. Launched January 2024. 
3. Defeudis G, et al. Erectile Dysfunction and Diabetes: A Melting Pot of Circumstances and Treatments. Diabetes/Metabolism Research and Reviews. February 2022. Found on the internet at https://onlinelibrary.wiley.com/doi/10.1002/dmrr.3494
4. McMahon CN, et al. Treating Erectile Dysfunction When PDE5 Inhibitors Fail.  BMJ. March 11, 2006. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1397768/
5. MedlinePlus. Tadalafil. Found on the internet at https://medlineplus.gov/druginfo/meds/a604008.html
6. American Urological Association. Erectile Dysfunction: AUA Guideline (2018). Found on the internet at https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline