Daily tadalafil for prostate and urinary symptoms

What an enlarged prostate does

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate. According to the National Institute of Diabetes and Digestive and Kidney Diseases, it is the most common prostate problem in men over 50, affecting about 5% to 6% of men aged 40 to 64 and 29% to 33% of men 65 and older.

Symptoms include trouble starting to urinate, a weak or stop-start stream, dribbling, needing to go often or urgently and getting up at night. They do not always match prostate size. Some medicines, including over-the-counter cold remedies, antidepressants and diuretics, can make them worse.

How tadalafil helps

NIDDK describes PDE5 inhibitors as relaxing the muscles around the bladder, bladder neck and prostate. That eases the squeeze on the urethra and can calm an irritable bladder. Tadalafil is the PDE5 inhibitor with this FDA-approved use, at 5 mg once a day.

It does not reduce the size of the prostate or lower PSA, and it is not a treatment for prostate cancer or infection. Its job is symptom relief.

How it compares with other prostate medicines

• Alpha-blockers (for example tamsulosin, alfuzosin, doxazosin) relax the prostate and bladder neck. They usually act quickly and are a common first choice, but can cause dizziness and ejaculation changes.
• 5-alpha reductase inhibitors (finasteride, dutasteride) slowly shrink the prostate over months. They can lower sexual desire or function in some men and lower PSA readings.
• Combination therapy: NIDDK notes research suggesting an alpha-blocker plus a 5-alpha reductase inhibitor may work better than either alone for some men.
• Daily tadalafil treats urinary symptoms and erectile dysfunction with one pill, which suits men troubled by both.

Simple habits that ease urinary symptoms

• Cut back on fluids in the two hours before bed, while keeping total daily intake adequate.
• Limit caffeine and alcohol, which can irritate the bladder and increase urgency.
• Review cold and allergy remedies containing decongestants or antihistamines, which can worsen flow.
• Try double voiding: wait a moment after urinating, then try again.
• Keep a simple bladder diary for a few days to show your clinician how often and how much you go.

Who it suits best

Daily tadalafil is often a good fit for men with mild to moderate urinary symptoms who also have erectile difficulties, or who want to avoid the sexual side effects some other prostate medicines can cause. Men with a very large prostate, frequent infections, bladder stones or urinary retention usually need a urologist's plan, which may include other medicines or procedures.

Two safety points that matter here

Nitrates: tadalafil must never be taken with nitroglycerin, isosorbide or other nitrates, including poppers. The combination can cause a dangerous drop in blood pressure.

Alpha-blockers: many men with prostate symptoms already take one. The Cialis label says tadalafil is not recommended in combination with alpha-blockers for treating BPH, because together they can lower blood pressure further and cause dizziness or fainting. If you take an alpha-blocker, tell your clinician; the plan may be to use one or the other, or to involve your urologist.

Other cautions include a heart attack in the past 90 days, a stroke in the past six months, unstable angina, low blood pressure and uncontrolled high blood pressure.

Get symptoms checked before treating them

Urinary symptoms after 50 are usually BPH, but not always. NIDDK points out that bladder problems, urinary tract infections, prostatitis and prostate cancer can cause similar symptoms. A proper evaluation may include a urine test, a PSA blood test and a physical exam including a rectal exam, which needs to be done in person.

Seek care right away if you cannot urinate at all, see blood in your urine, have painful urgent urination with fever and chills, or have significant lower belly pain.

What to expect and how HealifyMD helps

Give it several weeks of consistent daily use before judging the effect. Common side effects are headache, indigestion, back pain and muscle aches; sudden vision or hearing loss or an erection lasting more than four hours need urgent care.

Your HealifyMD clinician reviews your urinary symptoms, medicines and history, and may recommend a PSA test and in-person exam before or alongside treatment. Daily tadalafil is from $99/month, confirmed at the eligibility review. Tadalafil is an FDA-approved medicine, available as a generic.