Tadalafil for BPH and Other Conditions: An Overview

Whilst tadalafil is best known for treating erectile dysfunction, it’s licensed in the UK for other medical conditions as well. Understanding these additional uses can help you appreciate the versatility of this medication and whether it might address multiple health concerns simultaneously.

This guide explains tadalafil’s approved uses beyond erectile dysfunction, with a focus on benign prostatic hyperplasia (BPH). It is for informational purposes only and does not constitute medical advice. Only a qualified healthcare professional can determine whether tadalafil is appropriate for your specific condition.

Tadalafil’s Mechanism of Action

To understand why tadalafil works for multiple conditions, it helps to understand how it functions in the body.

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor. PDE5 is an enzyme found in various tissues throughout the body, including:

• Blood vessels in the penis (relevant for ED)
• Smooth muscle in the prostate and bladder (relevant for BPH)
• Blood vessels in the lungs (relevant for pulmonary hypertension)

By inhibiting PDE5, tadalafil increases levels of cyclic guanosine monophosphate (cGMP), which causes smooth muscle relaxation and improved blood flow. This same mechanism produces different therapeutic effects in different parts of the body.

For more detail on how tadalafil works, see our article on how does tadalafil work.

Tadalafil for Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia is a non-cancerous enlargement of the prostate gland that commonly affects men as they age. The enlarged prostate can press on the urethra and bladder, causing bothersome urinary symptoms.

What is BPH?

BPH is extremely common in older men. By age 60, about half of men have some degree of prostate enlargement, and by age 85, this rises to about 90%. Not all men with an enlarged prostate experience symptoms, but many do.

Symptoms of BPH

Common symptoms include:

• Difficulty starting urination
• Weak urine stream
• Intermittent flow (starting and stopping)
• Feeling that the bladder doesn’t empty completely
• Frequent need to urinate, particularly at night (nocturia)
• Sudden, urgent need to urinate
• Dribbling at the end of urination

These symptoms can significantly impact quality of life, affecting sleep, daily activities, and overall wellbeing.

How Tadalafil Helps with BPH

Tadalafil helps relieve BPH symptoms by relaxing smooth muscle in the prostate and bladder. This relaxation:

• Reduces resistance in the urethra
• Improves urine flow
• Decreases urgency and frequency
• Helps the bladder empty more completely

The mechanism is different from how tadalafil works for ED, though it involves the same basic action (PDE5 inhibition and smooth muscle relaxation).

Tadalafil Dosing for BPH

The approved dose of tadalafil for BPH in the UK is 5 mg once daily. This is the same dose used for daily treatment of erectile dysfunction, which means men with both ED and BPH may be able to address both conditions with a single daily tablet.

The 5 mg daily dose for BPH is taken continuously, not on-demand. It may take several weeks of regular use to notice the full benefit for urinary symptoms.

Tadalafil vs Other BPH Medications

Tadalafil isn’t the only medication for BPH. Other common treatments include:

Alpha-blockers (e.g., tamsulosin, alfuzosin):

• Work quickly (often within days)
• Relax prostate and bladder neck muscles
• Don’t shrink the prostate
• May cause dizziness or retrograde ejaculation

5-alpha reductase inhibitors (e.g., finasteride, dutasteride):

• Shrink the prostate over time
• Take several months to show full effect
• May affect sexual function
• More effective for very enlarged prostates

Combination therapy:

• Sometimes alpha-blockers and 5-alpha reductase inhibitors are used together
• Tadalafil may also be combined with other BPH medications in certain cases

The choice of medication depends on:

• Severity of symptoms
• Size of the prostate
• Presence of erectile dysfunction
• Other medications you’re taking
• Personal preference and response to treatment

Some prescribers prefer tadalafil for men who have both ED and BPH, as it can address both conditions. However, tadalafil may not be as effective as alpha-blockers for severe BPH symptoms.

Clinical Evidence for Tadalafil in BPH

Multiple clinical trials have demonstrated that tadalafil 5 mg daily improves BPH symptoms and urinary flow measurements. Studies show:

• Significant improvement in International Prostate Symptom Score (IPSS)
• Improved maximum urinary flow rate
• Reduced bother from urinary symptoms
• Benefits appear within 1-2 weeks and continue to improve over 12 weeks
• Well-tolerated with a side effect profile similar to tadalafil for ED

Tadalafil for BPH and ED Combined

One of the most significant advantages of tadalafil is that it’s licensed to treat both erectile dysfunction and BPH symptoms simultaneously. This is particularly relevant because these two conditions often occur together in middle-aged and older men.

Taking tadalafil 5 mg daily may:

• Improve erectile function
• Reduce BPH/urinary symptoms
• Simplify medication regimens (one tablet instead of multiple medications)
• Be more cost-effective than taking separate medications

However, not everyone with BPH has ED, and not everyone with ED has BPH. Your prescriber will assess whether combination treatment with tadalafil makes sense for your situation.

For more on daily dosing, see our article on tadalafil 5mg daily.

Tadalafil for Pulmonary Arterial Hypertension (PAH)

Pulmonary arterial hypertension is a serious condition involving high blood pressure in the arteries of the lungs. This is completely different from the common condition of high blood pressure (systemic hypertension).

What is PAH?

PAH occurs when the small arteries in the lungs become narrowed, blocked, or damaged. This makes the heart work harder to pump blood through the lungs, which can lead to heart failure if untreated.

PAH is a rare but serious condition that causes:

• Shortness of breath, especially during activity
• Fatigue
• Dizziness or fainting
• Chest pressure or pain
• Swelling in the ankles, legs, or abdomen
• Bluish colour to lips or skin

How Tadalafil Helps with PAH

Tadalafil helps treat PAH by relaxing the blood vessels in the lungs. This:

• Reduces pulmonary artery pressure
• Improves blood flow through the lungs
• Reduces strain on the right side of the heart
• Improves exercise capacity
• May slow disease progression

Tadalafil Dosing for PAH

For pulmonary arterial hypertension, tadalafil is prescribed at a higher dose than for ED or BPH:

• The typical dose is 40 mg once daily
• Treatment is continuous (not on-demand)
• It’s often marketed under the brand name Adcirca for this indication

The higher dose is needed to achieve sufficient blood vessel relaxation in the lungs.

Important Distinction

If you have PAH and are prescribed tadalafil for this condition, you should not take additional tadalafil for erectile dysfunction. The 40 mg daily dose for PAH will also affect erectile function, so adding more would be dangerous and unnecessary.

Similarly, if you’re taking tadalafil for ED or BPH, you should inform any specialist treating you for lung or heart conditions, as they need to know what medications you’re taking.

PAH Treatment is Specialist-Led

Unlike ED or BPH, pulmonary arterial hypertension is always managed by specialists (typically pulmonologists or cardiologists). You would not obtain tadalafil for PAH through a general online pharmacy service or high street chemist—this would be prescribed and monitored by a specialist clinic.

Other Potential Uses of Tadalafil (Research Stage)

Beyond its approved uses, researchers have investigated tadalafil for various other conditions. These are not currently licensed uses in the UK, but it’s worth being aware of ongoing research:

Raynaud’s Phenomenon

Some studies have explored whether PDE5 inhibitors including tadalafil might help with Raynaud’s phenomenon (a condition causing reduced blood flow to fingers and toes in cold temperatures). Results have been mixed, and this is not a standard use.

High-Altitude Pulmonary Edema

There’s research interest in whether tadalafil might help prevent or treat high-altitude pulmonary edema in mountaineers, though this remains investigational.

Intermittent Claudication

A few studies have looked at whether tadalafil might improve walking distance in people with peripheral artery disease, but results haven’t been conclusive enough for approval.

Other Conditions

Researchers continue to investigate tadalafil’s effects in various contexts, from wound healing to certain neurological conditions. However, these remain experimental, and tadalafil should only be used for its approved indications under medical supervision.

Using Tadalafil for Multiple Conditions

If you have more than one condition that tadalafil might help with, discuss this with your prescriber. The key considerations are:

Dose Optimisation

• For ED only: Typically 10-20 mg on-demand or 2.5-5 mg daily
• For BPH only: 5 mg daily
• For both ED and BPH: Usually 5 mg daily
• For PAH: 40 mg daily (which would also cover ED if present)

You should never take multiple tadalafil doses intended for different conditions. Work with your healthcare provider to find a single dosing regimen that addresses your needs.

Medication Interactions

Tadalafil’s interactions are the same regardless of which condition it’s treating. If you’re taking other medications for prostate problems, heart conditions, or blood pressure, these must all be considered together.

Monitoring

Using tadalafil for BPH or PAH typically involves more regular monitoring than using it solely for ED. Your healthcare provider will want to:

• Track symptom improvement
• Monitor any side effects
• Periodically assess whether the medication is still appropriate
• Adjust treatment if needed

Safety Considerations

The safety profile of tadalafil is generally consistent across its various uses, though some considerations are particularly relevant to BPH and PAH:

Blood Pressure Effects

Tadalafil can lower blood pressure modestly. This is usually not problematic, but men taking medications for high blood pressure or those with low blood pressure need careful monitoring.

For men taking alpha-blockers for BPH, combining with tadalafil requires caution as both medications can lower blood pressure. Your prescriber will guide you on safe use.

For more information, see our article on tadalafil, alcohol and blood pressure.

Prostate Cancer Screening

Tadalafil treats BPH symptoms but doesn’t diagnose or rule out prostate cancer. If you have urinary symptoms, your doctor should assess you for prostate cancer (typically with a PSA blood test and possibly a physical examination) before starting tadalafil.

Tadalafil isn’t appropriate for everyone with urinary symptoms—some conditions require different treatments or investigations.

Cardiovascular Assessment

Because tadalafil affects blood flow and blood pressure, men with heart conditions need careful assessment before starting treatment, regardless of which condition is being treated.

When Tadalafil Might Not Be Suitable for BPH

Although tadalafil can help with BPH, it’s not always the best choice:

• Severe BPH: Alpha-blockers or 5-alpha reductase inhibitors might be more effective
• Very large prostate: Surgery might be more appropriate than medication
• Acute urinary retention: This is a medical emergency requiring urgent treatment, not tadalafil
• Certain medication interactions: Some drugs contraindicate tadalafil use
• Specific health conditions: Your doctor will assess suitability

Alternative Treatments for BPH

If tadalafil isn’t suitable or effective, other options include:

• Other medications (alpha-blockers, 5-alpha reductase inhibitors)
• Combination drug therapy
• Minimally invasive procedures (e.g., TURP, laser treatments)
• Surgery for severe cases

Cost and Availability for BPH

In the UK, tadalafil for BPH is available on both NHS and private prescription, though availability on the NHS varies by local area (Clinical Commissioning Group).

Some men find that prescribers are more willing to provide NHS prescriptions for BPH than for ED alone, particularly if urinary symptoms are significantly affecting quality of life.

For more information on NHS vs private prescriptions, see our guide on tadalafil on the NHS vs private prescriptions.

Frequently Asked Questions

Can I use my ED tadalafil for BPH symptoms?

Technically, tadalafil 5 mg daily is the same medication whether prescribed for ED, BPH, or both. However, you should only use tadalafil as prescribed. If you have BPH symptoms and are currently taking tadalafil for ED, speak with your doctor about whether the dosing should be adjusted.

How long does it take for tadalafil to help with BPH?

You may notice some improvement in urinary symptoms within 1-2 weeks, but the full benefit typically develops over 4-12 weeks of continuous daily use.

Can tadalafil shrink my prostate?

No. Tadalafil relaxes smooth muscle and improves symptoms but doesn’t reduce the size of the prostate. If prostate size reduction is important, medications like finasteride or dutasteride might be more appropriate.

Is tadalafil better than tamsulosin for BPH?

This depends on your individual situation. Tamsulosin (an alpha-blocker) often works more quickly and may be more effective for severe symptoms. Tadalafil may be preferred if you also have erectile dysfunction. Some men find one works better than the other. Your prescriber can help you decide.

Can I take tadalafil with other BPH medications?

Possibly, but this requires careful medical supervision. Combining tadalafil with alpha-blockers needs caution due to blood pressure effects. Combining with 5-alpha reductase inhibitors is sometimes done. Never start combining medications without your doctor’s approval.

Does tadalafil for PAH also help with ED?

Yes. The higher dose (40 mg) used for PAH will also improve erectile function. You should not take additional tadalafil for ED if you’re already taking it for PAH.

Conclusion

Tadalafil’s versatility extends beyond erectile dysfunction. Its approved uses for benign prostatic hyperplasia and pulmonary arterial hypertension demonstrate that this medication can address multiple health concerns through its effect on smooth muscle and blood flow.

For men with both erectile dysfunction and BPH symptoms, tadalafil offers the potential benefit of treating both conditions with a single daily tablet. This can simplify medication regimens and potentially improve quality of life across multiple dimensions.

However, tadalafil isn’t automatically the right choice for everyone with BPH or PAH. The decision to use tadalafil for these conditions should be made by a qualified healthcare professional who can:

• Assess whether tadalafil is appropriate for your specific situation
• Determine the correct dose
• Rule out conditions that require different treatment
• Monitor your response and adjust as needed
• Consider interactions with your other medications

If you have BPH symptoms, erectile dysfunction, or both, speak with your doctor about whether tadalafil might be suitable. If you’re already taking tadalafil for one condition and develop symptoms related to another, inform your prescriber—they may be able to optimise your treatment.

This information is for educational purposes and should not replace professional medical advice. For personalised guidance about tadalafil for BPH or other conditions, always consult a qualified healthcare professional.