No. In the sildenafil vs tadalafil choice, both tablets work well for most men with erectile dysfunction, but they are not safe for everyone. Men who take nitrates for chest pain, had a recent heart attack or stroke, have very low blood pressure or past sudden vision loss should not take them. A doctor checks first.
Written by Dr. Ashutosh A Shah, M.B.B.S., M.S., M.Ch., D.N.B., Plastic and Reconstructive Surgeon.
Medically reviewed by Dr. Ashutosh A Shah · Written for adults
No. In the sildenafil vs tadalafil choice, both tablets work well for most men with erectile dysfunction, but they are not safe for everyone. Men who take nitrates for chest pain, had a recent heart attack or stroke, have very low blood pressure or past sudden vision loss should not take them. A doctor checks first.
Sildenafil and tadalafil are the two most commonly prescribed erectile dysfunction medicines. Because they are so familiar, many men assume they are harmless and buy them without seeing a doctor. This Q&A guide explains how the two medicines differ, who should avoid them, which medicines they clash with, and how a doctor decides whether erectile dysfunction tablets are safe for you.
They are prescription tablets that improve blood flow into the penis. Both belong to a group called PDE5 inhibitors, which are medicines that relax the smooth muscle in penile blood vessels so more blood can flow in during arousal.
Erection problems often point to an underlying health issue, such as diabetes, high cholesterol or low testosterone. Our guide to erectile dysfunction causes explains these in more detail.
The main difference is how long each one lasts. Sildenafil works for a few hours, while tadalafil can work for up to a day and a half, which gives more freedom with timing.
| Feature | Sildenafil | Tadalafil |
|---|---|---|
| Starts working | Usually within 30 to 60 minutes | Usually within 30 minutes to 2 hours |
| How long it lasts | About 4 hours | Up to 36 hours |
| Effect of food | A heavy, fatty meal can slow it down | Food has little effect |
| How it is taken | Before planned sex | Before sex, or as a low daily tablet in selected men |
| Common side effects | Headache, flushing, blocked nose, a blue tinge to vision | Headache, indigestion, back and muscle aches |
| Who cannot take it | The same groups for both medicines (see below) | |
Neither tablet is stronger or better for every man. The right one depends on your health, your other medicines and how you prefer to plan sex.
Some men should not take sildenafil or tadalafil at all, because the risk to the heart or blood pressure is too high. The NHS guidance on sildenafil and its matching page on tadalafil list the same main groups.
Many men in these groups can still use erectile dysfunction medicine, but only after a doctor adjusts the plan or the dose. These conditions do not always rule the tablets out.
Nitrates are the most important clash, but several other medicines can raise the level of sildenafil or tadalafil in the blood or drop blood pressure too far. Always tell your doctor everything you take.
Never take a second tablet, or switch between sildenafil and tadalafil on the same day, unless your doctor has told you to.
Most side effects are mild and settle within a few hours. Headache, facial flushing, a blocked nose, indigestion and dizziness are the most common.
Seek urgent medical help if you have:
It is not a good idea. In India, sildenafil and tadalafil are prescription medicines, and tablets sold without one, online or loose, may be fake, the wrong strength or mixed with other drugs.
Skipping the doctor also skips the safety check. A man taking a heart medicine he does not recognise as a nitrate, or one with undiagnosed diabetes or heart disease, can come to harm. Erection problems can also be an early warning of blood vessel disease, which only a proper check will pick up.
Through a short conversation, a basic examination and, often, simple blood tests. The aim is to confirm the tablets are safe and to look for the cause behind the erection problem.
In our clinic, we often see men who have tried tablets bought without advice, felt unwell or got no result, and stopped. Many of them do well once the dose, timing or medicine is matched to their health. Our article on what happens at the first erectile dysfunction assessment walks through the visit step by step.
The doctor helps you choose. Each medicine suits a different routine, and your health decides which is safer.
If tablets do not work after a fair trial, it does not mean nothing will. Our page on erectile dysfunction treatment covers every option, and the erectile dysfunction page explains the condition itself.
Sildenafil and tadalafil help most men, but they are safest when a doctor has first checked your heart, blood pressure and medicines. Book a consultation and bring a list of everything you take.
This page is for education and is not a substitute for medical advice. Do not start, stop or combine erectile dysfunction medicines without a doctor's review, especially if you take heart or blood pressure medicines.
No. Most men with erectile dysfunction can take them safely, but they are not suitable for men taking nitrates, men with a recent heart attack or stroke, very low or uncontrolled blood pressure, severe liver disease or past vision loss from the optic nerve. A doctor should check your health and medicines first.
Neither is better for every man. They work in the same way and have similar success rates. Sildenafil lasts about 4 hours, while tadalafil can last up to 36 hours and is less affected by food. Your health, other medicines and routine decide which suits you best.
Often yes, if your blood pressure is controlled and you take routine blood pressure medicines. The doctor will check for alpha blockers and nitrates, which can drop blood pressure too far. Men with very low or uncontrolled high blood pressure should not take these tablets until it is treated.
Yes, most men with diabetes can take them, and erection problems are common in diabetes. They may need a different dose or more time to respond. Good sugar control, a heart check and testing for low testosterone usually improve results, so these are reviewed alongside the tablets.
A small amount is usually fine. Heavy drinking makes erections harder to get and adds to side effects such as dizziness, headache and low blood pressure. If you feel faint after combining alcohol and a tablet, sit or lie down and seek help if it does not settle.
Adult men of any age can take them if a doctor finds them suitable. In younger men, erection problems are often linked to stress or anxiety, so the doctor may suggest counselling alongside or instead of tablets. Using them without a real erection problem is not advised.
Do not increase the dose yourself. Check that you took it at the right time, with arousal, and not after a heavy meal. Most doctors suggest several attempts before judging. If it still fails, the doctor can change the dose or medicine, or discuss injections, devices or a penile implant.
Book a discreet consultation at Elegance Clinic in Surat, or start online from home.
