Who needs extra medical review before taking tadalafil for ED?

Tadalafil is not appropriate for everyone. Your prescriber needs to know about heart disease, chest pain, a recent heart attack or stroke, an irregular heartbeat, and very low or poorly controlled high blood pressure. Sexual activity puts extra demand on the heart, so its safety matters along with the medicine's safety.

Kidney or liver disease can change how your body clears tadalafil. You may need a different dose, a longer gap between doses, or another treatment. Tell your prescriber about past sudden vision loss, serious eye disease, or hearing problems.

Also share any history of prolonged erections, changes in the shape of the penis, sickle cell disease, leukemia, or multiple myeloma. These conditions may raise the risk of a prolonged erection.

Do not use tadalafil if you take nitrates or riociguat, or if you have had a serious allergic reaction to tadalafil. A licensed physician in your state reviews your history and decides whether treatment is appropriate. An in-person evaluation may be needed.