You may have been prescribed Tadalafil alongside your Testosterone Replacement Therapy (TRT) plan, or as an alternative treatment to help improve your testosterone levels, sexual function, or overall quality of life.

Manual are here to support you with any questions or queries you may have with respect to your medicine. As a first step, it is important for you to take the time to read the manufacturer’s patient information leaflet (PIL) enclosed in your box. This gives you information about how to take Tadalafil, what to avoid, side-effects and potential interactions with other medications.

Why have you been prescribed Tadalafil?

Tadalafil is a class of medicines known as Selective PDE5 inhibitors (phosphodiesterase type 5 inhibitors). This comes from the same family of drugs as Sildenafil (Viagra), which you may have heard of. But unlike Viagra, Tadalafil stays in the body longer and so has more time to make a difference and provide benefits.

The use of Tadalafil to improve symptoms and boost testosterone levels is off-label. 

There is evidence to show that daily Tadalafil (5mg minimum dose), can promote an increase in testosterone production, and provide a relief in symptoms of low testosterone which may include:

• Sexual symptoms: lower sex drive, potential erectile dysfunction
• Lower energy or increase in fatigue
• Low mood and motivation
• Lack of muscle gain or difficulty to lose weight

Tadalafil can be used alongside TRT to improve sexual symptoms, reduce risk of heart disease and even improve waterwork symptoms. It can also complement the treatment plan to optimise the balance of testosterone and oestrogen. It can also be used to improve testosterone production without TRT.

It is important to know that the use of Tadalafil is not the only thing that you can do to maximise your own production of testosterone.

Lifestyle changes include:

• Exercise: Regular exercise, especially weight training, can increase testosterone levels.
• Diet: Eat a balanced diet that includes lean proteins, healthy fats, fruits, vegetables, and whole grains.
• Sleep: Getting enough restful sleep can help boost testosterone levels. Testosterone production typically peaks during REM sleep.
• Reduce stress: Chronic stress can inhibit testosterone production.
• Avoid certain substances: Avoid tobacco products, excessive alcohol, and opioid pain medications.

If you wish to discuss your prescribed treatment with one of the clinicians, you can book a call using the following link: www.manual.co/book

If you are also on TRT, please book to speak to our TRT Clinician using this link: https://calendly.com/d/44q-m6r-6dk/testosterone-replacement-therapy-clinician-consultation

How do I take it?

Take one Tadalafil 5mg tablet once daily, at approximately the same time each day.

• Do not take more than one tablet within 24 hours
• Tadalafil should not be taken with other medication of the same class, such as Sildenafil
• It is important that you are aware that certain “street drugs” may interact with Tadalafil. If you are using illicit drugs e.g. “Armos, Poppers or Odorisers”, please make sure the clinicians are aware as the combination could be dangerous
• If you miss a dose, take it as soon as you remember. However, if it is close to the time of your next scheduled dose, skip the missed dose and resume your regular dosing schedule.

You may want to monitor your progress on Tadalafil and monitor your testosterone levels whilst on treatment and you can do this by ordering out finger-prick blood test: https://www.manual.co/testosterone-replacement-therapy/initial-testosterone-blood-test

If you are on TRT, you will be monitored regularly as part of your plan, so do not worry about taking blood tests outside of this unless the doctor has requested it specifically.

What are the side-effects?

PDE5 inhibitors are generally safe and well tolerated, however all medicines have the potential to cause side-effects. The good news is that the majority of side effects are mild and not all men get them.

Side-effects include lightheadedness, headaches, indigestion, muscle aches, facial flushing and nasal congestion.

More serious side-effects, which are rare include; breathing difficulties, visual disturbances, kidney or liver dysfunction, widespread rashes, agitation, chest pain, anaphylaxis (a severe allergic reaction) and priapism (a painful and persistent erection that lasts for > 4 hours). If any of the rare but serious side-effects happen please go to your local Accident and Emergency immediately or call 999. If you have any concerns regarding the side-effects, please stop taking the medication and contact us.

What if I am taking other medicines?

It is important that you are completely honest with us when completing the questionnaire as some medicines are not safe to take with Tadalafil.

Interactions include but are not limited to:

Alpha blockers (such as tamsulosin, alfuzosin, doxazosin or terazosin). This could result in your blood pressure dropping dangerously low. Talk to your clinician or doctor if you are currently on these medications.

Nitrates (such as GTN (Glyceryl trinitrate) commonly used to manage chest pain associated with angina, or rectal GTN ointment used for anal fissures). The combination of nitrates with Tadalafil may cause your blood pressure to drop dangerously low. DO NOT TAKE Tadalafil if you have been prescribed Nitrates.

Please remember to inform our clinicians via your personal patient account: if you start taking any new medicines or if there are any significant changes to your medical history. Also if you experience any significant side-effects or want further advice on your treatment.

It is important that you inform your GP about the medicines you take to ensure they have an accurate medication history. If you do not share this information with your GP it could result in the healthcare professional not having enough information to make informed clinical decisions about your care, increasing your risk of injuries or side effects. On your account page, you can download a letter to share with your GP that contains all the relevant information about your treatment plan.

We're dedicated to continually improving our understanding of the medications we prescribe, including their side effects, to provide the highest level of care, guided by the latest medical insights. If you experience any side effects, please discuss them with your clinical team.

You can also report side effects, no matter how minor, through the government-run Yellow Card reporting scheme at https://yellowcard.mhra.gov.uk/ . Your input is vital for enhancing medication safety for all.