Tadalafil, sold under the brand name Cialis among others, is a medication used to treat erectile dysfunction, benign prostatic hyperplasia, and pulmonary arterial hypertension. It is taken by mouth. Onset is typically within half an hour and the duration is up to 36 hours.

Common side effects include headache, muscle pain, flushing, and nausea. Caution is advised in those with cardiovascular disease. Rare but serious side effects include a prolonged erection that can lead to damage to the penis, vision problems, and hearing loss. Tadalafil is not recommended in people taking nitrovasodilators such as nitroglycerin, as this may result in a serious drop in blood pressure. Tadalafil is a PDE5 inhibitor which increases blood flow to the penis. It also dilates blood vessels in the lungs, which lowers the pulmonary artery pressure.

Tadalafil was approved for medical use in the United States in 2003. It is available as a generic medication. In 2022, it was the 172nd most commonly prescribed medication in the United States, with more than 3 million prescriptions.

Tadalafil is used to treat erectile dysfunction, benign prostatic hyperplasia, and pulmonary arterial hypertension. In the United States, tadalafil (as Cialis) is indicated for the treatment of erectile dysfunction and the signs and symptoms of benign prostatic hyperplasia; and (as Adcirca) for the treatment of pulmonary arterial hypertension to improve exercise ability.

A meta‐analysis found that tadalafil is an effective treatment for lower urinary tract symptoms due to benign prostatic hyperplasia and that such treatment had a low rate of adverse effects. Tadalafil is FDA-approved for males as a therapy to treat and prevent symptoms of benign prostatic hyperplasia, such as urinary urgency, hesitancy, weak stream, dribbling, and incontinence. Tadalafil was found to have similar benefits for lower urinary tract symptoms as the usually prescribed tamsulosin.

Tadalafil is approved in the United States, Canada, and Japan to improve exercise ability in people with pulmonary arterial hypertension.

The most common potential side effects when using tadalafil are headache, stomach discomfort or pain, indigestion, burping, acid reflux, back pain, myalgia (pain in limbs and extremities), flushing, hypertension (or uncommonly hypotension), and stuffy/runny nose. Also common are dizziness, peripheral edema, fatigue, and urinary or respiratory tract infection; both diarrhea and constipation have been reported. Diarrhea was reported more frequently in patients 65 or older than in younger subjects. These side effects reflect the ability of PDE5 inhibition to cause vasodilation (causing blood vessels to widen) and usually resolve after a few hours.

In May 2005, the US Food and Drug Administration (FDA) found that tadalafil (along with other PDE5 inhibitors) was associated with vision impairment related to NAION (non-arteritic anterior ischemic optic neuropathy). Most, but not all, of these patients, had underlying anatomic or vascular risk factors for the development of NAION, unrelated to PDE5 inhibitor use. The FDA concluded that they were not able to draw a cause and effect relationship, only an association; the label of all three PDE5 inhibitors was changed to alert clinicians to that fact. A 2019 meta-analysis found that tadalafil exposure was not associated with NAION.