Tadalafil (Generic Cialis) as alternative to Viagra. Is it more cheaper/more effective/longer lasting?

[AlexKChen]

How to get? Kaeberlein mentioned

It seems like it could be way cheaper

[Agetron]

My Urologist suggested it to me. Any General Practice Physician can give you a prescripton.
On it for 3 + years.

[RapAdmin]

Cheap from US pharmacies if you see a doctor and get a prescription:

Or cheap from the regular Indian pharmacies if you don’t want to see a doctor:

[Joseph_Lavelle]

You can get it from Amazon health telehealth without insurance for cheap.

[DrFraser]

For longevity, neurodegenerative decline, I’ve favored Tadalafil, mostly due to those indications theoretically wanting a continuous serum/brain level. Tadalafil has the advantage of a 18 hr half life - so once a day dosing will provide excellent coverage for that goal - whereas Sildenafil has a 4 hr half life - so you’d need to be very frequently dosing to achieve a good level 24/7.

[desertshores]

“Tadalafil has the advantage of a 18 hr half life - so once a day dosing will provide excellent coverage for that goal”

I agree, but I am going to be very pi$$ed if the molecular difference between tadalafil and sildenafil favors sildenafil as a life extender. There is currently more evidence for sildenafil and we are just speculating that tadalafil may have the same or better results.

[DrFraser]

I agree that we have some information in that area. I’m going to be doing my research and write up on that topic on my blog in another couple of weeks, with a focus on neurocognitive decline. I’ve not thoroughly reviewed the evidence yet, but absolutely agree that there are some indicators of sildenafil having advantages. I however would think the main issue is nitric oxide generation and neuroinflammation reduction. This should be a drug class effect, not an affect of the molecular makeup of the drug - should be on drug activity.
Going to dig in on this in a couple of weeks and sort out where I think the best middle ground is.

[Pat25]

Is there any research that indicates whether similar potential longevity/neuroprotective benefits may also apply to women using Taladafil?

[RapAdmin]

Its interesting… the studies I’ve seen so far have all been population-based retrospective association studies. Obviously, since Tadalafil is a ED drug, not too many women are in that sample. I suspect specific studies looking at this issue would need to be conducted.

[DrFraser]

I wouldn’t anticipate that for neurodegenerative disease that things that work for men wouldn’t work for women. As much as we don’t have great data on that, for the present time, I’m not making any delineation on what I offer patients in this area based on gender (except type of HRT).
Yes - it’ll likely go as a no evidence zone - but on a risk/benefit, I offer it to such patients currently.

[Pat25]

Thank you very much for the helpful response, Dr.Fraser. Do you also prescribe it to patients that don’t experience neurodegenerative disease or (noticeable) cognitive decline, and from what age?

I’m wondering what doses are we should be looking at in such situations, and whether we should adjust dose based on age.

[DrFraser]

As a general principle - not as advice for you in particular … once you have disease, much more difficult to reverse or stabilize than avoiding disease.
I guess, with no evidence at all, I’m going to go with Dr. Green’s approach with ApoE status and Rapa start time … but furthermore, looking at the graph showing other ApoE subtypes and likelihood of not having Alz Dementia … I’m more in line with everyone considering treatment - possibly with ApoE2/E2 less prioritized.

Individuals considering speculative treatment certainly need to be consented to risk/benefit and the lack of certainty.

I don’t think I’d start the combination of therapy for decreasing risk of neurocognitive decline for someone in their 30’s (maybe an ApoE4/E4 who was super worried at age 35), but at 40 years old, might be a reasonable timing.

Anyone looking at this should consider a consult or be very up to date on the options, pros-cons, etc. Preferably see a specialist who offers these options and reviews everything properly.

That’s my current thinking. It is a work in progress for sure.

[Pat25]

Thank you very much. Definitely food for thought.

[Pestodude]

My cardiologist prescribed Tidalafil to me without hesitation.

[UCS]

I recently read somewhere, and I can’t remember where, that regular Tadalafil use can adversely affect the field of vision. I had this vision test coming up, so I stopped taking Tadalafil (2.5 mg/day) for the time being Does anyone know about this possible side effect?

[DrFraser]

Quote from a good review on this:

The most common visual symptoms that have been linked to PDE5 inhibitors include changes in color perception characterized by a blue tinge to the environment and changes in brightness perception, usually in the form of increased sensitivity to light 3, 13, 18, 19. These symptoms occur in 3–11% of men taking sildenafil 25–100 mg [13], 0.3–2% of vardenafil 20, 21, and 0.1% of tadalafil users [22]. These symptoms are mild, dose‐dependent, and completely reversible.

So only 1 in 1,000 tadalafil users … and fully reversible with cessation.

[UCS]

Thank you for the reply and the article link. I will carefully read the article.

[jnorm]

@AlexKChen I’d imagine Hims is the easiest route. That’s where I get my finasteride, and I also got fluoxetine from there once (no longevity evidence for that one, I just wanted to experiment with it). You literally just answer a few questions on their website, and boom, you’ve got a prescription.

[LukeMV]

I got a prescription for 5mg daily cialis from my urologist no problems

[Charles_Richardson]

Dr. Green, who I think is one of the best readers of the research I’ve ever been around, suggests tadalafil. I asked him specifically which was more effective, Cialis or Viagra, and he said that he thinks Cialis is better.

Take that for what it’s worth, but Alan Green and Matt Kaeberlein are the people in this space I trust the most. Also Dr Green has patients he is treating and monitoring so it’s not just a hypothetical for him.