• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Tadalafil is and what it is used for
2. What you need to know before you take Tadalafil
3. How to take Tadalafil
4. Possible side effects
5. How to store Tadalafil
6. Contents of the pack and other information

• are allergic to tadalafil or any of the other ingredients of this medicine (listed in section 6).
• are taking any form of organic nitrate or nitric oxide donors such as amyl nitrite. This is a group of medicines (“nitrates”) used in the treatment of angina pectoris (“chest pain”). Tadalafil has been shown to increase the effects of these medicines. If you are taking any form of nitrate or are unsure, tell your doctor.
• have serious heart disease or recently had a heart attack within the last 90 days.
• recently had a stroke within the last 6 months.
• have low blood pressure or uncontrolled high blood pressure.
• ever had loss of vision because of Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION), a condition described as “stroke of the eye”.
• are taking riociguat. This drug is used to treat pulmonary arterial hypertension (i.e. high blood pressure in the lungs) and chronic thromboembolic pulmonary hypertension (i.e. high blood pressure in the lungs secondary to blood clots). PDE5 inhibitors, such as Tadalafil, have been shown to increase the hypotensive effects of this medicine. If you are taking riociguat or are unsure, tell your doctor.

Talk to your doctor before taking Tadalafil.

Be aware that sexual activity carries a possible risk to patients with heart disease because it puts an extra strain on your heart. If you have a heart problem you should tell your doctor.

Since benign prostatic hyperplasia and prostate cancer may have the same symptoms, your doctor will check you for prostate cancer before starting treatment with Tadalafil for benign prostatic hyperplasia.

Tadalafil does not treat prostate cancer.

Before taking the tablets, tell your doctor if you have:

• sickle cell anaemia (an abnormality of red blood cells).
• multiple myeloma (cancer of the bone marrow).
• leukaemia (cancer of the blood cells).
• any deformation of your penis.
• a serious liver problem.
• a severe kidney problem.

It is not known if Tadalafil is effective in patients who have had:

• pelvic surgery.
• removal of all or part of the prostate gland in which nerves of the prostate are cut (radical non-nerve sparing prostatectomy).

If you experience sudden decrease or loss of vision, stop taking Tadalafil and contact your doctor immediately.

Decreased or sudden hearing loss has been noted in some patients taking tadalafil. Although it is not known if the event is directly related to tadalafil, if you experience decreased or sudden hearing loss, stop taking Tadalafil and contact your doctor immediately.

Tadalafil is not intended for use by women.

Tadalafil is not intended for use by children and adolescents under the age of 18.

Tell your doctor if you are taking, have recently taken or might take any other medicines.

Do not take Tadalafil if you are already taking nitrates.

Some medicines may be affected by Tadalafil or they may affect how well Tadalafil will work. Tell your doctor or pharmacist if you are already taking:

• an alpha blocker (used to treat high blood pressure or urinary symptoms associated with benign prostatic hyperplasia).
• other medicines to treat high blood pressure.
• riociguat.
• a 5- alpha reductase inhibitor (used to treat benign prostatic hyperplasia).
• medicines such as ketoconazole or itraconazole tablets (used to treat fungal infections).
• protease inhibitors for treatment of AIDS or HIV infection.
• phenobarbital, phenytoin and carbamazepine (medicines used to treat epilepsy known as anticonvulsants).
• rifampicin, erythromycin, clarithromycin (antibiotics used to treat bacterial infections).
• other treatments for erectile dysfunction.

Information on the effect of alcohol is in section 3.

Grapefruit juice may affect how well Tadalafil will work and should be taken with caution. Talk to your doctor for further information.

A reduction in sperm was seen in some men and reduced sperm development was seen during testing, in dogs. These effects are unlikely to lead to a lack of fertility.

Some men taking Tadalafil in clinical studies have reported dizziness. Check carefully how you react to the tablets before driving or using machines. If you experience side effects which may affect your ability to drive or operate machinery safely, then do not do either of these activities until the effects have completely disappeared.

If you have been told by your doctor you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

The recommended dose is one 5mg tablet taken once a day at approximately the same time of the day. Your doctor may adjust the dose to 2.5mg based on your response to Tadalafil. This will be given as a 2.5mg tablet.

When taken once a day Tadalafil allows you to obtain an erection, when sexually stimulated, at any time point during the 24 hours of the day. Once a day dosing of Tadalafil may be useful to men who anticipate having sexual activity two or more times per week.

It is important to note that Tadalafil does not work if there is no sexual stimulation. You and your partner will need to engage in foreplay, just as you would if you were not taking a medicine for erectile dysfunction.

Drinking alcohol may affect your ability to get an erection.

The recommended dose is one 5mg tablet taken once a day at approximately the same time of the day.

If you have benign prostatic hyperplasia and erectile dysfunction, the dose remains one 5mg tablet taken once a day.

Do not take Tadalafil more than once a day.

Contact your doctor. You may experience side effects described in section 4.

Take your dose as soon as you remember but do not take a double dose to make up for a forgotten tablet. You should not take Tadalafil more than once a day.

It is important to keep taking Tadalafil as prescribed unless your doctor tells you to stop your treatment.

• allergic reactions including rashes (frequency uncommon).
• chest pain - do not use nitrates but seek immediate medical assistance (frequency uncommon).
• priapism, a prolonged and possibly painful erection after taking Tadalafil (frequency rare). If you have such an erection, which lasts continuously for more than 4 hours you should contact a doctor immediately.
• sudden loss of vision (frequency rare).

Other side effects have been reported:

Common (may affect up to 1 in 10 people)

• headache
• back pain
• muscle aches
• pain in arms and legs
• facial flushing
• nasal congestion
• indigestion

Uncommon (may affect up to 1 in 100 people)

• dizziness
• stomach ache, feeling sick, being sick (vomiting) and reflux
• blurred vision
• eye pain
• difficulty in breathing
• presence of blood in urine
• prolonged erection
• pounding heartbeat sensation
• a fast heart rate
• high blood pressure
• low blood pressure
• nose bleeds
• ringing in the ears
• swelling of the hands, feet or ankles
• feeling tired

Rare (may affect up to 1 in 1000 people)

• fainting
• seizures and passing memory loss
• swelling of the eyelids
• red eyes
• sudden decrease or loss of hearing
• hives (itchy red welts on the surface of the skin)
• penile bleeding, presence of blood in semen
• increased sweating

Heart attack and stroke have also been reported rarely in men taking Tadalafil. Most of these men had known heart problems before taking this medicine.

Partial, temporary, or permanent decrease or loss of vision in one or both eyes has been rarely reported.

Some additional rare side effects (may affect up to 1 in 1000 people) have been reported in men taking Tadalafil that were not seen in clinical trials. These include:

• migraine
• swelling of the face
• serious allergic reaction which causes swelling of the face or throat
• serious skin rashes
• some disorders affecting blood flow to the eyes
• irregular heartbeats
• angina
• sudden cardiac death

The side effect dizziness has been reported more frequently in men over 75 years of age taking Tadalafil. Diarrhoea has been reported more frequently in men over 65 years of age taking Tadalafil.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via Yellow Card Scheme (website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store). By reporting side effects you can help provide more information on the safety of this medicine.

• The active substance is tadalafil. Each tablet contains 5mg of tadalafil.
• The other ingredients are:
  Tablet core: lactose monohydrate (see end of section 2), hydroxypropyl cellulose (E463), croscarmellose sodium (E468), sodium lauryl sulfate, povidone K-25, silica colloidal anhydrous, magnesium stearate (E572).
  Film-coat: hypromellose (E464), titanium dioxide (E171), macrogol, talc, iron oxide yellow (E172).

Tadalafil 5mg is a yellow to light yellow round film-coated tablet with ‘337’ imprinted on one side.

Tadalafil 5mg is available in blister packs containing 14, 28 or 84 tablets.

Not all pack sizes may be marketed.

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