Sildenafil v Tadalafil

User

Posted 18 Jul 2026 at 16:40

I had a unilateral prostatectomy in December last year, and was started on 100mg of Sildenafil 3 times a week in March. I have struggled with the side effects of the Sildenafil- headaches, sore eyes, blurred vision, blocked nose and generally feeling crap for about 24hrs after taking them. I was swapped onto 20mg Tadalafil a few weeks ago, and have been experiencing the same symptoms, albeit not as severely, but they seem to be longer lasting, so I’m not getting any respite from them. I’m also suffering from muscle aches.

I also don’t feel the Tadalafil is working as effectively as the Sildenafil did for my ED rehab.

Debating whether to just stick with the Tadalafil for a bit longer as it’s still early days, or to ask to go back onto the Sildenafil or to try something else. I’ve read conflicting info that the side effects should settle down after a few weeks, but also read they can be long term when taking it regularly.

Has anyone else had this experience and what did you do, or what other medication did you go onto?

Edited by member 19 Jul 2026 at 10:08 | Reason: Not specified

User

Posted 19 Jul 2026 at 10:49

Hi, Neil.

I'm a lot older older than you mate, almost seventy.

Not long before my diagnosis I was having ED issues. I dont know if it was linked to my PCa or just an age thing. Anyway, after my diagnosis I was prescribed Sildenafil, I can't rememeber the dosage, but it seemed to help, put a little extra lead in the pencil.

About two years later I had non nerve sparing RARP. The drug then became totally ineffective. That's when the ED clinic put me on Invicorp. Here's a thread on it:

https://community.prostatecanceruk.org/posts/t29845-Hooray-for-Invicorp

I guess you may have already read it.

All I'm saying mate, if all else fails, give the injections a go. 👍

Edited by member 19 Jul 2026 at 11:08 | Reason: Typo

User

Posted 19 Jul 2026 at 11:09

Hi Adrian thanks for your reply, the ED side of things aren’t my main concern at the moment, but more the side effects of the Tadalafil. I’ve woken up this morning in agony with muscle aches all down my neck, back, glutes and thighs. I know this can be a side effect of the Tadalafil but unsure if they are going to be short term whilst my body adjusts to the new medication, or it’s going to be long term in which case I’ll be asking to go back onto the Sildenafil.

I’ll have a read of the link you’ve posted. It’s early days for me, was told it could be upto 2 years to see any significant improvement. I was happy with how things were going with the Sildenafil and pump, just noticed a drop off with the Tadalafil but perhaps that’s just an issue with my body needing to adapt to the new meds.

I’ll admit the thought of injecting myself doesn’t appeal that much 😬😬 and I think I’m a long way off considering it

User

Posted 19 Jul 2026 at 20:56

Neil, when you write "unilateral prostatectomy" do you mean that only half your prostate was removed - which is the literal meaning of the phrase - or that only one nerve could be spared? Which is a much more common experience.

It is common to prescribe a PDE5 inhibitor such as sildenafil or tadalafil once a patient is recovering from prostatectomy and especially if the nerves can't both be spared. And judging by previous threads in the forum some men turn out to react badly to these drugs as you have done.

Tadalafil is usually thought to be the more appropriate drug in this situation, it has a long lasting effect on blood flow to the penis so that your 20 mg dose should continue to provide benefit for 2 to 3 days. Sildenafil in contrast has a rapid but short lasting effect, good for "event" use in erectile dysfunction but substituting for the action of the missing nerve over the longer term. Deficient blood flow to the penis is thought to lead to irreversible changes to the ability to have an erection.

Many doctors prescribe 5 mg tadalafil daily rather than your 20 mg three times a week, and you might ask to try that to see if the lower dose means you don't suffer the side effects. The only way to find out is to try.

The other possibility is mechanical promotion of blood flow by using a vacuum erectile device (VED). You will find quite a few threads about its use.

User

Posted 19 Jul 2026 at 22:59

Hi JB

By unilateral I mean only nerve sparing on one side.

I did expect to be on the 5mg daily dose when it was first discussed about changing my prescription so was surprised when it came as 20mg 3 times a week. The side effects subsided this afternoon, but I’m due to take my next tablet tomorrow so will see if I get any issues after this one. If so I’ll contact my urology nurse and ask about the 5mg dose.

I have a vacuum pump which I use 3 times a week. But with that not being arterial blood I find whilst it’s effective at gaining size, it’s a little false in that it diminishes very quickly. I know I’m supposed to use the constriction rings to maintain the effect, but I’ve not done that yet. Been combining my vacuum pump rehab with manual masturbation. Takes a lot more effort but find I get a longer lasting more natural result. I’m not too concerned about that though, as my main motivation for that at the moment is to maintain the health of the tissue. Its the side effects from the drugs that I need to be able to manage first.

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