Tadalafil Palpitations: Causes & What to Do

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How Common Are Tadalafil Palpitations?

Palpitations are classified as an uncommon side effect of tadalafil, meaning they occur in between 1 in 100 and 1 in 1,000 people who take the medicine [4][12]. This makes them less frequent than common side effects such as headache, indigestion, or facial flushing, but more frequent than rare reactions. The British National Formulary and the Summary of Product Characteristics for tadalafil both list palpitations under cardiovascular side effects [4][12].

The likelihood of experiencing palpitations may vary depending on the dose you take, your overall cardiovascular health, and whether you are taking other medicines that affect the heart or blood pressure. Higher doses of tadalafil (such as 20 mg on-demand) may carry a slightly higher risk than lower doses (such as 2.5 mg or 5 mg daily), though palpitations remain uncommon across all licensed doses [4]. If you have a history of heart rhythm problems or are taking medicines for high blood pressure, it is essential to discuss these with your prescriber during your consultation.

It is also worth noting that anxiety about sexual performance or the physical exertion of sexual activity itself can sometimes trigger palpitations, independent of the medication. Distinguishing between medicine-related palpitations and those caused by other factors can be challenging, so keeping a record of when symptoms occur can be helpful when discussing them with a healthcare professional.

Why Does Tadalafil Cause Palpitations?

Tadalafil works by inhibiting an enzyme called phosphodiesterase type 5 (PDE5), which increases blood flow to the penis and helps achieve an erection when sexually stimulated [4]. However, PDE5 is also present in small amounts in other tissues, including the walls of blood vessels throughout the body. When tadalafil blocks PDE5, it can cause mild widening (vasodilation) of blood vessels beyond those in the penis, leading to a small drop in blood pressure [4].

This drop in blood pressure is usually modest and well tolerated, but the body may respond by increasing the heart rate to maintain adequate blood flow to vital organs—a compensatory mechanism that can be felt as palpitations [4]. In most cases, this response is temporary and resolves as your body adjusts to the medicine. The effect is more noticeable if you are also taking other medicines that lower blood pressure, such as alpha-blockers (e.g. tamsulosin, doxazosin) or certain antihypertensives, because the blood-pressure-lowering effects can add together [4].

Additionally, tadalafil can interact with medicines that affect how it is broken down in the liver, particularly potent CYP3A4 inhibitors such as ritonavir, ketoconazole, or clarithromycin. These interactions can raise tadalafil levels in the blood, increasing the risk of side effects including palpitations [4][12]. Your prescriber will review all your current medicines during the consultation to identify and manage any potential interactions safely.

Other Factors That May Contribute

Caffeine, nicotine, heavy alcohol, recreational drugs (especially stimulants), stress, and lack of sleep can all trigger or worsen palpitations independently of tadalafil [1]. If you consume large amounts of caffeine or alcohol around the time you take tadalafil, this may increase the likelihood of noticing palpitations. Grapefruit juice can also raise tadalafil levels in the blood and should be avoided [4]. Keeping a diary of your activities, food, and drink intake alongside any symptoms can help identify contributing factors.

When to get urgent help

• Palpitations with chest pain, pressure, or tightness
• Severe shortness of breath or difficulty breathing
• Fainting, near-fainting, or severe dizziness
• Palpitations lasting more than a few minutes without improvement
• New or worsening palpitations if you have a known heart condition

Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.

How Long Do Tadalafil Palpitations Last?

The duration of palpitations depends on the formulation of tadalafil you are taking. Tadalafil has a long half-life, meaning it stays in your system longer than other erectile dysfunction medicines such as sildenafil or vardenafil [4]. On-demand tadalafil (10 mg or 20 mg) can remain active in the body for up to 36 hours, so side effects including palpitations may persist for several hours after taking a dose, though they typically peak within the first few hours and then gradually diminish [4].

Daily tadalafil (2.5 mg or 5 mg) is taken every day to maintain a steady level of the medicine in your bloodstream. If palpitations occur with daily dosing, they may be more persistent but are often milder because the dose is lower [4]. If palpitations continue beyond 24 hours after taking on-demand tadalafil, or if they are frequent or troublesome with daily tadalafil, you should contact your prescriber or GP for advice.

Most people who experience palpitations find that the sensation is brief and resolves without intervention. However, if palpitations are accompanied by chest pain, severe dizziness, shortness of breath, or fainting, you should seek urgent medical help immediately, as these may indicate a more serious cardiovascular problem [4][12].

Self-Care Tips for Managing Tadalafil Palpitations

If you notice mild palpitations after taking tadalafil, there are several practical steps you can take to help manage the sensation and reduce the likelihood of it recurring. First, sit or lie down in a comfortable position and try to relax. Slow, deep breathing can help calm your nervous system and may reduce the intensity of palpitations. Avoid sudden movements or strenuous activity until the sensation passes.

Stay well hydrated by drinking water, but avoid caffeine, alcohol, and energy drinks, as these can worsen palpitations [1]. If you smoke, consider reducing or stopping, as nicotine is a stimulant that can increase heart rate. Ensure you are taking the correct dose of tadalafil as prescribed—never take more than one dose in 24 hours, and do not combine tadalafil with other erectile dysfunction medicines [4].

Keep a record of when palpitations occur, how long they last, and any other symptoms or activities (such as exercise, meals, or stress) that coincide with them. This information will be valuable if you need to discuss the issue with your prescriber or GP. If palpitations are mild and infrequent, they may not require any change to your treatment, but your prescriber can review your dose or consider switching to a different erectile dysfunction medicine if needed.

Lifestyle Adjustments

Regular physical activity, a balanced diet, maintaining a healthy weight, and managing stress can all support cardiovascular health and may reduce the frequency of palpitations [1][2]. If you have underlying conditions such as high blood pressure, diabetes, or high cholesterol, keeping these well controlled with the help of your GP is important for both your general health and the safe use of erectile dysfunction medicines. Avoiding recreational drugs, particularly stimulants and 'poppers' (alkyl nitrites), is essential, as these can interact dangerously with tadalafil [4].

When to Seek Urgent Medical Help for Palpitations

While most palpitations associated with tadalafil are mild and short-lived, certain symptoms require immediate medical attention. You should call 999 or go to A&E if you experience palpitations alongside chest pain, pressure, or tightness; severe shortness of breath; fainting or near-fainting; or palpitations that last more than a few minutes and do not settle with rest [4][12]. These symptoms could indicate a serious heart problem that needs urgent assessment.

If you have a known heart condition—such as a history of heart attack, stroke, unstable angina, severe heart failure, or arrhythmia—and you develop new or worsening palpitations after taking tadalafil, contact your GP or cardiologist the same day for advice. Tadalafil is not suitable for everyone, and your prescriber will have assessed your cardiovascular fitness during the consultation, but new symptoms should always be reviewed [2][4].

Do not ignore persistent or troublesome palpitations, even if they are not accompanied by other symptoms. If palpitations occur every time you take tadalafil, or if they are affecting your quality of life or causing anxiety, book a review with your prescriber or GP. They can check your heart rhythm, review your medicines, and discuss whether a different dose or an alternative erectile dysfunction treatment would be more suitable for you.

Alternatives to Tadalafil If Palpitations Persist

If you continue to experience palpitations with tadalafil despite dose adjustments or self-care measures, your prescriber may recommend switching to a different erectile dysfunction medicine. Sildenafil (generic Viagra) has a shorter duration of action—typically 4 to 6 hours—which means any side effects, including palpitations, are likely to resolve more quickly [3]. Sildenafil is taken about one hour before sexual activity and may be better tolerated if you are sensitive to the longer-lasting effects of tadalafil.

Vardenafil (generic Levitra) and avanafil (Spedra) are other PDE5 inhibitors with different pharmacokinetic profiles. Avanafil has the fastest onset of action (15 to 30 minutes) and a relatively short duration, which may reduce the window for side effects [6][11]. Vardenafil works similarly to sildenafil but may have a slightly different side-effect profile for some individuals [5]. Your prescriber can discuss these options and help you find the most suitable treatment based on your medical history, lifestyle, and preferences.

If PDE5 inhibitors are not suitable or well tolerated, other treatments for erectile dysfunction are available. These include Eroxon, a topical gel medical device that works locally without entering the bloodstream; Vitaros, a prescription alprostadil cream applied to the urethra; and Caverject, an alprostadil injection [7]. These alternatives work differently from PDE5 inhibitors and may be appropriate if cardiovascular side effects are a concern. Your GP or a specialist can provide further guidance on these options.

Reviewing Your Overall Treatment Plan

Erectile dysfunction can be an early warning sign of cardiovascular disease or diabetes, so if you are experiencing new ED or persistent side effects from treatment, it is important to see your GP for a full health check [1][2]. They can assess your heart health, review your risk factors, and ensure that any underlying conditions are well managed. Addressing lifestyle factors such as smoking, alcohol intake, diet, and exercise can also improve both erectile function and overall cardiovascular health, potentially reducing the need for medication or improving how well it works [2].

In summary

• Tadalafil palpitations are uncommon, affecting between 1 in 100 and 1 in 1,000 people.
• They occur because tadalafil can lower blood pressure slightly, prompting the heart to beat faster.
• Palpitations usually resolve within hours but may last up to 36 hours with on-demand tadalafil.
• Seek urgent help if palpitations come with chest pain, severe dizziness, or shortness of breath.
• Switching to sildenafil or avanafil may help if palpitations persist with tadalafil.

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