Tadalafil Sudden Hearing Loss: How Common & What to Do
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Tadalafil and Sudden Hearing Loss: What You Need to Know
Published: 17 October 2026
Tadalafil sudden hearing loss is a very rare but serious side effect that requires immediate medical attention. While tadalafil (generic Cialis) is a safe and effective treatment for erectile dysfunction for most men, a small number of reports have linked PDE5 inhibitors to sudden sensorineural hearing loss (SSHL), often affecting one ear [4]. Understanding the warning signs and knowing when to seek help can protect your hearing and ensure you use ED treatment safely.
Key takeaways
- Sudden hearing loss with tadalafil is very rare, affecting fewer than 1 in 1,000 people.
- Stop tadalafil immediately and seek same-day medical help if you notice sudden hearing changes.
- Early treatment with corticosteroids within 72 hours gives the best chance of recovery.
- If hearing loss occurs, do not restart any PDE5 inhibitor; discuss alternatives with your prescriber.
- Alprostadil cream or injection is a safe alternative that does not affect hearing.
How Common Is Sudden Hearing Loss with Tadalafil?
Sudden hearing loss associated with tadalafil is extremely rare. The British National Formulary lists sudden hearing loss as an uncommon or rare side effect of PDE5 inhibitors, meaning it affects fewer than 1 in 1,000 people who take these medicines [4]. Most men who use tadalafil will never experience any hearing problems at all.
Post-marketing surveillance—reports collected after a medicine is licensed—has identified a small number of cases of sudden sensorineural hearing loss in men taking tadalafil and other PDE5 inhibitors. However, it is difficult to prove a direct cause-and-effect relationship because many of these men also had other risk factors for hearing loss, such as high blood pressure, diabetes, high cholesterol, smoking, or age over 50 [4][12].
Despite the rarity, sudden hearing loss is taken seriously by regulators. The Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency have included warnings about sudden hearing loss in the patient information leaflets for all PDE5 inhibitors, including tadalafil, sildenafil, vardenafil, and avanafil [12].
Why Does Tadalafil Sudden Hearing Loss Happen?
The exact mechanism by which tadalafil might cause sudden hearing loss is not fully understood. Tadalafil works by inhibiting an enzyme called phosphodiesterase type 5 (PDE5), which increases blood flow to the penis and helps achieve an erection [4]. However, similar enzymes—including PDE5 and other phosphodiesterases—are also found in the inner ear, particularly in the cochlea, which is responsible for hearing.
One theory is that blocking PDE5 in the cochlea may alter blood flow or the balance of chemical signals in the inner ear, potentially leading to damage of the delicate hair cells that convert sound into nerve signals [4][12]. Another possibility is that PDE5 inhibitors may affect the blood supply to the auditory nerve or the structures of the inner ear, though this remains speculative.
It is also important to note that many men with erectile dysfunction have cardiovascular risk factors—such as diabetes, high blood pressure, and high cholesterol—that are themselves independent risk factors for sudden hearing loss [1][2]. This makes it difficult to determine whether the hearing loss is caused by the medicine, the underlying health condition, or a combination of both.
Other Risk Factors for Sudden Hearing Loss
Sudden sensorineural hearing loss can occur without any medicine and is more common in people over 50, smokers, and those with cardiovascular disease or diabetes [12]. If you have a history of hearing problems, ear infections, or previous sudden hearing loss, it is important to discuss this with your prescriber before starting tadalafil or any PDE5 inhibitor.
At a glance
How Long Does Tadalafil-Related Hearing Loss Last?
The duration of sudden hearing loss associated with tadalafil varies from person to person. In some reported cases, hearing has improved partially or fully within days to weeks after stopping the medicine, especially if treatment is started quickly [12]. However, in other cases, the hearing loss has been permanent, particularly when medical help was delayed.
Sudden sensorineural hearing loss is a medical emergency, regardless of the cause. The sooner you seek treatment, the better the chance of recovery. If you notice a sudden decrease in hearing, muffled sounds, ringing in the ears (tinnitus), or a feeling of fullness in one or both ears while taking tadalafil, stop taking the medicine immediately and contact a doctor or go to A&E the same day [4][12].
Treatment for sudden hearing loss typically involves high-dose corticosteroids (such as prednisolone) to reduce inflammation in the inner ear. These are most effective when started within 72 hours of symptom onset, so prompt action is essential. Your GP or an ear, nose, and throat (ENT) specialist will assess your hearing and decide on the best course of treatment.
What to Do If You Experience Tadalafil Sudden Hearing Loss
If you develop sudden hearing loss, reduced hearing, ringing in the ears, or dizziness while taking tadalafil, stop taking the medicine immediately and seek urgent medical advice [4][12]. Do not wait to see if it gets better on its own—early treatment can make a significant difference to your outcome.
Contact your GP for a same-day appointment, call NHS 111, or go to your nearest A&E department. Explain that you are taking tadalafil and that you have noticed a sudden change in your hearing. The healthcare team will examine your ears, check your hearing, and may refer you to an ENT specialist for further tests, such as an audiogram (hearing test) or an MRI scan to rule out other causes.
Do not restart tadalafil or any other PDE5 inhibitor without discussing it with your doctor first. If your hearing loss is confirmed to be related to tadalafil, your prescriber will help you explore alternative treatments for erectile dysfunction that do not carry the same risk, such as alprostadil cream or injection, vacuum erection devices, or other non-drug approaches [7].
Self-Care and Monitoring
While taking tadalafil, be aware of any changes in your hearing, balance, or ear sensations. If you notice ringing, buzzing, or a feeling of pressure in your ears, even if your hearing seems normal, mention it to your pharmacist or doctor. Avoid loud noise, which can worsen hearing damage, and do not use cotton buds or other objects in your ears, as this can cause injury or infection.
Stop and Seek Help Immediately
If you notice sudden hearing loss, ringing in the ears, or a feeling of fullness in your ear while taking tadalafil, stop the medicine immediately and contact your GP, NHS 111, or go to A&E the same day. Early treatment can make a significant difference.
Alternatives to Tadalafil If Hearing Loss Persists
If you have experienced sudden hearing loss with tadalafil, your prescriber will advise you not to use any PDE5 inhibitor again, as the risk may apply to the whole class of medicines, including sildenafil (Viagra), vardenafil (Levitra), and avanafil (Spedra) [3][4][5][6]. Fortunately, there are several effective alternatives for treating erectile dysfunction.
Alprostadil is a prescription treatment that works in a completely different way from PDE5 inhibitors. It is available as a cream (Vitaros) applied to the tip of the penis or as an injection (Caverject) into the side of the penis [7]. Alprostadil causes blood vessels to widen directly, without affecting enzymes in the ear, so it does not carry the same hearing-loss risk. Your GP or a specialist can prescribe and teach you how to use it safely.
Non-drug options include vacuum erection devices (VEDs), which use gentle suction to draw blood into the penis, and penile implants, which are surgically inserted and can be inflated when needed. Psychological therapy, such as cognitive behavioural therapy (CBT) or psychosexual counselling, can also be helpful if anxiety or relationship issues are contributing to ED [1][2]. Your GP can refer you to the appropriate service.
Preventing Problems and Using Tadalafil Safely
Most men can use tadalafil safely without any hearing problems. To minimise your risk of side effects, always take tadalafil exactly as prescribed, and do not exceed the recommended dose [4]. Taking more than the prescribed amount does not improve effectiveness and increases the risk of side effects, including headache, flushing, dizziness, and potentially more serious problems.
Before starting tadalafil, tell your prescriber about any history of hearing loss, ear problems, or previous sudden hearing loss in either ear. Also mention any cardiovascular risk factors, such as high blood pressure, diabetes, high cholesterol, or smoking, as these can increase your overall risk [2][4]. Your prescriber will assess whether tadalafil is suitable for you and may recommend starting on a lower dose.
Avoid using tadalafil with nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or recreational drugs called 'poppers', as these combinations can cause a dangerous drop in blood pressure [4]. If you are taking alpha-blockers (such as tamsulosin or doxazosin) for an enlarged prostate, your prescriber will check that you are stable on the alpha-blocker and start you on the lowest dose of tadalafil [4]. Always declare all your current medicines, including over-the-counter and herbal products, during your consultation.
When to Seek Urgent Help
Seek immediate medical attention if you experience sudden hearing loss, sudden vision loss, an erection lasting more than four hours (priapism), or chest pain during sex [4][12]. These are rare but serious side effects that require urgent treatment. Do not drive yourself to hospital if you feel dizzy or unwell—call 999 or ask someone to take you.
When to get urgent help
- Sudden decrease in hearing or complete hearing loss in one or both ears
- Ringing, buzzing, or roaring sound in the ears (tinnitus) that starts suddenly
- Feeling of fullness or pressure in the ear with reduced hearing
- Dizziness or vertigo (spinning sensation) with hearing changes
- Sudden vision loss or blurred vision in one or both eyes
Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.
Scientific References
- NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 17 October 2026]
- National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 17 October 2026]
- Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 17 October 2026]
- Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 17 October 2026]
- Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 17 October 2026]
- Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 17 October 2026]
- Joint Formulary Committee. (n.d.). Alprostadil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/alprostadil/ [accessed 17 October 2026]
- Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [accessed 17 October 2026]
Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.
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Can tadalafil cause permanent hearing loss?
In some cases, sudden hearing loss associated with tadalafil has been permanent, particularly when medical help was delayed. Seeking urgent treatment within 72 hours gives the best chance of recovery.
Is sudden hearing loss more common with tadalafil than sildenafil?
No, sudden hearing loss is very rare with all PDE5 inhibitors, including tadalafil, sildenafil, vardenafil, and avanafil. There is no strong evidence that one is riskier than another.
What does sudden hearing loss feel like?
Sudden hearing loss typically involves a rapid decrease in hearing in one or both ears, often noticed upon waking. It may be accompanied by ringing (tinnitus), a feeling of fullness in the ear, or dizziness.
Should I stop taking tadalafil if I have ringing in my ears?
Yes, stop taking tadalafil immediately and contact your GP or NHS 111 the same day. Ringing in the ears (tinnitus) can be an early warning sign of hearing damage.
Can I switch to a lower dose of tadalafil if I have hearing problems?
No, if you have experienced sudden hearing loss with tadalafil, you should not take any dose of tadalafil or any other PDE5 inhibitor. Discuss alternative treatments with your prescriber.
Will my hearing come back if I stop tadalafil?
Some people recover partially or fully after stopping tadalafil and receiving prompt treatment with corticosteroids, but recovery is not guaranteed. Early medical help improves the chances.
Are there any warning signs before sudden hearing loss happens?
Some people notice ringing, buzzing, or a feeling of pressure in the ear before hearing loss occurs. If you experience any of these symptoms, stop tadalafil and seek medical advice immediately.
Can I use tadalafil if I already have some hearing loss?
You should discuss any existing hearing problems with your prescriber before starting tadalafil. They will assess your individual risk and may recommend an alternative treatment if appropriate.
Medically reviewed by
Tarun Kumar, Superintendent Pharmacist (GPhC 2233073)