TADALAFIL MUSCLE ACHE: Troubleshooting Advice and Action Steps (long post)

First, I am SUPER THANKFUL to all of you for your great suggestions and more important, your support. You all mean the world to me in this journey.

I’ve got some action steps and explainer here on what I decided to do below. I did a deep dive on Tadalafil / Cialis induced muscle ache (because, hey, that's what we do). In the literature, it is a well-known side effect of Tadalifil that hits about 10 percent of people. It’s called “Myalgia,” which is the medical term for muscle pain.

The sensation for me was a very deep and intense ache in the entire muscle area that was affected. It wasn’t intense all the time, but when it was, it was troubling (manageable, but dang). It kept me up at night. It radiated intensely when I was working out. It woke me up at night.

Everyone is different. In my case, it affected my quads/hamstring muscles (front and back muscles on your upper leg) and my upper back muscles (traps). It wasn’t fully throttle 24/7, but would kick in and out.

For me, it was triggered by two things; laying down and exercise. I hit the forums, the web and then put together a list of action steps to figure out what I could do. that’s a little farther down.

I’m not a doctor (although I’ll do a dad brag: three of my kids are doctors), but this is what I’ve learned.

Why take a PDe5 inhibitor?
Yeah, you could just stop taking the drug. But, post prostatectomy, it is standard practice to be prescribed a PDe5 inhibitor to encourage blood flow to penile tissues to prevent fibrosis (scarring) of tissues in the penis due to the lack of erections post-surgery for a long time. Will you get erections post surgery from Cialis. People say nope. But, the blood flow to the penile tissues should help prevent fibrosis until the day that maybe natural erections return, which is likely 1-2 years later as any preserved nerves that trigger erections that might have been saved during surgery recover/regrow slowly over time. So, the PDe5 inhibitor is to help preserve your penis tissue while it is dormant. Taking a PDE5 inhibitor is a big deal.

Why take Tadalifil over Viagra/Levitra?
Tadalafil appears to be the first choice for many practices because it has the longest half-life and duration of action in the body for a longer-lasting effect compared to other medications in its class ( Viagra/Levitra). Meaning, Tadalafil can remain effective for up to 36 hours after taking a dose. Viagra and Levitra last about four hours. Levitra and Viagra are related drugs. But, levitra is much more powerful than Viagra, so you can take a much lower dose, which appears to mitigate side effects. Cialis is very different.

Why does Tadalifil cause more muscle aches?
One of the differences from the other PDE5 drugs is that Tadalafil does more than affect PDE5s, it also affects PDE11. This appears to be the key difference. Crazy thing is, medical science doesn’t appear to fully understand PDE11 and only started digging deeper because of Tadalifil and its effect on PDE11s. Some people draw a connection between PDE11 and an increased side effect of muscle ache for some patients. It looks like they don’t know.

Is it causing muscle damage?
During the initial drug trials for Tadalis… “When researchers tested for inflammation, muscle injury markers in blood, or changes in kidney blood flow, they did not find any evidence of actual muscle damage. Imaging tests (PET scans and MRI) also showed no signs of muscle inflammation in the back or buttock areas.”

Cut to the chase, what did I decide to do? Action steps! (and please, check in with your doctor)

1. Take a OTC pain reliever to reduce the muscle ache intensity.
This worked. I found acetaminophen was more effective than ibuprofen.
However, this is just a short term fix. You shouldn’t take pain meds everyday.

“Muscle pain caused by Cialis is often mild and usually goes away on its own within 2 days. Talk with your doctor if you have bothersome muscle pain while taking this drug. They may recommend an OTC pain reliever such as ibuprofen (Motrin, Advil) or acetaminophen (Tylenol).”

2. Stop taking Tadafil for a day to reset and then retry again. (this helped)

3. Instead of taking Tadalifil at night, switch to taking in the morning.

Since my muscle aches typically get worse laying down (described in the literature) maybe it will help to take it in mornings. I took a day off from Tadalafil and then started in the morning. This actually worked for me! Thank goodness.

Additional steps to try:

4. Will it go away over time? Try for longer period with lower dose and see if lessens.
Options: Take your dose every other day until tolerated.
Or start with a 1/2 dose every day (pill splitter time)

5. Just switch to Viagra/Levitra.
These are also good PDE5 inhibitor drugs.

6. Do you take stains? There is a documented interaction between cholesterol meds and Tadalis. If this is the case, you may need to switch to Viagra/Levitra.

Lipitor was found to have an interaction in the original drug studies, but other statin drugs also can have an interaction.

One forum member said his doctor prescribed him 300 mg of CoQ10 daily at night and that helped him. But, I found mixed messaging online about the effectiveness for CoQ10 for muscle aches (most references were for using CoQ10 to reduce statin induced muscle ache). There is discussion of CoQ10 being helpful in suppressing prostate cancer, but no real evidence to back this up. https://www.mayoclinic.org/drugs-supplements-coenzyme-q10/art-20362602

••••
So, in the end, at least for now, my muscle ache has faded away. I took a day off and then switched dosing to mornings rather than evenings. I think giving it a few days and the different dosing time worked for me.

But, we’re all different. If you’re reading this, good luck with your process.