Tadalafil (Cialis): Any advice to manage muscle aches?

Same here, I started on 5 mg daily for about six months (post SBRT) and noticed the exact same side effects as you including Some low back pain as well. When I did a trial of discontinuing the drug, the side effects disappeared. I have gone to 5 mg every other day and found that this helped reduce the side effects.(I am 73 years old so expect that my tadaladil half life might be a bit longer due to age.) If the side effects continue, you might consider switching to Viagra or sildenafil 25mg daily. Tadalafil’s PDE 11 effect is the cause of these specific side effects. Sildenafil lacks PDE 11 inhibition. Good luck!

@jheadding Thanks so much! Glad to know I'm not the only one out there. It appears to be one of the rarer side effects. Not much out there on the web about it, but it is known.

I'm starting by switching to taking it in the morning. Apparently, the muscle ache is described in the literature as being typically worse when lying down, so going to see if taking it in the morning vs. night might help.

From there, I'll probably end up talking with my doc whether to switch to other PDE5 med or just alternate dosing. One person tole me that they switched to taking a 10mg Tadalafil every other day and that helped them.

It did really have me confused at first because I've been do vigorous walking on the treadmill with a weight vest to get in better shape pre-surgery....so I was wondering if that was why my thighs/shoulders were hurting so much. So, good news, no, not the treadmill. Bad news-it's the new drug.

We'll get there. Thanks for your help!

I'll be eliminating the 5 mg of tadalafil I've been taking for a while to see what happens. !
Thanks so much for reporting your experience!

I've been experiencing very similar things. I.e. pain in one of my thighs, hip, shoulder. The thigh and hip pain at times can keep me from sleeping. The pains are intermittent and variable. Some times on some days I experience no pain at all.

My first thought was my exercise program. Once I heard that exercise oncologists have discovered that increased muscle mass is directly related to better prostate cancer outcomes for those on ADT, I've never been so religious about aiming to increase my muscle size, almost regardless of pain. Nevertheless, I've had to stop doing certain exercises involving the thighs because the pain was severe enough I thought I must be doing damage. I added stretching and strengthening exercises of the type recommended by physical therapists for hip pain to my daily routine, but some days I wonder if these are making things worse.... I also added periodic rest days. These seem to help. The thing is, I am used to being suddenly subject to dramatic increases in what my body is expected to do and I am familiar with how it feels to experience the pain of muscle overuse and how it feels to recover and come back stronger. These pains I've been experiencing lately are not responding like that.

Another idea I had is that my symptoms were a possible side effect of Orgovyx. Apparently as many as 30% of patients on Orgovyx can experience some sort of "musculoskeletal" pain, This is defined as "myalgia (muscle pain), arthralgia (joint pain), back pain, pain in extremity, bone pain, and musculoskeletal stiffness". Data supporting this also comes from a recent study of the FDA database of adverse events reported since Orgovyx has been in widespread use. https://pmc.ncbi.nlm.nih.gov/articles/PMC11495556/.
However, my medical oncologist asserts that whatever I'm experiencing has nothing to do with his prescription for Orgovyx. I'm not sure why he is so certain. So far I'm not going to experiment with cutting out the Orgovyx for any length of time. I am grateful it is having its intended effect on the cancer.

@climateguy I applaud you whole heartily for your tenacity! Working out under this sort of muscle ache is not for for the faint of heart.

I do a morning high-intensity workout (Scientific Seven Minute Workout) everyday. But yesterday, my thighs, shoulders and glutes starting seizing up during the exercises that hit the core hardest so bad that I had to stop (planks/pushup rotations/side planks) . Today, I didn't take my Cialis yesterday and was able to do my workout this morning (though I feel a bit of the residual ache).

I did find this study (because you know that's all we do, hunt down studies) https://pubmed.ncbi.nlm.nih.gov/16034469/
that indicated that the myalgia (muscle ache) does not cause actual harm. "In a prospective study in healthy volunteers, no substantial changes were observed in laboratory markers indicative of inflammation or muscle damage, and tadalafil did not affect renal plasma flow nor produce lumbar or gluteal myositis by positron emission tomography scan or magnetic resonance imaging. "
So, according to them, the pain doesn't indicate harm. Hopefully, that's the case.

Hang in there climateguy-you're in my thoughts!

Had same problem. Dr lowered to 2.5 and I tolerated this without pain

@climateguy I definitely agree with not discontinuing Orgovyx except with doctor agreement It acts quickly but also disappears quickly. I have been fortunate not to notice additional pain with ADT (I already have osteoarthritis virtually everywhere), but I have experienced all of the side effects listed at the Orgovyx site plus loss of body hair. I'm very grateful to be in my last three months (of 18) of ADT and am hoping, at 74, more normal life returns afterward!

Update:

It seems that tadalafil has nothing to do with the pains I'm feeling. It's been 5 days since I stopped taking it and things have not changed.

@climateguy

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.

@fritzo thanks for describing what you've learned about tadalafil.