Daily dosing of medications remains a challenge still for the modern provider. Supplements and vitamins arguably require the same or greater commitment. Lack of short term symptomatic benefit can be a detriment, and if overcome would make compliance stronger.
Daily tadalafil breaks this mold. With the obvious benefits on erection quality, there is now supporting data from different fields to make a case for healthy men who do not have any erectile dysfunction to take the med.
For these benefits, one must be open to the concept of taking medications for preventive purposes, which will always be at odds with the traditional treatment based approach of all medications. To look beyond “what are you treating?” and instead ask “what could we be preventing?” is not intuitive and requires a conscious shift of attitude. What if you could be “less sick” or prevent disease by taking medications preventively? A baby aspirin a day for certain population is justified, but that was after decades of studies and presumably a lot of funding through big pharma.
Tadalafil might fill this role. Ponder the following
- Erectile function
One of the most salient reasons for long term usage in health men is the most obvious. This is what was what Tadalafil was made for. The effect on erectile function is consistant and provides the needed incentive symptomatic incentive to make daily dosing a long term success. And this is more so than on demand dosing daily use of tadalafil or sildenafil, which also helps leadto greater compliance in the long term(2).
In 2013 the FDA approved daily tadalafil for use in BPH. Considering two of the major medications (finasteride, dutasteride) for this condition have significant sexual side effects, this gives physicians a great option, that will presumably result in a higher rate of compliance(1). The move has been more than beneficial for physicians who tackle testosterone replacement as it give us another tool that aids in the prostatic hypertrophy that so commonly occurs with TRT. Although there are a multitude of other rationales that could be used, using it to augment testosterone’s positive effects on erectile function – again when considering the safety profile of tadalafil – seems to be a no brainer.
The notion that tadalafil may affect the heart is not new. When Viagra was created, it was originally intended to be used for cardiovascular diseases. Tadalafil confirms its effects on the heart in animal studies, (reference) (reference), (reference), (reference), (reference) possibly having an anti-inflammatory effect on the heart. There is also a thought that it might help with a improving blood flow after a heart attack (reference), and endothelial function(reference).
Also, diabetics who are at higher risk of ED, might consider taking (reference). It is thus feasible to think there may be some small benefit to health men who are at risk for diabetes, to help protect cardiac function. Currently diet and exercise is the mainstay for prevention for diabetes. A daily aspirin? Early metformin? Tadalafil would be an easy and logical addition to this list.
Anti-Inflammatory and Cardioprotective Effects (animal study)
Decreases Mortality in TDII (poster session – medscape article)
Post MI Reperfusion
- Cancer therapeutics
Chemotherapy – https://www.ncbi.nlm.nih.gov/pubmed/28238269 Tumor fighter
A small study (Reference) also demonstrated that tadalafil might bolster the body’s immune system to fight off head neck cancers. To suggest a therapeutic application may be premature. But If it could bolster the body’s protective mechanisms in such a way, there could be added benefits to the immune system.
Head and neck cancer – improves tumor fighting ability
- Cognitive function
Alzheimer’s for the most part is like diabetes of the brain. Just as we treat our pancreas like crap through our diets, lifestyle, and reliance on treatment based medicine, the brain can suffer from the same. Any idiot in a fast food restaurant can tell you that there are no silver bullets to treat diabetes. The same can be said for Alzheimer’s (despite the attempts at finding the cure all pill for alzheimer’s, by large financially motivated groups, who btw results have been dismal.
There are few things that scare a successful man more than losing his cognitive abilities. The traditional medical community offers very little to help the ravages of dementia and memory loss. For the concerned individual Is there anything else other than lifestyle changes that someone can engage in before they fall ill? Namenda might be one but considering the overall effect is minimal for severe dementia patients, there is strong data suggesting it doesn’t do anything for mild cognitive impairment or early dementia (reference)and no protective benefit. What else is out there? Clearly not much. Tadalafil has at least some data supporting it showing positive effects on non-severe cases of healthy animal brains. Clearly this could be the most salient reason for healthy men to take a medication indefinitely. We know that sildenafil might be able to improve cognitive function(reference) but what about tadalafil? This thought is not new as some have been looking at the potential application of tadalafil in dementia (reference) for a few years now. Solid data is obviously lacking but ancillary data is plentiful.
Animal studies have shown tadalafil can improve working memory & locomoter ability, and is suggestive that it can have a marked effect on cognitive decline both in prevention and actual reversal (reference). Although some human trials are underway(reference , reference), large trials are unlikely going to happen due to a lack of funding. Considering this pitiful progress of the cure-all pill approach to Alzheimer’s, and considering the overall safety profile of the medication, some liberty in prescribing it for prevention of cognitive decline is more than appropriate.
This easily is the one reason, that all men need to consider taking this daily. At this time there are simply way too few medical options for preventing Alzheimer’s. In tadalafil, we may have something that men that can actually help us. We can wait until big pharma or some other large scale study clearly shows it (I do believe this will occur at some point) or it’s not much of a stretch to ask your doctor for prescription now.
Obviously there is not enough data here to strongly recommend daily tadalafil to all men. But keeping an open mind, one should realize that a compelling argument can be made for daily dosing in healthy men. Particularly noteworthy is the fact that for men who want to help prevent alzheimer’s, nothing else really exists. Also, with a very benign side effect profile, it’s obvious effects on a man’s erectile quality and its’ potential implications for cardiac blood flow, healthy forward thinking men would be wise to at least consider it, and discuss with it with their doctor.
1) Adherence to Initial PDE5 Inhibitor Treatment: Randomized Open Label Study Comparing Tadalafil Once a Day, Tadalafil on Demand, and Sildenafil on Demand in Patients with Erectile Dysfunction
2) Chronic PDE-5 inhibition in patients with erectile dysfunction
Base list of side effect <%5
Higher daily dosing
Low daily dosing
Low Dosing compliance
Testicular and Hormone function – none
Tadalafil, sildenafil, and vardenafil all act by inhibiting the enzyme. These drugs also inhibit other PDE enzymes. Sildenafil and vardenafil inhibit PDE6, an enzyme found in the eye, more than tadalafil. Some sildenafil users see a bluish tinge and have a heightened sensitivity to light because of PDE6 inhibition. Sildenafil and vardenafil also inhibit PDE1 more than tadalafil.
PDE5 – penis etc
PDE6 – Eye
Another one shows mild reversal of cognitive decline, and
Enhancing before decline – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267185/ – NB GOOD PAPER FOR MEDS FOR HEALTH
PDEi in Cognitive Decline
Reversal of Cognitive decline in alzheimer’s (animal study)
Neuroprotective effects on dopamine neurons after cerebral ischemia (animal study)
Stem cell protection