News · Longevity & Aging
Tadalafil (Cialis) for urinary symptoms tied to 22% higher glaucoma risk in men
Tadalafil is widely prescribed to men for an enlarged prostate as well as erectile problems. In matched health records of nearly 74,000 men, users developed glaucoma somewhat more often over five years.
- An observational study of 73,854 men aged 40 or older with urinary symptoms, drawn from multinational health records.
- Half took tadalafil; half were matched men who did not take that class of drug.
- Over five years, glaucoma was diagnosed in 3.93% of tadalafil users against 3.16% of non-users.
- The link showed up for open-angle glaucoma and raised eye pressure, not for angle-closure glaucoma.
- Users may differ from non-users in ways records miss, so this does not prove the drug causes glaucoma.
Tadalafil, best known as Cialis, is prescribed not only for erectile dysfunction but also, daily, for the urinary symptoms of an enlarged prostate. That means large numbers of older men take it for years, often without thinking much about their eyes.
A study in the British Journal of Ophthalmology compared nearly 37,000 tadalafil users with a matched group of men who did not take it. Over five years, the users were diagnosed with glaucoma about 22% more often.
What glaucoma is
MedlinePlus explains that glaucoma is a group of diseases that can damage the optic nerve of one, or both, of your eyes, and that the most common type is open-angle glaucoma. It adds that you may not have any symptoms of glaucoma until vision is already affected.
Glaucoma is often linked to raised pressure inside the eye. Tadalafil belongs to a drug class, PDE5 inhibitors, that affects blood flow, which is why researchers have wondered about effects in the eye. The authors set out to evaluate the association between tadalafil use for lower urinary tract symptoms (LUTS) and the risk of developing glaucoma.
How the tadalafil study worked
The researchers used TriNetX, a network of health records from many countries, to find men aged 40 or older with urinary symptoms between 2012 and 2022, excluding anyone who already had glaucoma.
They compared men who took tadalafil with men who took no drug in that class, matching them on age, race, other illnesses, kidney function and other medicines. The cohort included 36 927 tadalafil users and 36 927 matched non-users.
What happened to glaucoma rates
Over five years, glaucoma was diagnosed more often among users. Tadalafil use was associated with an increased risk of glaucoma compared with non-PDE5i use, about 22% higher, and the five-year rate was 3.93% against 3.16%.
The pattern was specific. Risks were higher for raised eye pressure, for the common open-angle form of glaucoma, and for starting glaucoma treatment, but there was no clear link with angle-closure glaucoma or the low-pressure form. The results held in men over 50 and across other health conditions.
Why the eye link matters for tadalafil users
In absolute terms the difference is modest: about eight more glaucoma diagnoses per 1,000 men over five years. But tadalafil is taken long term by many older men, who are also the group most at risk of glaucoma, and glaucoma damage to vision cannot be reversed.
The authors do not call for stopping the drug. They conclude that ophthalmic evaluation and follow-up may be considered, particularly in patients with risk factors for glaucoma, such as a family history, older age or high eye pressure.
What a tadalafil records study cannot prove
Men prescribed tadalafil may differ from those who are not in ways that records do not capture, including how often they see doctors. More medical contact can mean more eye checks, and more eye checks mean more glaucoma found.
Diagnoses come from codes rather than standardized eye examinations, and the study did not measure dose or how long each man took the drug. It covered men with urinary symptoms, so it cannot say whether occasional use for erectile dysfunction carries the same pattern.
What this changes for men on tadalafil
For men taking tadalafil daily for prostate symptoms, the practical step is a regular eye examination, especially after 50 or with a family history of glaucoma. Early glaucoma is silent, and eye tests are the only way to catch it.
Nobody should stop a prescribed medicine on the strength of one observational study. If there is concern, the prescribing doctor can discuss alternatives for urinary symptoms and coordinate with an eye specialist.
People also ask
What did the study find?
Up to 5 years, tadalafil use was associated with increased glaucoma risk (hazard ratio 1.22, 95% CI 1.12 to 1.33), ocular hypertension (1.32), primary open-angle glaucoma (1.33) and starting glaucoma treatment (1.33). No clear associations were found for low-tension or primary angle-closure glaucoma. Five-year cumulative incidence was 3.93% against 3.16%.
What is tadalafil used for?
It treats erectile dysfunction and the urinary symptoms of an enlarged prostate, such as a weak stream and frequent urination. It belongs to a class called PDE5 inhibitors, which also includes sildenafil.
Why might it affect the eyes?
PDE5 inhibitors influence blood flow, including in the eye, and may affect fluid pressure inside it. The study did not test mechanisms.
How big is the extra risk?
About 0.8 percentage points over five years: roughly eight extra glaucoma diagnoses per 1,000 men. The relative increase was about 22%.
Should men stop taking tadalafil?
No, not on the basis of one observational study. Men who take it, particularly those with a family history of glaucoma or other risk factors, may want regular eye checks.
How is glaucoma detected?
Through an eye examination that measures eye pressure and looks at the optic nerve, often with a visual field test. Early glaucoma usually has no symptoms. This is general information rather than medical advice.