Erectile dysfunction drug used to treat enlarged prostate symptoms may raise glaucoma risk
· Medical Xpressedited by Sadie Harley, reviewed by Alexander Pol
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An erectile dysfunction drug that is also used to treat symptoms, such as sudden urgency and frequency, associated with an enlarged prostate in men may heighten the risk of glaucoma, a serious eye condition, a large comparative study published online in the British Journal of Ophthalmology finds.
The findings prompt the researchers to suggest that patients given tadalafil (Cialis) long term for this indication might need to have their eye health carefully monitored, especially those with glaucoma risk factors, such as a family history or existing high pressure inside the eye (ocular hypertension).
Tadalafil, like sildenafil (Viagra), belongs to a class of drugs called phosphodiesterase type 5 inhibitors (PDE5i). These drugs have been associated with various eye health issues, including conditions affecting the optic nerve and the macula—the part of the retina responsible for sharp, detailed vision—the researchers explain.
But the evidence linking them to a heightened risk of glaucoma is patchy and inconclusive, particularly for tadalafil when used to treat lower urinary tract symptoms, which typically involves long-term daily dosing, they add.
To extend the evidence base, the researchers wanted to find out whether tadalafil, a long-acting PDE5i, is associated with a heightened risk of glaucoma when prescribed to manage urinary tract symptoms associated with an enlarged prostate (benign prostatic hyperplasia).
They drew on anonymized data for 73,854 men ages 40 and older in the TriNetX Analytics Network (Global Collaborative Network). Half had been prescribed tadalafil or another PDE5i for up to five years, between January 2012 and December 2022, to treat their symptoms, while the other half had not been given these drugs.
They assessed how likely both groups of men were to develop glaucoma or ocular hypertension and to start treatment for glaucoma after five years.
The men were paired on the basis of similar potentially influential background features, including age; ethnicity; smoking; alcohol-related disorders; underlying conditions, such as cardiovascular disease, diabetes, cancer, high cholesterol, kidney function, obesity and chronic obstructive pulmonary disease (COPD); and prescribed medications.
Analysis of all the data showed that men prescribed tadalafil were significantly more likely to develop glaucoma (22% more likely), ocular hypertension (32% more likely) and primary open-angle glaucoma (the most common type; 33% more likely), and to start glaucoma treatment (33% more likely), than men who had not been prescribed tadalafil.
Further in-depth analysis revealed that these associations held true among those who developed glaucoma within one, three or six months of starting tadalafil treatment. They were also consistently observed among patients ages 50 and older, those of white ethnicity and those with various underlying conditions included in the study.
This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. The researchers also acknowledge various limitations to their findings. For example, they were not able to factor in changes in medication prescriptions and use or the development of other underlying conditions over time.
And most study participants were white, so the findings may not apply to men of other ethnic backgrounds, they add.
Nevertheless, they write, "These findings suggest that chronic PDE5 inhibition may influence ocular physiology, warranting further mechanistic investigation."
But they emphasize, "These findings do not contraindicate tadalafil use but highlight the importance of baseline ophthalmic assessment and regular follow-up, particularly in patients with pre-existing glaucoma, ocular hypertension, a family history of glaucoma, high myopia [nearsightedness], or those requiring long-term therapy."
Publication details
Risk of glaucoma among patients using tadalafil for lower urinary tract symptoms: a multinational cohort study, British Journal of Ophthalmology (2026). DOI: 10.1136/bjo-2026-329957
Journal information: British Journal of Ophthalmology
Key medical concepts
GlaucomaTadalafilOcular HypertensionPrimary Open Angle GlaucomaEnlarged Prostate (BPH)
Clinical categories
OphthalmologyUrologyMen's healthClinical pharmacology Provided by British Medical Journal Who's behind this story?
Sadie Harley
BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries. Full profile →
Alexander Pol
PhD nano-engineering from Delft University. Published researcher and journal reviewer. Brings scientific insight to content standards. Full profile →
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