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Sexual activity may be a strain on your heart, especially if you have heart disease. Patients should seek prompt medical attention if their erection lasts longer than four hours. Oral medicines for ED usually work well and cause few side effects. They enhance the effects of a chemical the body makes that relaxes muscles in the penis, called nitric oxide. Do not stop taking tadalafil without talking to your doctor.How Cialis Works. Tadalafil and other PDE5 inhibitors primarily work by inducing muscle relaxation. Tadalafil stops the breakdown of a chemical responsible for relaxing muscles. In ED and PAH, the drug targets muscle cells in blood vessels. When the blood vessel muscle cells relax, this expands the vessel and increases blood flow; this . Here are five things to know about the new topical gel and how it can help if you’re struggling to get an erection: 1. It Targets the Problem and Works Quickly. Being a . Side Effects. Headache, stomach upset, back pain, muscle pain, stuffy nose, flushing, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. To.

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