Tadalafil and Hearing Loss: Risks, Sudden Changes and When to Seek Help

Hearing problems that occur while taking tadalafil need careful assessment, particularly when hearing changes suddenly.

A hearing problem beginning after tadalafil does not prove the medicine caused it. But sudden unexplained hearing loss should be treated as a medical emergency, not monitored at home to see whether it improves.

NICE defines sudden-onset hearing loss as hearing loss developing over three days or less. Where sudden hearing loss in one or both ears is not explained by an external or middle-ear cause, and developed within the previous 30 days, NICE recommends immediate referral so that specialist assessment happens within 24 hours.

Do not delay medical assessment while trying to establish whether tadalafil is responsible.

Key things to know

• Hearing changes during treatment should not automatically be attributed to tadalafil
• Sudden unexplained hearing loss can be a medical emergency
• NICE recommends immediate specialist referral for qualifying sudden hearing loss developing within the previous 30 days
• Hearing loss has many causes unrelated to medicines
• Tinnitus, dizziness or vertigo alongside it provide important clinical information
• Do not deliberately take tadalafil again to test whether a hearing problem returns
• Suspected reactions can be reported through the MHRA Yellow Card scheme

Can Tadalafil Cause Hearing Loss?

Hearing changes have been reported in association with PDE5 inhibitors, the class that includes tadalafil, and sudden sensorineural hearing loss appears in the safety literature for these medicines.

A suspected adverse reaction means there is a possible relationship between a medicine and an event. It does not mean the medicine has been confirmed as the cause in an individual.

Hearing loss can arise from many other causes, and NICE notes that assessment may need to consider external or middle-ear explanations before determining the right referral pathway.

For the safety information covering your exact product, check the patient information leaflet supplied with it.

Is Sudden Hearing Loss an Emergency?

Sudden unexplained hearing loss can be a medical emergency regardless of whether tadalafil is suspected.

NICE states that adults with hearing loss developing over three days or less, within the previous 30 days, should be referred immediately where the problem is not explained by an external or middle-ear cause, and should be seen by a specialist service within 24 hours.

That recommendation is not tadalafil-specific. It applies because sudden hearing loss itself can need urgent investigation, and early treatment improves the chances of recovery.

Do not wait several days to see whether hearing returns. Waiting also makes it harder to establish the original timeline.

If Hearing Has Been Worsening Gradually

Rapidly worsening hearing also needs timely assessment. NICE defines rapid worsening as deterioration over 4 to 90 days, where the problem is not explained by external or middle-ear causes, and recommends urgent referral so the person is seen within two weeks.

That is a different pathway from the immediate one for loss developing over three days or less, so describe your timeline accurately. Sudden, rapidly worsening and longer-term hearing loss lead to different assessments.

What a Hearing Problem Can Involve

It may mean reduced hearing in one or both ears, a sudden change in clarity, or other ear symptoms. Tinnitus, dizziness, vertigo or a feeling of fullness in the ear can occur alongside it.

The experience varies, and symptoms alone cannot establish tadalafil as the cause.

Give the actual timing rather than simply saying tadalafil caused the problem.

Tinnitus

Tinnitus means hearing sounds that do not come from an external source, and it can occur alongside hearing difficulties. NICE recommends referral for certain patterns, including persistent tinnitus that is one-sided or pulsatile, meaning it appears to follow the heartbeat.

Record whether it began at the same time as the hearing change, whether it affects one or both ears, and whether it persists. Do not treat tinnitus as confirmation that tadalafil is responsible, and do not let it distract from the urgency of assessing the hearing change itself.

Dizziness or Vertigo

Report these to whoever assesses you, since they help determine what investigation is appropriate. Vertigo usually describes a sensation of movement or spinning rather than general light-headedness.

Hearing changes combined with balance symptoms can have causes unrelated to tadalafil, so it is particularly important not to diagnose it yourself. Tell the clinician when each symptom began, and whether they appeared together.

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Timing Is Not Causation

A hearing change after tadalafil establishes that one event followed another. It does not establish causation.

Hearing loss can result from problems in different parts of the hearing system. NICE distinguishes conductive hearing loss, involving the outer or middle ear, from sensorineural hearing loss involving the inner ear or auditory nerve.

So other explanations can exist even when a symptom appears soon after taking a medicine. Assessment should determine what needs investigating, rather than assuming either that tadalafil definitely caused the problem or that it could not be involved.

Other Causes to Consider

External or middle-ear problems, noise exposure and conditions affecting the inner ear or hearing pathways can all be relevant.

NICE recommends that people presenting with hearing difficulties for the first time are assessed for problems such as impacted earwax and acute infection before further audiological assessment is arranged.

This matters most with sudden hearing loss, because assuming the medicine is responsible could delay investigation of another treatable cause.

What to Do if Hearing Changes Suddenly

Seek immediate medical attention rather than waiting for a routine review. Contact your GP, NHS 111 or the urgent service you have been advised to use.

Record when the change began, which ear is affected, whether it was sudden or progressive, and whether tinnitus, dizziness or vertigo are present.

Tell the healthcare professional that you have taken tadalafil, when, and what else you take.

Do not take tadalafil again before getting urgent clinical advice, and never take another tablet deliberately to see whether the problem recurs. Deliberate re-exposure is not an appropriate way to test a suspected reaction.

Once the hearing problem has been assessed, a prescriber can review whether tadalafil remains suitable, considering the timing, any hearing assessment results, your other medicines and possible alternative explanations.

A Lower Strength Does Not Remove the Risk

A smaller number should not be assumed to eliminate the possibility of a hearing-related reaction, and strength should never be changed independently to manage a suspected serious reaction.

Do not divide tablets, combine presentations or select another strength yourself to try to avoid a recurrence. If a significant hearing problem has occurred, the appropriate response is clinical review.

Review Your Other Medicines Too

Tadalafil may not be the only relevant factor, so tell the healthcare professional about your prescription medicines, pharmacy medicines and supplements.

Do not stop another prescribed medicine because you suspect it might be contributing. The clinician can consider your complete medicine history alongside the timing and character of the hearing problem, which avoids attributing the event to tadalafil simply because tadalafil was taken beforehand.

How It Is Assessed

Assessment aims to establish the type of hearing problem, its severity, where in the hearing system it originates, and whether specialist investigation is needed.

It may begin by checking for an external or middle-ear explanation, such as an obstruction or acute ear problem. Hearing assessment can then help distinguish conductive from sensorineural hearing loss.

Exactly what is investigated depends on the circumstances, and further specialist investigation may be arranged where initial treatment does not help.

Can Hearing Return?

Outcomes vary with the cause, severity and individual circumstances, so recovery cannot be guaranteed. Some people improve, and others have persistent hearing impairment. That uncertainty is another reason not to delay assessment.

Do not assume that waiting for the medicine to leave the body will restore hearing. Equally, improvement after stopping a medicine does not prove the medicine caused the problem, and assessment still matters even when symptoms begin to improve.

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Reporting a Suspected Reaction

Suspected adverse reactions can be reported through the MHRA Yellow Card scheme, and you do not need to establish with certainty that tadalafil caused the problem before reporting.

Reports contribute to UK medicine safety monitoring, helping regulators identify patterns when information from multiple reports is considered. A report does not prove causation in an individual case.

Useful information includes the medicine name, when tadalafil was taken, when the hearing problem began, whether one or both ears were affected, additional symptoms such as tinnitus or vertigo, your other medicines, relevant medical history, and what happened afterwards.

Keep the packaging or medicine information where possible, since the exact product is useful when documenting a suspected reaction.

Reporting should never replace medical assessment. If hearing loss has occurred suddenly, clinical care comes first.

The Practical Takeaway

Take a hearing problem after tadalafil seriously, without assuming tadalafil caused it. There is a recognised association in the safety literature, but that does not establish causation in any individual case.

The immediate concern is that sudden unexplained hearing loss can be a medical emergency. NICE recommends immediate specialist referral for qualifying cases developing within the previous 30 days, with assessment inside 24 hours.

Do not wait for hearing to return, take tadalafil again, or change strength yourself to investigate the problem.

Prompt assessment comes first, and the medicine safety review can follow.

Medical Disclaimer

This page provides general educational information about tadalafil and hearing loss. It does not diagnose the cause of hearing loss, or provide personalised prescribing or treatment-changing instructions.

Tadalafil is used to treat erectile dysfunction. Seek urgent medical attention for sudden changes in hearing or vision, chest pain, or an erection lasting four hours or longer. Treatment suitability depends on an individual clinical assessment.

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