Long-term use of the erectile dysfunction drug tadalafil may be associated with a greater risk of glaucoma when used to relieve symptoms associated with an enlarged prostate.
A large comparative study, published online in the British Journal of Ophthalmology,1 said men using tadalafil over extended periods may benefit from closer monitoring of their eye health.
They said this may be especially important for people who already have glaucoma risk factors, including a family history of the disease or ocular hypertension.
Tadalafil belongs to a group of medications known as phosphodiesterase type 5 inhibitors (PDE5i). Previous research has connected PDE5i medications with several types of eye problems, including disorders of the optic nerve and the macula.
However, researchers say the evidence surrounding glaucoma has remained inconsistent.
In particular, relatively little is known about glaucoma risk when tadalafil is used for lower urinary tract symptoms, a treatment that commonly involves taking the medication every day over a long period.
The risk of glaucoma overall was 22% higher among tadalafil users
To investigate, the research team analysed anonymised health information from almost 74,000 men aged 40 or older in the TriNetX Analytics Network. Half had been prescribed tadalafil or another PDE5i for up to five years to manage their symptoms; half were matched non-users of PDE5 inhibitors.
The risk of glaucoma overall was 22% higher among tadalafil users. Primary open-angle glaucoma was 33% higher while no significant associations were found for low-tension or primary angle-closure glaucoma. Ocular hypertension was a 32% higher risk.
Men prescribed tadalafil were also 33% more likely to begin glaucoma treatment.
The researchers caution that because it was an observational study, the findings do not establish that tadalafil directly causes glaucoma.
“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, or those requiring long-term therapy.”
Reference
- Hsia Y, Tsai CY, Chou CC, et al. Risk of glaucoma among patients using tadalafil for lower urinary tract symptoms: a multinational cohort study. Br J Ophthalmol. 2026:bjo-2026-329957. doi: 1136/bjo-2026-329957.
