Experts warn of risks as tadalafil sales grow 2000% among young people
The popularity of tadalafil, a drug designed to treat erectile dysfunction, has grown significantly among young men in recent years. In addition to being used recreationally to improve sexual performance, the substance was promoted on digital platforms as a supposed aid in bodybuilding, although without any scientific support. This trend is confirmed by figures from the National Health Surveillance Agency (Anvisa), which reveal an impressive jump in sales: from 3.2 million units in 2015 to 74.9 million in 2025, representing an increase of more than 2,000% in just one decade.
The expansion of tadalafil use goes beyond government data. Throughout the journalistic investigation for this article, several narratives about taking the medicine emerged in casual discussions with men between 20 and 30 years old. Most of these stories were linked to the search for optimized sexual performance and, more recently, its incorporation into the training routine.
However, the increase in consumption of this medication without a prescription has led organizations focused on the conscious use of drugs to issue warnings about the dangers involved. The Support Center for Rational Therapy through Information on Medicines (CEATRIM), linked to the Fluminense Federal University (UFF), was one of the entities to take a stand. The center indicated that the search for quick solutions to optimize physical performance, often encouraged by content on social media, can promote the irresponsible use of medicines.
According to CEATRIM, uncontrolled administration of tadalafil is capable of generating unwanted effects and harmful interactions with other substances. Among the most frequently observed symptoms are headache, digestive discomfort, low back pain, facial redness, nasal obstruction and myalgia. In less common situations, the drug can trigger changes in visual, hearing and even heartbeat.
Part of this growth in tadalafil consumption is attributed to its increasing dissemination on online platforms, where it was presented as a resource to improve sexual performance and even performance in physical activities. The substance, which was previously mainly linked to urological consultations, began to appear in productions by digital influencers, who endorsed it as a type of “pre-workout” among the public.
The prospect of improved blood circulation and superior physical performance even boosted the development of items with tadalafil in the form of chewable candies, called “gummies”. In the year 2025, Anvisa vetoed the sale of these products, citing regulatory and health safety concerns.
For this report, several men aged 26 to 30 were interviewed on condition of anonymity, in order to protect their identities. One of the participants shared that he has colleagues who use medication excessively.
“I know a friend who took up to four doses at once. Afterwards, he experienced headaches, back discomfort and muscle pain, feeling exhausted. On the other hand, I never had any reactions, as I only took one pill”, reported the young man.
The interviewee indicated that men often choose not to reveal the use of the medicine to their partners before sexual intercourse. “I looked for information about the contraindications and, even so, I decided to use it, believing that it would benefit the relationship. I use it occasionally and persist for fear of possible adverse effects”, he explained.
Working in the nighttime events sector, the young man stated that the search for tadalafil is routine in this context. “At parties, it is normal for someone to question the availability of tadalafil sellers. There are those who take advantage of the situation, purchasing the product in pharmacies and reselling it in nightlife environments. A package costs around R$10, but there are those who sell a single tablet for R$30”, he detailed.
In a spontaneous interaction during an event, multiple young people confirmed that they had already consumed tadalafil. Certain individuals mentioned the habit of taking the medicine on leisurely evenings, with the intention of extending the duration of their intimate encounters. One of the boys, who is in a long-term relationship, revealed that he had chosen to try the compound to improve his performance with his partner. “The experience was positive. We had several consecutive relationships”, he shared.
A colleague in the same age group admitted using the substance more regularly. “It’s a male issue, I wouldn’t be able to understand it,” he replied when asked about the motivations for consumption.
During the discussion, those present shared experiences and suggestions. Those who used tadalafil most frequently encouraged others to test the compound, repeatedly reiterating: “It poses no danger whatsoever.”
One of the boys mentioned that most of his friends use the medicine, and he himself is rarely without a package. “I use it and enjoy excellent nights”, he commented, amidst laughter. He also stated that he was aware of individuals who use the substance for physical activity purposes. “Several colleagues even consume it to train. They guarantee that it helps a lot and does not cause any harm”, he added.
Among boys, tadalafil is popularly nicknamed “little blue”, a direct allusion to Viagra, which has sildenafil citrate as an active component. Viagra was the pioneer among oral treatments for erectile dysfunction and became notorious for the bluish color of its pills.
The current scenario surrounding tadalafil is amplified by the ease of obtaining it. None of the young people interviewed had a medical prescription to purchase the drug. At the same time, digital influencers garner millions of views on social networks by sharing experiences about the drug’s alleged benefits. In most of these materials, tadalafil is dissociated from its purpose as a specific medical treatment, being promoted as a “sexual energizer” or a facilitator of performance in physical activities, which trivializes the use of a substance with potent effects.
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However, experts warn that self-medication and non-prescribed use can pose health risks and intensify a culture of demanding sexual performance, which especially affects younger men. According to cardiologist Marcelo Bergamo, tadalafil is safe if administered correctly and under medical supervision, but it is not free from unwanted reactions.
“The primary action of tadalafil consists of the dilation of blood vessels, which can result in a decrease in blood pressure. For individuals with pre-existing heart conditions, hypotension, arrhythmias or coronary diseases, consumption without medical supervision increases the risk of dizziness, syncope and, in certain cases, more serious cardiovascular consequences”, detailed the specialist.
Bergamo emphasized that a large part of the population ignores the existence of asymptomatic heart diseases, making self-medication even more worrying. Another frequent risk among young people is the association of the drug with alcoholic beverages and recreational substances. According to the doctor, alcohol can intensify the reduction in blood pressure, increasing the likelihood of dizziness, weakness, fainting and accidents.
The scenario worsens considerably when tadalafil is combined with stimulants such as cocaine, ecstasy and amphetamines. “These substances increase heart rate and blood pressure, while tadalafil induces vasodilation. This association can generate an overload on the cardiovascular system, increasing the danger of arrhythmias, chest pain, heart attack and, in susceptible individuals, even sudden death”, warned the cardiologist.
The doctor also highlighted that the most critical interaction occurs with nitrate-based drugs, commonly used in the management of angina and other cardiac pathologies. Examples include nitroglycerin, isosorbide mononitrate, and isosorbide dinitrate. “The joint use of these drugs with tadalafil can trigger a sudden and potentially lethal decrease in blood pressure”, he assured.
In addition to nitrates, the cardiologist advises caution for patients who use certain medications for hypertension, alpha-blockers prescribed for urinary dysfunction and drugs that influence the metabolism of tadalafil. Although the common perception is that the risks only affect older individuals, Bergamo clarifies that young age does not eliminate the chance of complications. “Serious incidents are rare, but they can arise, especially when the medicine is administered in high doses or combined with alcohol and recreational drugs,” he highlighted.
Warning signs that require urgent medical intervention include chest pain, difficulty breathing, severe palpitations, fainting, severe vertigo, sudden changes in vision or hearing, and painful erections that persist for more than four hours, a phenomenon known as priapism.
According to the cardiologist’s assessment, the rise in recreational consumption among young people has raised concern in the medical community and scientific associations. “Use without prescription can lead to an unrealistic perception that the medication is essential for sexual performance, especially for young people without any clinical need. Furthermore, there are already records of emergency care linked to inappropriate use, covering cases of hypotension, syncope, arrhythmias, priapism and complications resulting from the combination with alcoholic beverages and illicit substances”, he explained.
Bergamo reiterated that tadalafil does not offer improvements to cardiovascular health or prevent heart conditions. “It is a proven effective and safe drug when used under guidance, but its unregulated application, especially in recreational situations and in conjunction with alcohol or drugs, can generate significant dangers to cardiovascular health and general well-being. The vast popularity of the substance does not make it harmless”, he concluded.
In the view of psychiatrist Gustavo Estanislau, who works as a specialist in Child and Adolescent Psychiatry at the Hospital de Clínicas de Porto Alegre (UFRGS) and researcher at the Ame Sua Mente Institute, the increase in tadalafil consumption among young people is directly related to a confluence of factors: the ease of access to the medicine, its vast promotion on social networks and a growing uncertainty regarding their own sexual performance.
The psychiatrist explained that digital platforms intensify the premise that men need to be “constantly able to perform” in an “impeccable” manner, fueling feelings of anxiety and insufficiency. Given this, countless young people who do not have a diagnosis of erectile dysfunction seek medication as a way to ensure that “no unforeseen events will occur” in their experiences.
Estanislau warned that the most significant risk is the emergence of psychological dependence. “Young people start to believe that their good performance is linked to the use of medication”, he commented. The doctor added that this belief leads them to fear failure without the drug, highlighting the seriousness of emotional dependence. For him, tadalafil can disguise insecurity and performance anxiety, but it does not solve the origin of the problem.
Estanislau also showed that the consumption of the substance is often linked to the intake of alcohol and other drugs, inserted in a panorama of experimentation and search for social acceptance. “We observed a decrease in confidence that they are capable of performing well without the support of medication”, concluded the psychiatrist.
According to the psychiatrist’s analysis, the fixation on impeccable performance distances young people from more authentic experiences of intimacy, self-discovery and development. “Imperfections and mistakes are interpreted as something extremely serious”, he clarified, adding that this perspective reduces resilience to disappointments and can compromise the formation of more stable emotional bonds.
