For healthcare professionals. Compounded preparations are dispensed on a doctor’s prescription.
Short answer: A 2026 network meta-analysis of on-demand PDE5 inhibitor trials (83 studies, 6,029 participants) reported odds ratios versus placebo of 7.13 for tadalafil 20 mg and 3.14 for tadalafil 10 mg (PMID 42296271), with sildenafil ranked highest. Compounded tadalafil is prepared only on a named patient’s prescription under Good Compounding Practice (GCP).
Where tadalafil sits in erectile dysfunction management
Erectile dysfunction (ED) is a multifactorial condition. The 2026 network meta-analysis describes it as having “psychological, vascular, hormonal, neurological, and systemic risk factors” (PMID 42296271). For a Malaysian prescriber, the question is what the evidence says about tadalafil specifically and what a patient-specific formulation would require.
The regimen decision sits with the prescriber after assessment. Lynnity’s condition page on compounded ED treatment options summarises the wider formulation choices at compounded erectile dysfunction treatment options.
Study table
| Design | Participants | Dose | Outcome as reported | PMID |
|---|---|---|---|---|
| Systematic review and network meta-analysis of double-blind, placebo-controlled RCTs (on-demand dosing only) | 83 studies, 6,029 participants | Tadalafil 10 mg and 20 mg, on demand | Odds ratios for satisfactory erectile function versus placebo: 20 mg OR 7.13; 10 mg OR 3.14 | 42296271 |
| Systematic review and meta-analysis of head-to-head comparisons | 16 trials; participant numbers not stated in the abstract | Not stated in the abstract | Tadalafil and sildenafil “appeared to have similar efficacies and overall adverse event rates” | 28741090 |
| Randomised trial | 180 patients with ED | Tadalafil 5 mg once daily (alone arm); combined arm with sildenafil 50 mg as needed | In severe ED, total IIEF-5 scores were significantly higher in the combined arm than in the tadalafil-alone arm | 24387078 |
Dosing ranges with sources
| Study | Regimen | Dose | Schedule | PMID |
|---|---|---|---|---|
| Network meta-analysis of on-demand PDE5 inhibitors | Tadalafil, on demand | 10 mg and 20 mg | Per dose, on demand | 42296271 |
| Randomised trial in ED | Tadalafil alone arm | 5 mg | Once daily | 24387078 |
What the trials show, in the abstracts’ own words
The 2026 network meta-analysis included only on-demand doses and used the proportion of participants reaching satisfactory erectile function, defined as an IIEF domain score above 26, among its primary outcomes (PMID 42296271). Its authors wrote that “PDE5is are highly effective, with sildenafil showing a significantly greater efficacy compared with the other PDE5is” (PMID 42296271). A prescriber reading this for tadalafil should note that sildenafil ranked highest in the same analysis.
On adverse events, the same analysis reports that “the odds of treatment-related adverse events were highest for vardenafil, followed by avanafil and sildenafil, and lowest for tadalafil compared to placebo” (PMID 42296271). The authors qualify this: in some instances the wide confidence intervals showed higher variability and potential uncertainty in effect estimates (PMID 42296271).
The 2017 meta-analysis of 16 trials compared tadalafil with sildenafil directly. Its results state that the two drugs “appeared to have similar efficacies and overall adverse event rates” (PMID 28741090). Its conclusion reads: “Tadalafil shares a similar efficacy and safety with sildenafil” and “Hence, tadalafil may be a better choice for ED treatment” (PMID 28741090). The same abstract reports that tadalafil significantly improved psychological outcomes compared with sildenafil (PMID 28741090).
The randomised trial of 180 patients compared tadalafil 5 mg once daily with the same dose plus sildenafil 50 mg as needed. Its abstract reports that “total IIEF-5 scores of patients with severe ED in combined medication group were significantly higher than in tadalafil alone group” (PMID 24387078). This is a comparison of two regimens, not a comparison with placebo, and it does not describe a compounded preparation.
Limits of the evidence
- The 2026 analysis pools placebo-controlled trials.
- In some instances, the wide CI showed higher variability and potential uncertainty in effect estimates (PMID 42296271). Effect estimates for some doses carry wide intervals.
- The head-to-head evidence is from a 2017 meta-analysis that pooled trials of varying design (PMID 28741090).
What it means for prescribing
The 2026 evidence describes tadalafil at the on-demand doses shown in the table above (PMID 42296271). The prescriber determines the strength and form required for the named patient. The cited trials do not evaluate a Lynnity preparation.
Forms Lynnity prepares for this indication
Lynnity prepares tadalafil as a capsule or a liquid, each made to the prescriber’s written specification for one named patient. The choice of form is clinical and belongs to the prescriber, who should record the reason on the prescription.
Safety, monitoring and interactions
The evidence on adverse events is summarised above and is limited to the trials’ own populations.
Reviewed by Vitthia Rama Murti, RPh (RPh 15632).
How to prescribe
Who can prescribe. A registered doctor practising in Malaysia, after assessing the patient, prescribes the compounded preparation for a named patient.
What the prescription must state. The active (tadalafil), the strength the prescriber has determined, the form (capsule or liquid), the quantity, the directions and the patient’s identity.
How to send it. Lynnity’s referral process is a named-patient prescription with a short formulation brief, sent to the pharmacy. Kuala Lumpur and Klang Valley referral guide for clinics
Contact. Vitthia Rama Murti, RPh (RPh 15632). Start the conversation through the contact page. GCP laboratory page
Related reading: is a compounding pharmacy safe, and what Good Compounding Practice means in Malaysia, and how a compounding pharmacy tailors a formulation.
Frequently asked questions
When is a patient-specific tadalafil formulation considered?
The prescriber determines the active, strength, form, quantity and directions for the named patient. The studies cited here examine tadalafil in specified study regimens; they do not test a patient-specific compounded preparation. Formulation decisions and clinical assessment remain separate from the trials’ reported results.
What did the 2026 network meta-analysis find for tadalafil?
The analysis included 83 studies with 6,029 participants and reported odds ratios versus placebo of 7.13 for tadalafil 20 mg and 3.14 for tadalafil 10 mg for satisfactory erectile function. It also reported that sildenafil showed significantly greater efficacy than the other PDE5 inhibitors (PMID 42296271).
How does tadalafil compare with sildenafil for safety?
A 2017 meta-analysis of 16 head-to-head trials reported that tadalafil and sildenafil “appeared to have similar efficacies and overall adverse event rates” (PMID 28741090). A separate 2026 analysis ranked adverse-event odds against placebo only, with tadalafil lowest (PMID 42296271).
What must a prescription for compounded tadalafil state?
It should name tadalafil, the strength the prescriber has chosen, the form (capsule or liquid), the quantity, the directions and the patient’s identity.