Tadalafil, a medication typically prescribed for erectile dysfunction in men over 40, is increasingly being used recreationally by young Brazilian adults. Commonly nicknamed “tadala” on social media, the drug is promoted in videos as a quick fix for sexual performance or even as a pre-workout supplement to enhance muscle gains. Yet, experts warn that this practice can be dangerous for those without a medical need for the drug.
A recent review published in 2024 in the Diversitas Journal analyzed over 20 national and international studies spanning the last two decades and found a consistent trend: individuals are acquiring the medication without a prescription. This trend raises concerns about potential health risks and the lack of medical oversight.
Motivations for leverage often stem from behavioral and psychosocial factors, including curiosity about its effects, a desire for increased self-confidence, pressure to perform well sexually, and attempts to reduce anxiety or stress before intercourse. “None of this, however, can be solved with medication alone,” says Gustavo Alves Andrade dos Santos, a pharmaceutical biochemist and researcher at the University of São Paulo in Ribeirão Preto (USP-RP), and co-author of the publication.
Tadalafil, vardenafil, and sildenafil – better known by the brand name Viagra – are all phosphodiesterase type 5 (PDE5) inhibitors used to treat organic erectile dysfunction. They work by relaxing the tissues in the penis and increasing blood flow, facilitating erections.
However, according to the Brazilian Society of Urology (SBU), there is no proven benefit for men without a physiological problem. The sensation of a “pump” – a temporary swelling of muscles – reported by some users is likely due to transient peripheral vasodilation and represents a placebo effect, the SBU noted in a statement published in 2025. This finding highlights the psychological nature of the perceived effects among young people.
Daniel Suslik Zylbersztejn, a urologist at the Einstein Hospital Israelita, explains that the use of these drugs among young people tends to produce only a psychological effect. “What happens is that, believing their sexual performance will be better with the medication, the individual tends to feel more confident and less pressured,” he says. “In practice, it’s a kind of psychological crutch.”
Risks to Physical and Mental Health
The main side effects of PDE5 inhibitors stem from their mechanism of action – systemic vasodilation, which can cause facial flushing and nasal congestion. However, abusive use can lead to tachycardia, changes in blood pressure, fainting, temporary vision or hearing loss, and, in severe cases, heart attack, stroke, and sudden death. The potential for serious adverse events underscores the dangers of using these medications without medical supervision.
Another potential consequence is priapism, an abnormal, persistent erection that is not accompanied by sexual desire and is often painful. This condition is more common in patients with liver impairment, who have difficulty metabolizing the drug, causing it to remain in the body for a longer period.
Recreational use of these drugs in combination with alcohol can also have a paradoxical effect. While alcohol also causes vasodilation, it is a central nervous system depressant, reducing dopaminergic activity. This can compromise the success of an erection.
The risks to health are not solely physical. “There is no evidence of physiological dependence on these medications; they do not cause withdrawal syndrome or persistent biochemical changes. However, psychological dependence can occur,” notes Santos. Young people today often struggle with social interactions, as communication increasingly happens through messages and videos, coupled with the impact of pornography, which creates unrealistic expectations about sex. This can lead to relationship difficulties and frustrations.
The recreational use of drugs for erectile dysfunction emerges as an attempt to cope with these insecurities. “The person comes to believe that the pills will solve their anxiety, their body image issues, and even questions related to their ability to satisfy their partner,” says Zylbersztejn. “But it’s important to remember that sex is not just about penetration. Many men forget that. The obsession with penis size or the rigidity of an erection prevents these individuals from enjoying the situation and creating good connections.”
Use Without Prescription or Monitoring
A 2020 study published in the International Journal of Clinical Practice interviewed over 92,000 young men and found that of nearly 25,000 who had taken some type of medication for erectile dysfunction, 51% did so without professional advice. This highlights a significant gap in safe medication practices and the need for increased awareness.
This is further complicated by the circulation of unregulated formulations of these substances, including in Brazil. Online, it is easy to find gums and supplements that are not authorized by Anvisa (the National Health Surveillance Agency) and may pose a high risk of contamination. “When these medications are packaged in a way that doesn’t identify them as medicine, to reach a young audience, banalization is inevitable. The only way to address this is through education and public awareness,” says the physician from Einstein Hospital.
Combating self-medication can be achieved through educational campaigns. Given that a large proportion of acquisitions occur without a prescription, pharmacists should also play a central role in this mission, reinforcing the requirement for a prescription and providing warnings at the point of sale. “You don’t use an antibiotic before reaching a diagnosis, and you don’t prescribe a GLP-1 analog without considering clinical criteria. The same must happen with tadalafil, sildenafil, and vardenafil. They can only be adopted with a medical indication,” observes Santos.
“An isolated episode of erectile failure can cause insecurity, but that is normal and does not justify the systematic use of these medications,” adds the USP-RP researcher. If this type of situation is happening to you, seek a specialist doctor to investigate what may be behind it and what the best treatment is.
