Cialis in Japan: ED Medicine Without a Prescription

You can now buy Cialis in Japan without a prescription. In 2026, Cialis (シアリス), a tadalafil tablet for erectile dysfunction (ED), went on sale at Japanese pharmacies and drugstores. Its maker calls it the first over-the-counter ED medicine in Japan.

No prescription doesn't mean self-service, though. Cialis is a Pharmacist-Guidance Drug (要指導医薬品): you fill in a check sheet, show it to a pharmacist, and buy it after they explain it to you. Some people must not take it at all, so read the warnings below first.

How Cialis Works

The active ingredient, tadalafil 10 mg, relaxes the blood vessels of the penis and increases blood flow to it. According to the Japanese package insert:

• Taking it alone doesn't cause an erection. An erection happens only with sexual stimulation.
• It starts working about 30 minutes after you take it, and the effect has been seen for up to 36 hours.
• You can take it before or after a meal.
• It is not an aphrodisiac and doesn't increase sex drive.
• It does not protect against sexually transmitted infections.

How to Take Cialis

• Adult men aged 18 and older: 1 tablet, about 1 hour before sex, with water or lukewarm water.
• Don't take more than 1 tablet a day, and leave at least 24 hours between doses.
• Taking it every day is not recommended. If you want to take it daily, talk to a doctor.
• Avoid taking it when you have been drinking heavily. Erections can temporarily get weaker, and dizziness or a drop in blood pressure when standing up has been reported.
• Avoid grapefruit juice, and processed food made with a lot of grapefruit juice or peel, for at least 48 hours before and after taking it. They affect this medicine.

Who Must Not Take Cialis

The package insert also says not to take it if you:

• Have ever had an allergic reaction to Cialis or its ingredients.
• Use riociguat (Adempas, etc.), ketoconazole (oral; not sold in Japan), itraconazole (Itrizole, etc.), or clarithromycin (Clarith, Klaricid, etc.).
• Have a heart or blood vessel condition that makes sex inadvisable.
• Have unstable angina, or have had angina during sex.
• Have an irregular heartbeat that medicine doesn't control, low blood pressure (below 90/50 mmHg), or high blood pressure despite medicine (resting above 170/100 mmHg).
• Have had a heart attack in the last 3 months, or a stroke (brain infarction or bleeding) in the last 6 months.
• Have been told by a doctor that you have a liver problem or a kidney problem.
• Have been diagnosed with retinitis pigmentosa.
• Are a woman.

Sex carries a risk for the heart. If you might have a heart or blood vessel problem, the package insert says to check with a doctor first, because it can lead to a heart attack.

Talk to a Doctor or Pharmacist First If You

• Are being treated by a doctor or take prescribed medicine, especially medicine for an enlarged prostate or high blood pressure (alpha blockers such as doxazosin, amlodipine, etc.), HIV medicine (ritonavir, saquinavir, etc.), antibacterial medicine (rifampicin, etc.), or epilepsy medicine (phenytoin, phenobarbital, etc.).
• Are elderly (the check sheet says 65 or older).
• Have ever had an allergic reaction to a medicine.
• Have been diagnosed with priapism (an erection that lasted 4 hours or more), a blood disease (sickle cell anemia, multiple myeloma, leukemia, etc.), a bleeding disorder, a peptic ulcer, or a deformed penis (curvature, fibrosis, Peyronie's disease, etc.).
• Are using another ED treatment.
• Get very short of breath or feel chest pain with light or moderate exercise, such as walking briskly for about 20 minutes or running up one flight of stairs.

How to Buy Cialis in Japan, Step by Step

Look for this yellow box. It holds 4 tablets (4 doses).

Step 1: Before you go, answer the check sheet

• SS Pharmaceutical offers the check sheet on the web, on LINE, and as a printable sheet. Its English page has English web and printable versions. If you want the printed version, you print it yourself.
• It asks whether you are a man aged 18 or older with ED, which medicines you use, and about your heart, blood pressure, liver, kidneys, and eyes. Have the names of every medicine you take ready.
• One "no" in the first part, or one "yes" in the second or third part, means you can't take Cialis. The sheet tells you to talk to a doctor about other treatment.
• One "yes" in the fourth part (other medicines, age 65 or older, some conditions) means you may not be able to take it, so talk to a doctor or pharmacist.
• The official site has a store finder.

Step 2: At the store, talk to the pharmacist

• Show your check sheet result to the pharmacist. Pharmacists who sell Cialis have had training on this medicine.
• The pharmacist checks whether you can take it and explains it to you. If needed, they can point you to a doctor or clinic.
• Before you buy, you and the pharmacist go through four rules together: avoid grapefruit juice; if 4–8 doses don't work, talk to a doctor or pharmacist; if you see a doctor for chest pain or angina after taking it, tell them you took Cialis; and take care with driving and work at heights.
• SS Pharmaceutical asks you to read its "information for users" leaflet before buying. It is also on the official site, in Japanese and English.

Step 3: Buy it

• You can buy one box (4 tablets) per purchase.
• The maker says buying again is simpler with the LINE version of the check sheet.
• SS Pharmaceutical warns about counterfeit ED medicine, and recommends buying where a pharmacist explains it to you.

Step 4: At home, before your first dose

• Read the package insert in the box and the information for users.
• For at least 48 hours before and after taking it, don't drink grapefruit juice or eat processed food made with a lot of grapefruit juice or peel.
• Never give your Cialis to anyone else. They may have a heart condition that makes sex risky, or take a medicine that reacts with it.
• Sex always needs consent from both people. The leaflet also reminds you that Cialis doesn't prevent sexually transmitted infections, so use a condom or another proper method.

For how this class of medicine works in general, see our guide to Japan's OTC medicine classes.

After You Start: See a Doctor Within About 6 Months

The information for users recommends seeing a doctor as early as you can, within about 6 months of starting Cialis, even if it works for you. ED can be a sign of heart or blood vessel disease, high blood pressure, or diabetes, and a doctor can check for these and tell you whether you should keep taking it.

If it doesn't work, or you get symptoms that may be side effects, go to the clinic or department the pharmacist suggests.

When to Get Medical Help Right Away

• An erection that lasts 4 hours or more: see a doctor immediately. If it lasts 6 hours or more and treatment is delayed, you can lose erectile function.
• Sudden loss of vision or blindness: stop taking it and see an eye doctor immediately.
• A serious skin or allergic reaction: rash, hives, facial swelling; reddening of almost all the skin with peeling, often with fever; or high fever, red eyes, sores on the lips, sore throat, and a widespread rash.
• Chest pain or angina symptoms after taking it: if you go to a hospital, always tell the doctor that you took Cialis.

If side effects appear, stop taking it right away and talk to a doctor or pharmacist, bringing the package insert with you. The package insert lists many, including headache, flushing, indigestion, a stuffy nose, back pain, muscle pain, palpitations, dizziness, and blurred vision. Because dizziness and blurred vision can occur, take care with driving and work at heights.

FAQ

Sources & Documents

• Package insert (Japanese PDF)
• Check sheet (Japanese PDF)
• Information for users (Japanese PDF)
• SS Pharmaceutical's English page: the English check sheet, package insert, and information for users are linked from here.