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Cialis 20 mg pill is typically taken as needed, about 30 minutes before sexual activity. Cialis may also be used in a lower daily dose for continuous management of erectile dysfunction or BPH. While effective, Cialis can cause side effects, including headaches, indigestion, back pain, and muscle aches. Cialis (tadalafil) 20 mg is a commonly prescribed medication for the treatment of erectile dysfunction (ED) and symptoms of benign prostatic hyperplasia.