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Background: Smokers are known to have a higher risk of erectile dysfunction. We examined how daily consumption of low-dose tadalafil affected erectile function and circulation in smokers and assessed the medication safety. Methods: Men aged over 20 years with current smoking status were selected to complete four weeks of treatment with 5 mg tadalafil daily. Erectile function was measured using the International Index of Erectile Function (IIEF), and additional tests included measuring various serum parameters, electrocardiogram, and nail capillary blood flow. Results: The IIEF scores, capillary blood flow, and serum liver function enzyme levels significantly improved. There were no reported adverse side effects. Conclusions: Smokers who were administered 5 mg tadalafil daily for four weeks had improved International Index of Erectile Function scores, dilated capillary vessels, and improved blood liver function enzyme levels; proving not only safety of usage and its effectiveness but also possible features that can indicate usages of the drug in other purposes.