Taking ED Pills With Other Medications: What Doesn't Mix And What Needs Care
Sildenafil and tadalafil are a good fit for a lot of men, but they don't mix with everything. Much of what makes them risky isn't the pill itself; it's what else you're taking. Here's what the FDA labels for Viagra and Cialis say, in plain terms.
The Hard No: Nitrates And Riociguat
ED pills relax blood vessels, and so do nitrates, the medicines used for chest pain, such as nitroglycerin and isosorbide. Together they can drop blood pressure to dangerous levels, which is why both labels say not to combine them in any form, including amyl nitrite “poppers.” Riociguat (Adempas), used for certain types of pulmonary hypertension, is on the same do-not-combine list. If you ever need emergency care for chest pain, tell the team whether and when you last took an ED pill. The Cialis label says at least 48 hours should pass after a tadalafil dose before a nitrate is considered.
Alpha-Blockers For The Prostate
Alpha-blockers such as doxazosin, terazosin, tamsulosin, and alfuzosin are often taken for an enlarged prostate, and some for blood pressure. Combined with an ED pill, they can cause dizziness or fainting from a drop in blood pressure. The labels don't rule the combination out, but they say you should be stable on the alpha-blocker before starting, and that the ED pill should be started at the lowest dose.
Other Blood Pressure Medicines
ED pills lower blood pressure slightly on their own, and the labels note that this adds to the effect of other blood pressure medicines. In the studies described on the labels, the extra drop was modest. It's still the reason a provider needs your full medication list, not just the ones you think are relevant.
Medicines That Raise ED Pill Levels
Some drugs slow how your body clears sildenafil and tadalafil, so more of the ED medicine stays in your blood and side effects become more likely. The labels name the HIV medicine ritonavir, the antifungals ketoconazole and itraconazole, and the antibiotic erythromycin among them. If you take one, a provider may lower the ED dose or limit how often you use it. Going the other way, rifampin can make tadalafil less effective.
Alcohol, Supplements, And Doubling Up
Alcohol widens blood vessels too. Cialis's patient information warns that drinking too much, for example five glasses of wine or five shots of whiskey, raises the chance of headache, dizziness, a faster heartbeat, and lower blood pressure. Don't take two ED medicines together, and that includes Revatio and Adcirca, which are sildenafil and tadalafil prescribed for pulmonary arterial hypertension. Mention any supplement sold for sexual performance as well: the FDA has repeatedly found hidden sildenafil or tadalafil in products marketed that way.
Where To Start
Every Osirius sexual health intake asks for your current medications and supplements, and a licensed provider reviews them before prescribing anything. For how the two medicines compare, see sildenafil vs. tadalafil. Get emergency care for an erection lasting more than four hours, sudden loss of vision or hearing, or chest pain during sex.
This guide explains general information and is not medical advice. It doesn't replace a licensed provider reviewing your own history.