Does Tadalafil Lower Blood Pressure: Risky Interactions

Tadalafil is an oral pill used to treat Erectile Dysfunction (ED), with effects lasting for 36 hours. It relaxes blood vessels and increases blood inflow to the penis during sexual stimulation. Since it directly affects blood vessels and circulation, many men wonder whether it can lower blood pressure (BP).

In healthy men with normal BP (around 120/80 mmHg), any BP drop associated with Tadalafil is usually mild. In fact, due to this effect, it is also used for Pulmonary Arterial Hypertension (PAH). In PAH, it helps lower pressure in the lung arteries and improves blood flow.

However, the BP-lowering effect can become serious when Tadalafil is combined with certain medicines, such as alpha-blockers and nitrates. This article outlines does Tadalafil lower blood pressure and the interactions that can increase the risk of this effect. We will also discuss key considerations for using this ED pill.

Does Tadalafil lower blood pressure?

Yes, Tadalafil, with the brand name Cialis, can lower blood pressure as a side effect by inhibiting the Phosphodiesterase Type 5 (PDE5) enzyme, which is present in blood vessels throughout the body (systemic). This way, Tadalafil can systemically relax and dilate the vessels, and not just the penile vessels, triggering a mild drop in blood pressure. The drop is typically 1.6/0.8 mmHg while lying down and 0.2/4.6 mmHg while standing, measured as systolic/diastolic blood pressure.

A 2022 study reports that this mild drop in blood pressure is short-lived and does not increase the risk of side effects or major cardiovascular events, including among people taking standard blood pressure-lowering medications.

But this effect can become significant and risky in specific situations, particularly when it is taken with certain medication classes or substances like alcohol that also lower BP.

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Tadalafil interactions that cause low blood pressure

While Tadalafil causes only a mild drop in BP when used alone, it can lead to a dangerous BP dip (below 90/60 mm Hg) when combined with certain medications. The symptoms of Low Blood Pressure typically include nausea, fatigue, fainting, blurred vision, and lightheadedness or dizziness.

Strictly consult a doctor if you experience such symptoms and before using the following medicines with PDE5 inhibitors:

Nitrates

Nitroglycerin, isosorbide mononitrate, or isosorbide dinitrate are some of the nitrates prescribed for chest pain (Angina). They also act as vasodilators, which is why combining them with PDE5 inhibitors can lead to a severe drop in BP. It is suggested to keep at least 24 to 48 hours of gap between the two medications to prevent this adverse reaction.

Alpha-blockers

Doxazosin, Tamsulosin, and certain other alpha-blockers treat High Blood Pressure (Hypertension) and Benign Prostatic Hyperplasia (BPH). These relax blood vessels to lower blood pressure, and when taken with Tadalafil, the combined effects lead to a significant low BP. Under medical supervision, you can separate the dose timing or take a lower dose of Tadalafil.

PDE5 inhibitors

Taking Cialis with multiple other PDE inhibitors, such as Sildenafil, Vardenafil, Avanafil, and Udenafil, is strictly not recommended. It doesn’t improve efficacy; rather, it increases the risk of side effects, including Hypotension. Instead of combining different ED medications, consult your doctor for dose adjustments or a change of medication if Tadalafil is not giving the desired results.

CYP3A4 inhibitors

Antifungals like Ketoconazole, some macrolide antibiotics like Erythromycin, and HIV Protease Inhibitors are CYP3A4 inhibitors that block the CYP3A4 enzyme in the liver. In turn, it prevents Tadalafil from breaking down, thereby increasing its concentration in the body. This drug accumulation increases the risk of side effects, including its BP-lowering effects. Consult a doctor to see if the dosage can be adjusted.

Guanylate Cyclase (GC) stimulators

GC stimulators, such as riociguat, increase cyclic Guanosine Monophosphate (cGMP) levels, enabling relaxation of blood vessels and helping control blood pressure. When taken with Cialis, the BP-lowering effect intensifies, leading to severe Hypotension.

Antihypertensives

As discussed, Tadalafil has no major impact on BP when used with blood pressure-lowering medicines (Antihypertensives), but some BP-lowering effect can still occur. Therefore, it is best to consult a doctor before using an ED pill if you are already taking BP medications to avoid any potential risk.

Alcohol

Alcohol can expand blood vessels and decrease blood pressure on its own. When taken with Tadalafil, this effect can become stronger and lead to dizziness and nausea, with the risk increasing in case of excessive alcohol consumption. It is suggested to avoid or limit drinking alcohol to prevent a sudden drop in BP.

What to keep in mind before using Tadalafil

Although Tadalafil is highly effective for ED, it is not suitable for everyone. Since it influences blood circulation and has known interactions with certain medications, there are several points to consider before using it:

• Consult a doctor: Tadalafil is a prescription-only medication and requires a doctor’s evaluation before use. Make sure to always take this ED pill under medical supervision for accurate dosing.
• Choose a reputable provider: Always buy Tadalafil from reputable pharmacies that require a valid prescription. Such pharmacies, like GoodRxMedicine, also offer generic pills that are 90-95% cheaper than the brand version (Cialis) without insurance. Buying it from unauthorized providers or unverified websites can increase the risk of counterfeit (fake) products. Fake Tadalafil may contain harmful ingredients, leading to toxicity and severe health risks.
• Who should be cautious: PDE5 inhibitors must be avoided or used under strict doctor’s supervision in case of a history of cardiovascular diseases, such as a recent heart attack or Stroke, uncontrolled Hypotension (Low Blood Pressure) and Hypertension, unstable Angina, severe liver diseases, serious kidney impairment, and some inherited eye disorders.
• Side effects: The pill can cause some mild, temporary side effects, including headache, nasal congestion, flushing, muscle ache, and blurred vision. In rare cases, it can cause a painful erection lasting more than 4 hours (Priapism), sudden vision loss, hearing loss, or chest pain. Contact your doctor if common effects persist or if rare effects occur.

Conclusion

Tadalafil is an oral pill that treats ED by increasing blood flow to the penis. Tadalafil can lower blood pressure, but the effect is mostly mild and temporary when used alone in healthy men.

However, when it is combined with certain medications, such as nitrates, other PDE-5 inhibitors, and CYP3A4 inhibitors, the effect can combine and become severe. Other interactions that increase the risk of severe Hypotension include antihypertensives, excessive alcohol, GC stimulators, and alpha-blockers.

Before using Tadalafil, consult a doctor who will assess your health and prescribe it. It can also cause some side effects like headache and nasal congestion, and, in rare cases, hearing loss and Priapism. Avoid using it in case of cardiovascular events, certain eye disorders, Hypertension and Hypotension.

Gina, Master of Clinical Pharmacy

Gina Walters is the diet and lifestyle writer at Goodrxmedicine.com. She holds a level 6 diploma in natural nutrition and lifestyle and is an ardent preacher of veganism. A fitness enthusiast by heart, Gina’s passion for fitness follows into her personal life too.