A Comprehensive Guide on Interactions of Tadalafil

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Written By Julie Ingram
interactions of tadalafil

Tadalafil is a medication used to treat Erectile Dysfunction (ED), Benign Prostatic Hyperplasia (BPH), and Pulmonary Arterial Hypertension (PAH). 

It is marketed under two different brand names, i.e., Cialis for treating ED and BPH and Adcirca for treating PAH.

Although Tadalafil is generally safe and effective, it’s essential to be aware of potential interactions that can occur when taking this medication. 

Interactions can happen with other drugs, certain diseases, as well as specific foods. 

This article is a comprehensive guide to understanding all the interactions of Tadalafil and offers insights on how to minimize the risk of such interactions. 

Interactions of Tadalafil

Tadalafil belongs to a category of Phosphodiesterase Type 5 (PDE5) inhibitors. 

It works by blocking the action of the PDE5 enzyme, which increases cGMP levels. 

cGMP is a molecule that helps in the dilation of blood vessels and improves blood flow to certain areas of the body.

It also relaxes the smooth muscles in the prostate and helps manage BPH symptoms. 

As mentioned, certain drugs, diseases, and food can interact with Tadalafil and affect this mechanism of action.

Here we will delve deeper into each type of Tadalafil interaction. 

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  • Drug interactions of Tadalafil

    Drug interactions refer to the effects that occur when one drug interacts with the other medication.

    This can lead to changes in the way one or both medications work. Thus, potentially resulting in unexpected side effects or reduced effectiveness. 

    It can occur when multiple medications share the same pathway for metabolism or when one medication affects the absorption, distribution, metabolism, or elimination of another.

    Drugs that can interact with Tadalafil and affects it include Nitrates, Alpha-blockers, antifungals, Protease inhibitors, etc. 

    1. Nitrates

    Nitrates are the medications that are prescribed for treating chest pain (Angina). They work by lowering blood pressure, which is a similar effect to Tadalafil.

    Taking Nitrates and Tadalafil together can intensify this blood pressure-lowering effect. Thus, leading to a potentially dangerous drop in blood pressure. 

    Such an interaction can result in severe health complications. Therefore, it is crucial to avoid using Nitrates alongside Tadalafil.

    2. Alpha-blockers 

    Alpha-blockers are prescribed for treating conditions like high blood pressure and prostate problems. 

    They can interact with PDE5 inhibitors like Tadalafil. 

    Both medications have a blood pressure-lowering effect. So if combined, it may lead to a decrease in blood pressure to a dangerous level. This can cause symptoms like lightheadedness and fainting. 

    Therefore, if you are taking an Alpha-blocker like Doxazosin, avoid using Tadalafil. 

    When Alpha-blockers like Tamsulosin are taken with Tadalafil, it does not intensify the blood pressure-lowering effect.

    3. Antibiotics and antifungals

    Certain antibiotics and antifungal medications can interfere with Tadalafil’s metabolism and can affect its clearance from the body. 

    This may lead to increased medicine levels in the body.

    Thus, potentially intensifying Tadalafil’s effects and causing side effects.

    Examples include Itraconazole, Ketoconazole, Erythromycin, etc. 

    4. Other medicines 

    Various other medicines also have a history of interactions with Tadalafil. These include:

    • Protease inhibitors 
    • Other Erectile Dysfunction medicines (e.g. Sildenafil)
    • Diuretics
    • Beta-blockers
    • sGC stimulators (eg. Riociguat)

    Disease interactions of Tadalafil

    Disease interactions refer to the effects that a medical condition can have on the working mechanism of the medication. 

    Certain diseases can influence the metabolism, distribution, and elimination of drugs. 

    Additionally, some medical conditions may alter how the body responds to specific medications. 

    These can impact the medication’s effectiveness and safety. 

    Tadalafil’s disease interactions include interaction with cardiovascular diseases, liver diseases, kidney diseases, etc. 

    1. Cardiovascular diseases

    Heart problemSource: Thatphichai Yodsri_from_Getty_Images
    Heart disease

    Individuals with cardiovascular conditions, like heart disease or irregular heart rhythms, should take caution when using PDE5 inhibitors.  

    As Tadalafil (a PDE5 inhibitor) can affect blood flow and heart function, it may interact with existing cardiovascular issues. Thus, potentially leading to complications. 

    It is important to note that it does not imply that all heart patients cannot use Tadalafil. Patients with stable conditions can use this medicine with a doctor’s recommendation. 

    2. Liver or kidney diseases

    Medicines are primarily metabolized in the liver and excreted by the kidneys. 

    Patients with liver or kidney diseases may experience impaired drug metabolism or clearance.

    This can result in Tadalafil accumulating in the body to higher levels than usual. 

    Thus, potentially leading to side effects or reduced effectiveness. 

    Doctors may consider adjusting the dosage or recommending alternative treatments for patients with liver or kidney impairment. 

    3. Other diseases 

    There are also other medical conditions that have the potential to interact with Tadalafil. These include:

    • Pulmonary Veno-Occlusive Disease (PVOD)
    • Priapism
    • Retinitis Pigmentosa
    • Seizure disorders
    • Hearing loss

    Food interactions of Tadalafil

    Food interactions occur when the consumption of certain foods or beverages affects how a medication is absorbed or metabolized by the body. 

    This can alter the effectiveness of the medication or lead to potential side effects.

    Tadalafil’s food interaction includes alcohol and grapefruit juice. 

    1. Alcohol 

    Drinking alcohol excessively can impair sexual function and decrease the effectiveness of Tadalafil.

    Moreover, alcohol can interfere with the metabolism of the medication. Thus, potentially affecting its absorption and elimination from the body.

    2. Grapefruit juice

    Grapefruit contains compounds that block the action of CYP3A4 enzymes, which are responsible for metabolizing Tadalafil. 

    If they are consumed together, this will prevent the breakdown of the medication. Thus, resulting in higher levels of Tadalafil in the bloodstream, which can increase the risk of side effects. 

    Therefore, it is advisable to avoid consuming grapefruit or grapefruit juice while taking Tadalafil. 

    How to minimize the risk of Tadalafil interactions

    Some steps must be taken to minimize the risk of interactions of Tadalafil. These include consulting a doctor, reading labels, following dosage instructions, and timely reporting of side effects. 

    1. Consult a doctor

    Consult a doctorSource: Syda_Productions
    Consult a doctor to know about prescribed dosage

    Do not indulge in self-medication. Always consult a doctor before taking Tadalafil. 

    Inform your doctor about the medications you are taking. This helps them to determine whether the medication is safe for them to use or not. 

    2. Read medication labels

    Pay close attention to the labels of all medications you take, including over-the-counter products.

    In case of any doubts, contact your doctor or pharmacist to get clarity. 

    3. Follow dosage recommendations

    Take Tadalafil as your doctor prescribes. Avoid changing the dosage or frequency without consulting them first.

    4. Report side effects

    If you experience any unusual side effects while using Tadalafil, inform your doctor.

    They can evaluate the reason for those side effects and adjust the dosage or medication accordingly. 

    It is advisable not to take more than one Tadalafil dose in 24 hours. This can lead to overdosing and may cause adverse effects.


    Tadalafil is an effective medication for managing ED, BPH, and PAH.

    However, like any medicine, it has the potential to interact with other drugs, diseases, and even food. 

    The most dangerous interaction of Tadalafil include drugs like Nitrates or Alpha-blockers and diseases like cardiovascular problems. 

    By understanding these Tadalafil interactions and following precautionary measures, individuals can use it safely and effectively.

    The interactions of the medications vary from person to person. Thus, it is important to consult a doctor for personalized advice and guidance on Tadalafil usage. 

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    Frequently Asked Questions

    Can Tadalafil interact with herbal supplements or vitamins?

    Yes, Tadalafil may interact with herbal supplements and vitamins. It is essential to inform your doctor about all the supplements you are taking to ensure safe usage of the medication. Some supplements may affect their effectiveness or increase the risk of side effects.

    Does Tadalafil interact with medications for Depression or Anxiety?

    Tadalafil may interact with certain antidepressants and anti-anxiety medications. Patients using these medications should consult their doctor before using Tadalafil to ensure safety.

    Is it safe to use Tadalafil if I have a history of allergies or Asthma?

    Patients with a history of allergies or Asthma can generally use Tadalafil safely. However, it is essential to inform your doctor about any medical conditions you have, including allergies or Asthma. In fact, Tadalafil has proven to offer therapeutic benefits in managing Bronchial Asthma. 

    Can I use Tadalafil if I have an eye condition like Glaucoma?

    Patients with certain eye conditions, such as Glaucoma, should discuss their condition with a doctor before using Tadalafil. In some cases, it may not be recommended, as it can potentially worsen eye conditions or interact with Glaucoma medications.

    Is Tadalafil safe to use if I have a bleeding disorder?

    Tadalafil can influence clotting mechanisms, and special precautions may be necessary to avoid excessive bleeding. Regular monitoring and medical supervision are essential for the safe usage of Tadalafil in patients with bleeding disorders. 

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