Cialis interactions: Alcohol, medications, and other factors

Cialis interaction with cannabis or CBDCannabis (marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Cialis. The exact effect of cannabis products on Cialis may vary from person to person. In some cases, cannabis products may decrease the level of Cialis in the body, which could cause the drug to be less effective than usual.In other cases, cannabis products may raise the level of Cialis in the body. This could increase your risk of side effects from Cialis. (To learn about possible side effects of Cialis, see this article.)Before you start treatment with Cialis, tell your doctor and pharmacist if you take cannabis. By sharing this information with them, you may help prevent possible interactions.Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Cialis (Tadalafil)

The Cialis brand of tadalafil is used in men to treat erectile dysfunction (impotence) and symptoms of benign prostatic hypertrophy (enlarged prostate).

Adcirca and Alyq are used in men and women to treat pulmonary arterial hypertension (PAH) and to improve exercise capacity.

Do not take Cialis for erectile dysfunction if you are taking Adcirca or Alyq for pulmonary arterial hypertension.

Tadalafil may also be used for purposes not listed in this medication guide.

What is Cialis (Tadalafil) used for?

• Pulmonary Hypertension
• Pulmonary Impairment
• Pulmonary Heart or Vascular Disease
• Thromboembolic Pulmonary Hypertension

warnings

What is the most important information I should know about Cialis (Tadalafil) ?

You should not take tadalafil if you are allergic to it, or:

Do not take tadalafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. Nitrates are also found in some recreational drugs such as amyl nitrate, butyl nitrate or nitrite (“poppers”). Taking tadalafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

Some tadalafil can remain in your bloodstream for 2 or more days after each dose you take (longer if you have liver or kidney disease). Avoid nitrate use during this time.

• heart problems (chest pain, a heart rhythm disorder, heart failure);
• a heart attack or stroke;
• high or low blood pressure;
• liver disease;
• kidney disease (or if you are on dialysis);
• retinitis pigmentosa (an inherited condition of the eye);
• blindness in one or both eyes;
• hearing problems;
• blood circulation problems;
• a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
• pulmonary veno-occlusive disease (PVOD);
• a physical deformity of the penis (such as Peyronie’s disease), or an erection lasting longer than 4 hours;
• a stomach ulcer; or
• health problems that make sexual activity unsafe.

A small number of people taking tadalafil have had sudden vision loss. Most of these people already had eye problems, or had diabetes or other health conditions that can affect blood vessels in the eyes. It is not clear whether tadalafil causes vision loss.

Do not start or stop taking tadalafil during pregnancy without your doctor’s advice. Having pulmonary arterial hypertension (PAH) during pregnancy may cause heart failure, stroke, or other medical problems in both mother and baby. Tell your doctor right away if you become pregnant.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

Cialis interactions: Alcohol, medications, and other factors

Cialis (tadalafil) is a brand-name prescription drug used in males* to treat erectile dysfunction and symptoms of benign prostatic hyperplasia.

As with other medications, Cialis can interact with certain other drugs, foods, and alcohol. An interaction occurs when one substance causes another substance to have a different effect than expected.

For details about Cialis’s interactions, keep reading. For additional information about Cialis, see this article.

* Sex and gender exist on spectrums. Use of the term “male” in this article refers to sex assigned at birth.

In some cases, a factor or condition could prevent your doctor from prescribing Cialis due to the risk of harm. This is known as a contraindication. The contraindications of Cialis include:

Taking a guanylate cyclase stimulator

Doctors are not likely to prescribe Cialis with guanylate cyclase (GC) stimulators. These medications are used to treat pulmonary arterial hypertension. (This is a form of high blood pressure in the arteries of the lungs.)

Both Cialis and GC stimulators may lower blood pressure. Taking Cialis in combination with a GC stimulator could lower your blood pressure further.

Examples of GC stimulators that can interact with Cialis include vericiguat (Verquvo) and riociguat (Adempas).

If you’re taking a GC stimulator, talk with your doctor before taking Cialis. They can recommend a treatment other than Cialis for your condition.

Taking a nitrate

Doctors are not likely to prescribe Cialis with nitrates. These medications are used to help prevent or treat angina (a type of chest pain).

Both Cialis and nitrates can lower blood pressure. Taking Cialis in combination with a nitrate may lower blood pressure further. A sudden drop in blood pressure can lead to fainting and dizziness. In severe cases, it may lead to heart attack or stroke.

Examples of nitrates that can interact with Cialis include:

In addition to the medications above, nitrates also include a group of drugs called poppers. An example of a popper is amyl nitrate.

If you’re taking a nitrate, talk with your doctor before taking Cialis. They can advise you on treatments other than Cialis for your condition.

Having had an allergic reaction to Cialis or any of its ingredients

If you have had an allergic reaction to Cialis or any of its ingredients, your doctor will likely not prescribe Cialis. Taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices.

Note: Before you start treatment with Cialis, it’s important to tell your doctor if any of these contraindications apply to you. They can determine whether to prescribe Cialis.

Doctors may recommend limiting the amount of alcohol you consume while taking Cialis. This is because both alcohol and Cialis can lower blood pressure. Drinking alcohol during Cialis treatment could lower blood pressure further.

If you drink alcohol, talk with your doctor before taking Cialis. They can recommend an amount, if any, that’s safe to consume during your treatment.

Before you start treatment with Cialis, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a chart of drugs that can interact with Cialis. Due to the risk of interactions, doctors may not prescribe Cialis with these medications. Keep in mind that this chart does not include all drugs that may interact with Cialis. Some of these interactions are described in detail just below in “Drug interactions in depth.”

Drug class or drug name	Drug examples	Interaction result with Cialis
guanylate cyclase (GC) stimulators*	• vericiguat (Verquvo) • riociguat (Adempas)	can increase the effect of GC stimulators
nitrates*	• isosorbide dinitrate (Isordil) • isosorbide mononitrate (Monoket) • nitroglycerin (Nitro-Dur, NitroMist, Nitrostat)	can increase the effect of nitrates
alpha-blockers	• tamsulosin (Flomax) • terazosin • alfuzosin (Uroxatral)	can increase the effect of alpha-blockers
blood pressure drugs	• angiotensin receptor blockers, such as losartan (Cozaar) • angiotensin converting enzyme inhibitors, such as enalapril (Epaned, Vasotec) • calcium channel blockers, such as amlodipine (Norliqva, Norvasc) • beta-blockers, such as metoprolol (Lopressor, Toprol XL)	can increase the effect of blood pressure drugs
PDE5 inhibitors	• avanafil (Stendra) • vardenafil (Staxyn) • sildenafil (Viagra, Revatio) • other forms of tadalafil (Adcirca, Alyq)	can increase the risk of side effects from Cialis†
certain protease inhibitors	• ritonavir (Norvir) • atazanavir (Reyataz) • darunavir (Prezista)	can increase the risk of side effects from Cialis†
certain antifungal drugs	• itraconazole (Sporanox, Tolsura) • levoketoconazole (Recorlev) • ketoconazole • voriconazole (Vfend)	can increase the risk of side effects from Cialis†
certain antibiotic drugs	• clarithromycin • erythromycin (E.E.S., EryPed, Ery-Tab, others) • rifampin (Rifadin, Rimactane)	can increase the risk of side effects from Cialis†
certain antiseizure drugs	• carbamazepine (Carbatrol, Epitol, Tegretol, others) • phenobarbital • phenytoin (Dilantin, Phenytek)	can make Cialis less effective than usual

* For details about this interaction, see “When to avoid Cialis” above.
† To learn about possible side effects of Cialis, see this article.

Here’s a closer look at certain drug interactions of Cialis.

PDE5 inhibitors

Interaction result. Taking a PDE5 inhibitor with Cialis can increase the risk of low blood pressure.

Interaction explained. Cialis belongs to a class of drugs called PDE5 inhibitors. Medications in this class, including Cialis, can lower blood pressure. Taking Cialis with other drugs in the same drug class can increase the risk of low blood pressure further.

Examples of PDE5 inhibitors. PDE5 inhibitors that may interact with Cialis include the following:

Steps you or your doctor may take. Due to this risk, doctors typically will not prescribe Cialis in combination with other PDE5 inhibitors. Before taking Cialis, it’s important to tell your doctor if you’re already taking a PDE5 inhibitor. They’ll likely prescribe a treatment other than Cialis for your condition.

Certain antibiotic drugs

Antibiotic drugs are used to treat infections caused by bacteria.

Interaction result. Taking Cialis with certain antibiotics can increase the risk of side effects of Cialis. (To learn more about the side effects of Cialis, see this article.)

Interaction explained. Certain antibiotics can prevent your body from breaking down Cialis. This can result in a higher level of the drug in your body than usual. A high level of the drug in your system could increase risk of side effects from Cialis.

Examples of antibiotic drugs. Below are a few antibiotics that may interact with Cialis:

Steps you or your doctor may take. If you’re taking an antibiotic, talk with your doctor before starting Cialis treatment. They can advise you on whether it’s safe for you to take Cialis with these medications.

Certain antiseizure drugs

Interaction result. Taking Cialis with certain antiseizure drugs can make Cialis less effective than usual.

Interaction explained. Certain antiseizure drugs may cause your body to break down Cialis more quickly than usual. This could result in a lower level of the drug in your body than usual, which could make the drug less effective for treating your condition.

Examples of antiseizure drugs. Antiseizure drugs that may interact with Cialis include those listed below:

Steps you or your doctor may take. Before taking Cialis, tell your doctor if you’re taking antiseizure drugs. They can advise you on whether these medications may interact with Cialis.

Cialis may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below.

Cialis and supplements

It’s possible for drugs to interact with supplements such as vitamins and herbs.

Cialis and herbs

Taking Cialis with an herb called St. John’s wort can decrease how well Cialis works. The herb is sometimes used to treat depression.

Be sure to talk with your doctor about taking both St. John’s wort and Cialis. Your doctor may be able to provide you with alternative treatment options.

Cialis and vitamins

No vitamin interactions have been reported with Cialis. You should still check with your doctor or pharmacist before taking any vitamins during Cialis treatment.

Cialis interactions with food

Drinking grapefruit juice or eating grapefruit while taking Cialis could raise the level of Cialis in your body. A higher level of the drug could increase your risk of side effects. (To learn about possible side effects of Cialis, see this article.)

If you have questions about taking Cialis with other foods or drinks, such as coffee, talk with your doctor or pharmacist.

Cialis and vaccines

Vaccines have not been reported to interact with Cialis. If you have questions about getting certain vaccines during your Cialis treatment, talk with your doctor or pharmacist.

Cialis and lab tests

There are no specific reports of lab tests interacting with Cialis. For more information about having certain lab tests while taking Cialis, talk with your doctor or pharmacist.

Cialis interaction with cannabis or CBD

Cannabis (marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Cialis.

The exact effect of cannabis products on Cialis may vary from person to person. In some cases, cannabis products may decrease the level of Cialis in the body, which could cause the drug to be less effective than usual.

In other cases, cannabis products may raise the level of Cialis in the body. This could increase your risk of side effects from Cialis. (To learn about possible side effects of Cialis, see this article.)

Before you start treatment with Cialis, tell your doctor and pharmacist if you take cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Cialis. Before you take Cialis, be sure to talk with your doctor about your health history. Cialis may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Cialis include the following:

Misshaped penis. Before starting treatment with Cialis, tell your doctor if you have a condition that affects the shape of your penis, such as Peyronie’s disease. Such conditions can increase your risk of priapism as a side effect. Your doctor can help determine whether Cialis is a safe treatment option for you.

Heart problems or stroke. Doctors typically will not prescribe Cialis if you have a heart problem or have had a stroke. Examples of heart problems include having heart failure in the past 6 months or a heart attack in the past 90 days.

Cialis is also not recommended in people with problems such as:

It’s not known whether Cialis is safe if you have any of these conditions. If you do, your doctor will likely prescribe a treatment other than Cialis.

Liver or kidney problems. If you have a liver or kidney problem, be sure to tell your doctor before taking Cialis. Examples of these problems include liver failure and kidney failure. Your doctor may give you a lower dosage of Cialis than what’s typically prescribed. (For details about the dosage of Cialis, see this article.)

Bleeding problems. Before taking Cialis, tell your doctor if you have a bleeding problem. An example is hemophilia. Your doctor can advise you on whether Cialis is a safe treatment option for you.

Blood cancers or blood cell problems. Before taking Cialis, tell your doctor if you have a blood cancer. Examples include multiple myeloma and leukemia. Also tell them if you have certain blood cell problems, such as sickle cell anemia. These conditions could increase your risk of priapism as a side effect. Your doctor can help determine if Cialis is right for you.

Peptic ulcers. If you have a peptic ulcer, talk with your doctor before taking Cialis. You may have an increased risk of bleeding with the drug. Your doctor can advise you on whether Cialis is safe to take.

Eye problems. In rare cases, Cialis can cause vision loss or other serious eye problems. If you already have an eye problem, you may have an increased risk of eye side effects with the drug. Before taking Cialis, tell your doctor if you have a problem with your retina or optic nerve. This includes conditions such as retinitis pigmentosa. They can help determine whether it’s safe for you to take Cialis.

Allergic reaction. If you’ve had an allergic reaction to Cialis or any of its ingredients, your doctor will likely not prescribe Cialis. For details, see “When to avoid Cialis” above.

Pregnancy. Cialis is not approved for use in females.* It’s not known if the drug is safe to use during pregnancy. You can talk with your doctor to learn more.

Breastfeeding. Cialis is not approved for use in females.* It’s not known if Cialis passes into breast milk. For additional information about Cialis and breastfeeding, talk with your doctor.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Here are some frequently asked questions about Cialis and possible interactions.

Does Cialis interact with NSAIDs, such as ibuprofen or meloxicam?

There’s no known interaction between Cialis and nonsteroidal anti-inflammatory drugs (NSAIDs). Although NSAIDs are typically used to treat pain, they can also be used for inflammation.

If you’re interested in treating inflammation or pain while taking Cialis, talk with your doctor or pharmacist.

Can I drink coffee while taking Cialis?

Coffee and Cialis are not known to interact with each other.

Coffee often contains high amounts of caffeine. The results of one study found that consuming caffeine may lower the risk of erectile dysfunction (ED), which Cialis is used to treat. However, it’s unknown whether coffee or caffeine is effective for treating this condition.

If you’d like to learn more about Cialis and coffee, talk with your doctor.

Do Cialis and finasteride interact?

Cialis is not known to interact with the drug finasteride (Propecia, Proscar). Finasteride is used to treat conditions such as baldness and benign prostatic hyperplasia.

Finasteride may cause ED as a side effect. Cialis is used to treat ED. If you develop ED while taking finasteride, your doctor may prescribe medication to ease the side effect. This may include Cialis. Your doctor can tell you more.

Is there an interaction between Cialis and Xanax?

There’s no known interaction between Cialis and alprazolam (Xanax).

Xanax may cause sexual side effects, including changes in libido (sex drive). Having a low libido could result in ED. Therefore, it’s possible that taking Xanax could result in ED. If you have ED due to Xanax, your doctor may prescribe Cialis to treat your condition.

If you have other questions about Cialis and Xanax, talk with your doctor or pharmacist.

Can I take Cialis with omeprazole?

Cialis and omeprazole (Prilosec) are not known to interact with each other. Omeprazole is used to treat certain digestive problems, such as acid reflux.

The results of one report suggest that ED is a possible side effect of omeprazole. If you have ED that’s related to omeprazole, your doctor can recommend the right treatment option for you. This may include taking Cialis.

You can take certain steps to help prevent interactions with Cialis. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan the following:

• Let them know if you drink alcohol or take cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list , which your doctor and pharmacist can help you fill out.

It’s also important to read the label of Cialis and other paperwork that comes with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the prescribing information , may contain details about interactions. If this information is difficult to understand, ask your doctor or pharmacist to help explain it.

You can also help prevent interactions with Cialis by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Cialis. These resources might help:

• Overview of Cialis. For a general overview of Cialis, read this article.
• Side effects. If you’re interested in the side effects of Cialis, see this article. Another option is to refer to the Cialis prescribing information.
• Dosage specifics. You can refer this article to learn about the dosage of Cialis.
• Drug comparison. Find out how Cialis compares with Viagra, Levitra, and Adcirca.
• Facts about your condition. To learn more about your condition, see our men’s health hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Last medically reviewed on July 16, 2022

How we reviewed this article:

Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Cialis Interactions: Alcohol, Medications, and Others

Cialis (tadalafil) is a prescription drug that’s used to treat erectile dysfunction and symptoms of enlarged prostate in adult males.* Like other drugs, Cialis may have interactions.

Some interactions occur because one substance causes another substance to have a different effect than expected. For example, sometimes alcohol, another drug, or a supplement can affect how a drug acts in your body. Interactions can also occur if you have certain health conditions.

Keep reading to learn about Cialis’s possible interactions. And for more information about Cialis, including details about its uses, see this article.

* In this article, we use the term “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

Certain health conditions or other factors could raise your risk of harm if you take Cialis. In such cases, your doctor may not prescribe Cialis for you. These are known as contraindications. The list below includes contraindications of Cialis.

If you take a nitrate. If you take a nitrate drug, your doctor likely won’t prescribe Cialis. Nitrates are used to treat a type of chest pain called angina.

Taking Cialis with nitrates may cause very low blood pressure. And having very low blood pressure can lead to dizziness and fainting. In severe cases, very low blood pressure may lead to stroke or heart attack.

Below are examples of nitrates that can interact with Cialis:

Certain drugs called poppers are also nitrates. Amyl nitrate is an example of a popper. If you take poppers, your doctor likely won’t prescribe Cialis.

Before taking Cialis, tell your doctor if you’re already taking a nitrate drug. They can recommend treatments other than Cialis for your condition.

If you take a guanylate cyclase stimulator. If you take a guanylate cyclase (GC) stimulator, your doctor likely won’t prescribe Cialis. GC stimulators are used to treat pulmonary arterial hypertension. (This is a form of high blood pressure that occurs in the arteries of your lungs.)

Adempas (riociguat) and Verquvo (vericiguat) are examples of GC stimulators that can interact with Cialis.

Before taking Cialis, tell your doctor if you’re already taking a GC stimulator. They can recommend other treatments other than Cialis for your condition.

If you’ve had an allergic reaction. If you have had an allergic reaction to Cialis or any of its ingredients, your doctor likely won’t prescribe Cialis. This is because taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better options for you.

Before you start taking Cialis, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Cialis is safe for you to take.

Your doctor will likely recommend limiting the amount of alcohol you drink during Cialis treatment. This is because both Cialis and alcohol can lower your blood pressure. So, drinking alcohol while taking Cialis could lower your blood pressure even further.

If you drink alcohol, talk with your doctor before starting Cialis treatment. They can tell you whether there’s an amount that’s safe to consume while taking Cialis.

Before you start taking Cialis, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions.

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The chart below lists drugs that may interact with Cialis. Keep in mind that this chart does not include all drugs that may interact with Cialis. For more information about some of these interactions, see the “Drug interactions explained” section below.

Drug group or drug name	Drug examples	What can happen
nitrates*	• isosorbide mononitrate (Monoket) • isosorbide dinitrate (Isordil) • nitroglycerin (Nitro-Dur, NitroMist, Nitrostat)	can increase the effect of nitrates
guanylate cyclase (GC) stimulators*	• riociguat (Adempas) • vericiguat (Verquvo)	can increase the effect of GC stimulators
alpha-blockers	• tamsulosin (Flomax) • alfuzosin (Uroxatral) • terazosin	can increase the effect of alpha-blockers
blood pressure medications	• calcium channel blockers, such as amlodipine (Norliqva, Norvasc) • beta-blockers, such as bisoprolol • angiotensin-converting enzyme inhibitors, such as lisinopril (Zestril) • angiotensin receptor blockers, such as losartan (Cozaar)	can increase the effect of blood pressure drugs
PDE5 inhibitors	• sildenafil (Viagra, Revatio) • vardenafil (Staxyn) • avanafil (Stendra) • other forms of tadalafil (Adcirca, Alyq)	can increase the risk of side effects from Cialis
certain antibiotics	• rifampin (Rifadin, Rimactane) • clarithromycin • erythromycin (E.E.S., EryPed, Ery-Tab, others)	can increase the risk of side effects from Cialis
certain antifungals	• ketoconazole • itraconazole (Sporanox, Tolsura) • voriconazole (Vfend)	can increase the risk of side effects from Cialis
certain protease inhibitors	• ritonavir (Norvir) • darunavir (Prezista) • atazanavir (Reyataz)	can increase the risk of side effects from Cialis
Certain seizure drugs	• carbamazepine (Carbatrol, Epitol, Tegretol, others) • phenytoin (Dilantin, Phenytek) • phenobarbital	can make Cialis less effective

* To learn more about this interaction, see the “When should I avoid Cialis?” section above.

Learn more about certain drug interactions that can occur with Cialis.

Interaction with alpha-blockers

Taking Cialis with alpha-blockers can increase the effect of alpha-blockers. These medications are used to treat high blood pressure and enlarged prostate.

What could happen

Both Cialis and alpha-blockers can lower blood pressure. Taking these drugs together can lower your blood pressure too much.

What you can do

Before taking Cialis, tell your doctor about any alpha-blockers you take. They’ll tell you whether it’s safe to take Cialis with these drugs. If you do take them together, your doctor may prescribe a lower dosage of Cialis than usual. (To learn more about the dosage of Cialis, see this article.)

Interaction with blood pressure medications

Taking Cialis with blood pressure drugs, known as antihypertensives, can increase the effect of these medications.

Examples of blood pressure drugs include:

What could happen

Both Cialis and blood pressure medications can lower your blood pressure too much. Taking these medications together can lead to very low blood pressure.

What you can do

Before taking Cialis, tell your doctor about any blood pressure medications you take. They may monitor your blood pressure more closely than usual while you’re taking these drugs together.

Interaction with certain antibiotics

Taking Cialis with certain antibiotics can raise your risk of side effects from Cialis. (Antibiotics are used to treat infections caused by bacteria.)

What could happen

Certain antibiotics may keep the body from breaking down Cialis as it should. This can increase the amount of Cialis in your body. As a result, you may have a higher risk of side effects from Cialis.

What you can do

Before you take Cialis, tell your doctor about any antibiotics you take. They’ll tell you whether it’s safe to take Cialis with these drugs. If they tell you it’s safe, they may monitor you closely for side effects from Cialis.

Cialis may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Cialis.

Does Cialis interact with food?

Cialis may interact with grapefruit or grapefruit juice. Specifically, grapefruit or grapefruit may keep your body from breaking down Cialis as it should. This may increase the amount of Cialis in your body, which could raise your risk of side effects from the drug.

If you have questions about taking Cialis with certain foods or drinks, talk with your doctor or pharmacist.

Does Cialis interact with supplements?

Before you start taking Cialis, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Cialis interactions with herbs

Cialis may interact with an herb called St. John’s wort. (Some people take St. John’s wort to treat depression and various other conditions.)

St. John’s wort may cause your body to break down Cialis faster than it should. This may decrease the amount of Cialis in your body. And a low level of the drug in your body may make Cialis less effective for treating your condition.

If you take St. John’s wort, be sure to tell your doctor before starting Cialis treatment. They may recommend alternatives to St. John’s wort or Cialis.

Cialis and vitamins

There are currently no reports of Cialis interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Cialis.

Does Cialis interact with vaccines?

There are currently no reports of Cialis interacting with vaccines. If you have questions about getting certain vaccines while taking Cialis, talk with your doctor.

Does Cialis interact with lab tests?

There are currently no reports of Cialis interacting with lab tests. If you have questions about getting specific lab tests while taking Cialis, talk with your doctor.

Does Cialis interact with cannabis or CBD?

Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Cialis. Using cannabis and cannabis products with Cialis can lead to various effects. For some people, using these products together can increase the risk of side effects with Cialis. For others, using cannabis and cannabis products with Cialis can make Cialis less effective than usual.

Before you start treatment with Cialis, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions or other health factors may raise the risk of interactions with Cialis. Before taking Cialis, talk with your doctor about your health history. They’ll determine whether Cialis is right for you.

Health conditions or other factors that might interact with Cialis include:

Kidney or liver problems. If you have a kidney or liver problem, tell your doctor before starting treatment with Cialis. Examples of these problems include kidney failure and liver failure. If you have one of these conditions, your doctor may prescribe a lower dosage of Cialis than usual. (To learn more about the dosage of Cialis, see this article.)

Bleeding problems. If you have a bleeding problem, such as hemophilia, tell your doctor before taking Cialis. Your doctor can tell you whether Cialis is safe to take with your condition.

Eye problems. In rare cases, Cialis can cause serious eye problems, including vision loss. Your risk of eye problems with Cialis may be higher if you already have an eye problem before taking the drug. If you have a problem with your optic nerve or retina, tell your doctor before taking Cialis. They can determine whether it’s safe to take Cialis.

Misshaped penis. If you have a condition that affects the shape of your penis, such as Peyronie’s disease, tell your doctor before taking Cialis. Such conditions can increase your risk of priapism from Cialis. Your doctor can tell you whether it’s safe to take Cialis with your condition.

Peptic ulcers. If you have a peptic ulcer, tell your doctor before taking Cialis. This condition may raise your risk of bleeding with the drug. Your doctor can determine whether it’s safe to take Cialis with your condition.

Blood cell problems or blood cancers. If you have a blood cell problem, such as sickle cell anemia, tell your doctor before taking Cialis. Also, tell them if you have a blood cancer, such as leukemia or multiple myeloma. These conditions could raise your risk of priapism from Cialis. Your doctor can tell you whether Cialis is a safe treatment option for you.

Stroke or heart problems. Doctors typically will not prescribe Cialis if you have had a stroke or have certain heart problems. Examples of heart problems include having a heart attack in the past 90 days or having heart failure in the past 6 months.

Also, taking Cialis is not recommended if you have any of the following conditions:

It is unknown whether Cialis is safe for people who have any of these conditions. If you have any conditions mentioned above, your doctor will likely prescribe a treatment other than Cialis.

• Pregnancy. It is unknown whether Cialis is safe to use during pregnancy. The drug is only prescribed for use in males.* For more information about Cialis and pregnancy, talk with your doctor.
• Breastfeeding. It is unknown if Cialis is safe to use while breastfeeding. The drug is only used in males.* For more information about Cialis and breastfeeding, talk with your doctor.
• Allergic reaction. If you’ve had an allergic reaction to Cialis or any of its ingredients, your doctor will likely not prescribe Cialis. This is because taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

* In this article, we use the term “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

Find answers to some frequently asked questions about Cialis and possible interactions.

Should I avoid coffee or other sources of caffeine while taking Cialis?

Not necessarily. Coffee and other sources of caffeine are not known to interact with Cialis. It should be safe to consume coffee and caffeine while taking this drug.

According to one study , consuming caffeine may lower the risk of erectile dysfunction (ED). (Cialis is used to treat ED.) But whether coffee or caffeine is effective for treating or preventing ED is unknown. More research in this area is needed.

To learn more about taking Cialis with coffee or caffeine, talk with your doctor.

Can I take Cialis with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen?

Yes, you can take Cialis with NSAIDs. There isn’t a known interaction between these medications.

NSAIDs are typically used to reduce swelling or ease pain. Examples of NSAIDs include:

If you’re interested in treatment options to reduce swelling or ease pain while taking Cialis, talk with your doctor or pharmacist.

Does Cialis interact with finasteride?

No, Cialis isn’t known to interact with finasteride (Proscar, Propecia). Finasteride is a drug used to treat enlarged prostate and balding.

Erectile dysfunction (ED), which Cialis is used to treat, is a possible side effect of finasteride. If you have ED with finasteride, your doctor may prescribe a drug to treat it. This could include Cialis. Talk with your doctor to learn more.

Is it safe to take Cialis with Xanax?

Yes, it should be safe to take Cialis with Xanax (alprazolam). There isn’t a known interaction between these medications.

Xanax may cause certain sexual side effects, including changes in your sex drive. And erectile dysfunction (ED) may result from a low sex drive. So, it’s possible that taking Xanax could lead to ED. If you have ED with Xanax, your doctor may prescribe Cialis to treat this condition.

To learn more about Cialis and Xanax, talk with your doctor or pharmacist.

Taking certain steps can help you avoid interactions with Cialis. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list .
• What to do if you start taking a new drug during your Cialis treatment.

It’s also important to read Cialis’s label and other paperwork that may come with the drug. You may see colored stickers on the label that describe interactions. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Cialis, ask your pharmacist to print a copy for you.) If you need help understanding this information, your doctor or pharmacist can help.

Taking Cialis exactly as prescribed can also help prevent interactions.

If you still have questions about Cialis and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• Do I have any health conditions or take any medications that could affect my Cialis dosage?
• Do other drugs that treat my condition have similar interactions?
• What should I do if I start a new medication while I’m taking Cialis?

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

10 Drugs To Avoid When You Take Viagra

Viagra is safe for most people, but that is not true for all.

That’s why you can’t find viagra on the shelf with over-the-counter drugs.

You need a prescription because it has interactions with several medications.

Also, your doctor needs to evaluate sildenafil contraindication before prescribing this drug.

But what are the dangers of viagra for people who take multiple drugs? Who shouldn’t take viagra?

In this article, you will find the main ingredient in viagra and what drugs you should not take with this medication.

What is Viagra?

Viagra is the most famous drug for erectile dysfunction. It belongs to a family of medications called phosphodiesterase type 5 inhibitors. They increase the blood flow to the penis structures, facilitating erections and intercourse.

The ingredient in viagra is known as sildenafil, and it is not the only PDE5 inhibitor in existence. We also have others, such as tadalafil, vardenafil, and avanafil.

The drug does not increase the sensitivity of the penis. But it facilitates erections and gives a little push to those who need it.

How does Viagra work?

You could say that nitric oxide and viagra work together to prompt and maintain an erection. Initially, and as a result of sexual stimulation, nitric oxide is released in the corpus cavernosum.

One of the key benefits of nitric oxide sexually is that it helps the body increase blood flow. Then, a substance known as cGMP is also released, causing muscle relaxation in the erectile tissue. When the muscle is relaxed, the blood flow can freely access the corpora cavernosa. That’s how a normal erection happens.

After sex, it is also normal that cGMP gets destroyed by an enzyme known as PDE5. However, men with erectile dysfunction have too much PDE5.

It activates before due time, and men can’t achieve an erection. That’s when viagra can help. It inhibits PDE5 and helps you achieve an erection.

However, the enzyme PDE5 is not only found in the erectile tissue. That’s why doctors have very specific viagra prescribing information for patients.

It also has an interaction with other drugs. Thus, the side effects of viagra in older men depend on their health problems and current medications.

For instance, one of the side effects of sildenafil is hypotension. It causes a slight blood pressure change, which is why it is useful in pulmonary arterial hypertension. But it won’t be noticeable unless you have a hypotensive problem or use other hypotensive drugs.

Another side effect is nasal congestion due to increased blood flow in the nasal cavity (1).

10 drugs you should not take with Viagra

Sildenafil by itself won’t likely cause problems in healthy individuals. When side effects happen, it is usually due to a baseline health problem or drug interactions.

Co-administration of these drugs with viagra can have a consequence. Below we share which drugs you should not take with Viagra.

1) Nitrate medications

Medicines with nitrates are probably the most dangerous interaction of viagra. Examples of nitrates are isosorbide mononitrate, isosorbide dinitrate, and nitroglycerin.

Using viagra and nitroglycerin in combination can cause an excessive dilatation of the blood vessels. The blood pressure drops dramatically, and the patient can experience a stroke, heart attack, or another cardiovascular event (2).

2) Mifepristone

This is also popularly known as the abortion pill. But why would a man take this type of medication? It happens to be useful for men with Cushing syndrome.

But concomitant use of mifepristone and viagra can be dangerous. The drug slows down the removal of viagra. The drug stays in your system and can cause serious adverse events.

3-4) Riociguat and Vericiguat

Viagra started as a drug to treat pulmonary hypertension, but they found that erections as a side effect were more pronounced than its current aim.

Riociguat and vericiguat work similarly, but they are designed for primary pulmonary hypertension and heart failure, respectively.

Patients taking this drug and viagra simultaneously will have double effects and excessive dilatation of the blood vessels. It happens similar to what we discussed about nitrates medication use (3).

5-6) Lefamulin and Voxelotor

These drugs are used as antibiotics and as a treatment for sickle cell disease, respectively. But they share a common contraindication with viagra.

They both slow down the removal of Viagra. They do so to a lesser degree than mifepristone, but you should not overlook the interaction.

7) Poppers

This is a recreational drug commonly used to enhance sexual sensation. That’s why many people wonder if you can use poppers and viagra together.

The answer is no because poppers can include different nitrates and cause the same blood vessel dilatation and cardiovascular risk as nitroglycerine.

You will also be at a higher risk of sexually transmitted diseases after using viagra and poppers (4).

8) Anti-hypertensives and benign prostatic hyperplasia medications

This interaction is not as bad as the ones listed above but is still worth noting.

Alpha-blocker therapy can induce hypotension when taken together with viagra. The interaction depends on the alpha-blocker dose and your own baseline blood pressure levels.

Thus, talk to your doctor before using viagra if you use drugs such as doxazosin, terazosin, and tamsulosin. They are commonly used for benign prostatic hyperplasia.

9) Protease inhibitor therapies

These drugs inhibit a liver enzyme that breaks down viagra. It interacts with how the liver processes viagra. Thus, these inhibitors will potentially cause other side effects associated with viagra.

10) Other medications

Other medications can interfere with viagra processing—for example, itraconazole and erythromycin. Thus, if you are taking meds or starting a new treatment, always talk about this to your doctor to ensure no interactions are expected.

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What interferes with Viagra working?

Two main things interfere with Viagra working. They are (5):

• High-fat meals: Ideally, you should take Viagra on an empty stomach. That’s the best way for sildenafil to be absorbed without interference. If you eat a large meal and take viagra, part of the main component will be lost, mainly if the meal contains a high proportion of fatty acids.
• Alcoholic beverages: High blood alcohol levels cause nervous system depression and contribute to erectile dysfunction. Also, alcohol impairs the absorption of viagra, too. These beverages interact with many drugs, including viagra.

Other things to avoid while taking Viagra

Besides the drugs we mentioned above, is there anything else you need to avoid when you take Viagra?

We’re covering a few common questions around viagra:

Can you take viagra if you have hemorrhoids?

In most cases, you can. But keep in mind that viagra has a slight platelet antiaggregatory activity. Thus, if your hemorrhoids tend to bleed, viagra could worsen it.

Is it fine taking viagra and aspirin together?

The effect of aspirin and viagra on your platelets can add up and cause bleeding problems. Talk to your doctor to see whether this combination is a good idea.

Can I use viagra before a workout?

Some people use viagra as a pre-workout supplement to increase muscle blood flow. However, its effectiveness is not warranted, and you’ll be exposed to uncomfortable erections and other side effects in the gym. Most doctors would not recommend this use.

Is it ok to use viagra in case of kidney disease?

The kidneys help your body eliminate viagra. Thus, you will need dose adjustments in case of renal impairment (defined with a creatinine clearance

When should you not take Viagra?

Absolute viagra contraindications include nitroglycerin interactions and allergies. But you should be careful with viagra and ask your doctor about it if you have the following conditions (5):

• Sickle cell anemia, as it may increase the risk of a vaso-occlusive crisis
• Ventricular outflow obstruction, for example, if you have idiopathic hypertrophic subaortic stenosis
• Retinitis pigmentosa, or pigmentary retinopathy
• Life-threatening ventricular arrhythmia, myocardial infarction, coronary artery disease, or severe cardiovascular disease.

Conclusion

If you need viagra for erectile dysfunction, remember: do not take it with nitrates. Other drugs that interact with viagra and cause serious adverse events are riociguat, vericiguat, and mifepristone.

If you have a chronic condition or start taking new medications, it is always important to inform your doctor and find out if there is an interaction with viagra.