Sildenafil and Bisoprolol: Can They Be Taken Together?
Learn how these medicines interact and how a UK pharmacist-led consultation ensures safe, effective treatment.
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Sildenafil and Bisoprolol: Understanding the Interaction
Published: 16 October 2026
Many men wonder whether sildenafil and bisoprolol can be taken together safely. The good news is that sildenafil (Viagra) can usually be used alongside bisoprolol, a beta-blocker commonly prescribed for high blood pressure, angina, or heart failure, but the combination requires careful assessment by a prescriber because both medicines can lower blood pressure.
Stand up slowly
When taking sildenafil with bisoprolol, stand up slowly from sitting or lying down to reduce the risk of dizziness caused by a drop in blood pressure.
What is sildenafil and bisoprolol used for?
Sildenafil is a prescription medicine used to treat erectile dysfunction (ED) in men. It belongs to a group of medicines called PDE5 inhibitors, which work by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused [3]. Sildenafil is the active ingredient in Viagra and is available in 25mg, 50mg, and 100mg tablets. You take it about one hour before sexual activity, and it can help you get and keep an erection suitable for sex. Sexual stimulation is still needed for the medicine to work.
Bisoprolol is a beta-blocker, a type of medicine that slows the heart rate and reduces the force of the heart's contractions. It is commonly prescribed to treat high blood pressure (hypertension), angina (chest pain caused by reduced blood flow to the heart), and heart failure. By lowering blood pressure and reducing the heart's workload, bisoprolol helps protect against heart attacks, strokes, and other cardiovascular problems. Many men taking bisoprolol for these conditions also experience erectile dysfunction, which can sometimes be related to the underlying heart condition, the medication itself, or a combination of factors [1].
Can you take sildenafil and bisoprolol together?
Yes, sildenafil and bisoprolol can generally be taken together, but only under the supervision of a prescriber who will assess your individual circumstances [3]. There is no absolute contraindication between these two medicines, meaning they are not forbidden to be used at the same time in the way that sildenafil is with nitrates (such as GTN spray) or nicorandil. However, both medicines can lower blood pressure, so when taken together there is a risk that your blood pressure may drop more than intended, potentially causing dizziness, light-headedness, or fainting.
Your prescriber will check your current blood pressure, heart health, and overall fitness for sexual activity before approving sildenafil. If you are stable on bisoprolol and your blood pressure is well controlled, sildenafil is often suitable. The key is that your doctor or pharmacist prescriber needs to know about all your medicines, including bisoprolol, so they can choose the right starting dose and give you tailored advice. Never take sildenafil without declaring bisoprolol or any other heart or blood pressure medicine during your consultation.
How the interaction works
Both sildenafil and bisoprolol cause blood vessels to relax, which lowers blood pressure. Bisoprolol does this by blocking the effects of adrenaline on the heart and blood vessels, while sildenafil works by increasing levels of a chemical called cyclic GMP, which relaxes smooth muscle in blood vessel walls [3]. When you take both medicines, their blood-pressure-lowering effects can add together. For most men on a stable dose of bisoprolol, this additive effect is manageable and does not cause problems, but it is why your prescriber will start you on a lower dose of sildenafil if needed and monitor how you respond.
What your prescriber checks before approving sildenafil with bisoprolol
During your online consultation at Cured Pharmacy, the UK-registered prescriber will ask detailed questions about your heart health, blood pressure, and current medications. They will want to know why you are taking bisoprolol, whether your blood pressure is stable, and if you have any history of heart attack, stroke, angina, or heart failure. Sexual activity itself puts extra demand on the heart, so the prescriber must ensure that your cardiovascular system is healthy enough for sex before approving any ED treatment [2].
The prescriber will also check for any medicines that must not be taken with sildenafil, such as nitrates (GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, or recreational drugs known as poppers (amyl or alkyl nitrites). If you are taking any of these, you cannot use sildenafil or any other PDE5 inhibitor because the combination can cause a dangerous, potentially life-threatening drop in blood pressure. If you take an alpha-blocker (such as doxazosin or tamsulosin) as well as bisoprolol, extra caution is needed, and you will be started on the lowest dose of sildenafil.
Starting dose and monitoring
If you are approved for sildenafil while taking bisoprolol, your prescriber may start you on a lower dose, typically 25mg or 50mg, to see how you tolerate the combination [3]. You should take sildenafil about one hour before you plan to have sex, and you must not take it more than once in 24 hours. After your first dose, pay attention to how you feel: if you experience dizziness, light-headedness, or feel faint when you stand up, sit or lie down and contact your GP or pharmacist. If the lower dose works well without side effects, your prescriber may increase the dose on a future prescription if needed.
What you need to know
- Sildenafil and bisoprolol can usually be taken together after a prescriber checks your heart health and blood pressure.
- Both medicines lower blood pressure, so the combination may cause dizziness; your prescriber may start a lower sildenafil dose.
- Never take sildenafil with nitrates, nicorandil, or poppers, as this can cause dangerous blood pressure drops.
- Seek urgent help for chest pain during sex, erections lasting over four hours, or sudden vision or hearing loss.
Practical advice for taking sildenafil and bisoprolol safely
Always take bisoprolol and sildenafil exactly as prescribed. Do not stop, start, or change the dose of bisoprolol without speaking to your GP, as stopping a beta-blocker suddenly can be harmful. Take your bisoprolol at the same time each day as directed, and take sildenafil only when you plan to have sex, about one hour beforehand. Avoid drinking large amounts of alcohol when using sildenafil, as alcohol can make erectile dysfunction worse and adds to the blood-pressure-lowering effect, increasing the risk of dizziness [3].
Stand up slowly from sitting or lying down, especially after taking sildenafil, to reduce the chance of feeling dizzy. If you feel unwell, dizzy, or experience chest pain during or after sex, stop the activity, sit down, and seek medical help. Do not take sildenafil if you have taken a nitrate medicine (such as GTN spray) in the past 24 hours, and do not take a nitrate for at least 24 hours after taking sildenafil. If you develop chest pain and need emergency treatment, tell the paramedics or A&E staff that you have taken sildenafil.
Other ED treatments if sildenafil and bisoprolol are not suitable
If your prescriber decides that sildenafil is not the best option for you while taking bisoprolol, there are alternative PDE5 inhibitors that may be considered. Tadalafil (Cialis) is another PDE5 inhibitor that works in a similar way to sildenafil but has a longer duration of action, lasting up to 36 hours [4]. It can be taken on-demand (10mg or 20mg at least 30 minutes before sex) or as a lower daily dose (2.5mg or 5mg) that allows for more spontaneous sexual activity. The same precautions about blood pressure apply, and your prescriber will assess whether tadalafil is suitable.
Vardenafil (Levitra) and avanafil (Spedra) are also PDE5 inhibitors licensed for ED [5][6]. Vardenafil is taken 25 to 60 minutes before sex, while avanafil works faster, often within 15 to 30 minutes. All PDE5 inhibitors have similar interactions with bisoprolol and other blood pressure medicines, so the same careful assessment is needed. If PDE5 inhibitors are not suitable at all, your GP may discuss other options such as vacuum devices, alprostadil (a medicine applied as a cream or injection), or referral to a specialist [2]. Always see your GP if you have new or worsening erectile dysfunction, as it can be an early warning sign of heart disease or diabetes [1].
Lifestyle measures to support treatment
Lifestyle changes can improve both your heart health and erectile function. Stopping smoking, losing weight if you are overweight, exercising regularly, eating a balanced diet, and reducing alcohol intake can all help [1][2]. These measures support the effectiveness of bisoprolol in controlling your blood pressure and may improve your response to sildenafil. Managing stress and getting enough sleep are also important, as tiredness and anxiety can contribute to erectile difficulties. Your GP or practice nurse can offer support and advice on making these changes.
When to get urgent help
- Chest pain during or after sex (call 999; tell paramedics you have taken sildenafil)
- Erection lasting longer than 4 hours, even if painful (go to A&E immediately)
- Sudden loss of vision in one or both eyes
- Sudden decrease or loss of hearing, possibly with ringing in the ears or dizziness
- Severe dizziness, fainting, or very slow or irregular heartbeat after taking both medicines
Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.
When to seek urgent help with sildenafil and bisoprolol
Most men tolerate the combination of sildenafil and bisoprolol well, but you should know the warning signs that need urgent attention. If you develop chest pain during or after sex, stop the activity, sit down, and call 999. Do not take a nitrate medicine (such as GTN spray) if you have used sildenafil in the past 24 hours, as this can cause a dangerous drop in blood pressure; tell the paramedics you have taken sildenafil so they can treat you safely.
Seek emergency help if you have an erection that lasts longer than four hours (priapism), even if it is painful, as this can cause permanent damage to the penis [3]. Contact a doctor urgently if you experience sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing, which may be accompanied by ringing in the ears or dizziness. These are rare but serious side effects. If you feel severely dizzy, faint, or your heart is beating very slowly or irregularly after taking sildenafil with bisoprolol, seek medical advice the same day.
Scientific References
- NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 16 October 2026]
- National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 16 October 2026]
- Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 16 October 2026]
- Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 16 October 2026]
- Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 16 October 2026]
- Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 16 October 2026]
Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.
Your Questions Answered
Is it safe to take sildenafil if I'm on bisoprolol?
Yes, sildenafil can usually be taken with bisoprolol, but only after a prescriber has assessed your blood pressure, heart health, and overall fitness for sexual activity. Both medicines can lower blood pressure, so careful monitoring is needed.
Will bisoprolol make sildenafil less effective?
Bisoprolol does not directly reduce the effectiveness of sildenafil. However, beta-blockers can sometimes contribute to erectile dysfunction, so your prescriber will review your overall treatment and may adjust doses if needed.
What dose of sildenafil should I start with if I take bisoprolol?
Your prescriber will usually start you on 25mg or 50mg of sildenafil to see how you tolerate it alongside bisoprolol. The dose can be adjusted based on your response and any side effects.
Can I take sildenafil and bisoprolol on the same day?
Yes, you can take both on the same day. Take bisoprolol at your usual time each day, and take sildenafil about one hour before you plan to have sex, but no more than once in 24 hours.
What should I do if I feel dizzy after taking sildenafil with bisoprolol?
Sit or lie down until the dizziness passes, and avoid standing up quickly. If dizziness is severe or does not go away, contact your GP or pharmacist for advice.
Can I use tadalafil instead of sildenafil if I'm on bisoprolol?
Tadalafil is another PDE5 inhibitor that may be suitable, but the same precautions about blood pressure apply. Your prescriber will assess which ED treatment is best for you based on your individual health and preferences.
Do I need to tell my GP I'm taking sildenafil with bisoprolol?
Yes, always inform your GP and any other healthcare professional about all the medicines you are taking, including sildenafil, especially if you need treatment for chest pain or other heart problems.
Can I drink alcohol while taking sildenafil and bisoprolol?
Limit alcohol intake, as drinking too much can worsen erectile dysfunction and add to the blood-pressure-lowering effects of both medicines, increasing the risk of dizziness or fainting.
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