Sildenafil and Empagliflozin: Can You Take Them Together?

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Key takeaways

• No major interaction is commonly reported between sildenafil and empagliflozin.
• Both medicines can lower blood pressure, so your prescriber checks this is safe for you.
• Good diabetes control supports better erectile function alongside sildenafil treatment.
• Never take sildenafil with nitrates, nicorandil, riociguat, or poppers.
• Declare all medicines and supplements during your online consultation for safe prescribing.

What Is Sildenafil and Empagliflozin?

Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor used to treat erectile dysfunction (ED). It works by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused [3]. Sildenafil is available as generic Viagra in 25mg, 50mg, and 100mg tablets, and is usually taken about one hour before sexual activity, with effects lasting up to four hours. You should not take it more than once a day.

Empagliflozin (brand name Jardiance) is an SGLT2 inhibitor prescribed for type 2 diabetes and sometimes for heart failure. It works by helping your kidneys remove excess glucose from your blood through your urine. Empagliflozin is typically taken once daily in the morning, with or without food. Many men with diabetes also experience erectile dysfunction, so it is not uncommon to be prescribed both medicines [1].

How Do Sildenafil and Empagliflozin Interact?

No major direct interaction is commonly reported between sildenafil and empagliflozin. They work through different mechanisms in the body: sildenafil affects blood vessels in the penis, while empagliflozin acts on the kidneys to control blood sugar. However, both medicines can have an effect on blood pressure. Sildenafil causes a mild, temporary drop in blood pressure as part of how it works, and empagliflozin can also lower blood pressure, particularly when you first start taking it or if you are dehydrated.

Because both medicines may lower blood pressure, there is a theoretical risk that taking them together could cause dizziness, light-headedness, or fainting, especially when standing up quickly. This is why your prescriber will review your full medical history, current blood pressure readings, and all other medicines you take during your consultation. Most men tolerate the combination well, but individual assessment is essential to ensure it is safe for you [3].

Why Blood Pressure Matters

Your blood pressure needs to be within a safe range to take sildenafil. Very low blood pressure (hypotension) is a contraindication for PDE5 inhibitors because the additional blood-pressure-lowering effect could be dangerous. If you are taking empagliflozin and experience symptoms such as dizziness or feeling faint, it is important to tell your prescriber before starting sildenafil. They may check your blood pressure or adjust your treatment plan to ensure your safety.

At a glance

What Your Prescriber Checks Before Prescribing Sildenafil and Empagliflozin

When you request sildenafil through Cured Pharmacy's online consultation, a UK-registered prescriber will review your medical history and current medications, including empagliflozin. They will check your blood pressure status, any history of cardiovascular disease, and whether you have experienced dizziness or fainting. If you have diabetes, they will also consider how well controlled your blood sugar is, as poorly controlled diabetes can contribute to erectile dysfunction [2].

Your prescriber will ensure you are not taking any medicines that are contraindicated with sildenafil, such as nitrates (GTN spray, isosorbide mononitrate), nicorandil, riociguat, or amyl nitrites (poppers). They will also check for other medicines that can interact, such as alpha-blockers for prostate symptoms or potent CYP3A4 inhibitors. If you are stable on empagliflozin and your blood pressure is within a safe range, sildenafil is usually suitable, often starting at a lower dose to minimise any risk of dizziness [3].

Practical Advice for Taking Sildenafil with Empagliflozin

If your prescriber approves sildenafil while you are taking empagliflozin, follow these practical tips for safe use. Take sildenafil about one hour before sexual activity, on an empty stomach or after a light meal, as a heavy or high-fat meal can delay its effect. Continue taking your empagliflozin exactly as prescribed by your diabetes doctor, usually once daily in the morning. Do not skip or alter your diabetes medication without medical advice.

Stay well hydrated, especially in hot weather or if you exercise, because dehydration can increase the blood-pressure-lowering effect of empagliflozin and make you more prone to dizziness when taking sildenafil. Avoid heavy alcohol on the day you plan to take sildenafil, as alcohol can worsen erectile dysfunction and add to the risk of low blood pressure. If you feel dizzy or light-headed after taking sildenafil, sit or lie down until the feeling passes, and avoid driving or operating machinery [3].

Managing Your Diabetes and ED Together

Good diabetes control can improve erectile function over time. Work with your GP or diabetes nurse to keep your blood sugar, blood pressure, and cholesterol within target ranges. Regular physical activity, a healthy diet, and not smoking all support both diabetes management and erectile health. If you notice your erectile dysfunction worsening or not improving with sildenafil, discuss this with your doctor, as it may indicate that your diabetes needs better control or that another underlying issue needs investigation [1][2].

Warning Signs and When to Seek Help with Sildenafil and Empagliflozin

Most men tolerate sildenafil and empagliflozin together without problems, but you should be aware of warning signs that need medical attention. If you experience severe dizziness, fainting, or a rapid heartbeat after taking sildenafil, stop and seek medical advice. An erection lasting more than four hours (priapism) is a medical emergency and requires immediate treatment at A&E to prevent permanent damage. Sudden loss of vision or hearing after taking sildenafil is rare but serious; stop the medicine and seek urgent medical help [3].

If you develop chest pain during or after sexual activity, stop and rest. If the pain does not go away quickly, call 999. Do not take GTN spray or any nitrate medicine if you have taken sildenafil in the past 24 hours, as this combination can cause a dangerous drop in blood pressure. If you experience symptoms of low blood sugar (hypoglycaemia) such as shaking, sweating, or confusion, treat it as you normally would with fast-acting carbohydrate, and contact your diabetes team if episodes become more frequent.

Other Medicines and Sildenafil: What Else to Consider

While empagliflozin does not have a major interaction with sildenafil, other medicines you take might. Never take sildenafil with nitrates (used for angina), nicorandil, riociguat (for pulmonary hypertension), or amyl nitrites (poppers), as these combinations can cause a life-threatening drop in blood pressure [3]. If you take alpha-blockers such as tamsulosin or doxazosin for prostate symptoms, you must tell your prescriber, as these can also lower blood pressure; you may need to start on a lower dose of sildenafil and be stable on the alpha-blocker first.

Some medicines can raise sildenafil levels in your blood, including potent CYP3A4 inhibitors like ritonavir, ketoconazole, itraconazole, and clarithromycin. Your prescriber will adjust your sildenafil dose if you take any of these. Conversely, CYP3A4 inducers such as rifampicin, carbamazepine, phenytoin, and St John's wort can make sildenafil less effective. Always declare every medicine, supplement, and herbal remedy you take during your consultation, even if you think it is unrelated. The prescriber and pharmacist check every current medicine to ensure your safety [3][12].

Can I Take Other ED Medicines with Empagliflozin?

Yes, other PDE5 inhibitors such as tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra) can also be considered if you take empagliflozin, provided your prescriber assesses them as suitable for you. The same precautions about blood pressure apply. Never take more than one PDE5 inhibitor at the same time. If sildenafil does not work well for you, speak to your prescriber about trying a different PDE5 inhibitor, as individual responses vary [2][4][5][6].

When to get urgent help

• Erection lasting more than 4 hours (priapism) – go to A&E immediately
• Sudden loss of vision or hearing – stop sildenafil and seek urgent medical help
• Chest pain during or after sex – stop, rest, and call 999 if pain persists
• Severe dizziness, fainting, or rapid heartbeat – seek same-day medical advice
• Do not take GTN or nitrates within 24 hours of sildenafil – call 999 and tell paramedics you took sildenafil

Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.