Sildenafil and Ramipril: Can You Take Them Together?

Takes less than 2 minutes to complete 100% online

At a glance

What is sildenafil and ramipril?

Sildenafil is a medicine used to treat erectile dysfunction (ED). It belongs to a group of medicines called PDE5 inhibitors, which work by relaxing blood vessels in the penis, allowing more blood to flow in when you're sexually aroused [3]. Sildenafil is the active ingredient in Viagra and is available in 25mg, 50mg, and 100mg tablets. You take it about an hour before sexual activity, and it works only when you're sexually stimulated.

Ramipril is an ACE inhibitor (angiotensin-converting enzyme inhibitor) prescribed to treat high blood pressure, heart failure, and to protect the heart and kidneys after a heart attack. It works by relaxing and widening your blood vessels, which lowers blood pressure and makes it easier for your heart to pump blood around your body. Ramipril is usually taken once or twice daily as a long-term treatment.

Both medicines affect your blood vessels and blood pressure, which is why it's important to understand how they interact when taken together.

Can you take sildenafil and ramipril together?

Yes, sildenafil and ramipril can usually be taken together, but only after a prescriber has checked that it's safe for you [1][2]. There is no absolute contraindication between these two medicines, meaning they are not forbidden to be used at the same time. However, because both medicines lower blood pressure, there is a risk that taking them together could cause your blood pressure to drop too much, leading to dizziness, light-headedness, or fainting.

The interaction is described as additive: sildenafil causes a modest, temporary drop in blood pressure (typically around 8–10 mmHg systolic), and ramipril lowers blood pressure as part of its intended effect. When combined, the blood-pressure-lowering effects can add together. For most men whose blood pressure is well controlled on ramipril, this is manageable and safe, but it must be assessed individually.

Your prescriber will review your current blood pressure readings, how well controlled your blood pressure is, any symptoms of low blood pressure you've experienced, and your overall heart health. If your blood pressure is stable and you have no history of dizziness or fainting, sildenafil is usually considered safe to use. You should never take sildenafil if you're also taking nitrates, nicorandil, riociguat, or poppers, as these combinations can cause a dangerous drop in blood pressure [3].

How the interaction works

Sildenafil works by blocking an enzyme called PDE5, which leads to relaxation of smooth muscle in blood vessels, particularly in the penis. This same relaxation effect occurs to a lesser extent in blood vessels throughout the body, causing a mild drop in blood pressure. Ramipril blocks the production of a hormone that narrows blood vessels, so your vessels stay wider and your blood pressure stays lower. When you take both medicines, the blood-vessel-relaxing effects can combine, potentially causing a more noticeable drop in blood pressure than either medicine alone.

What your prescriber checks before prescribing sildenafil with ramipril

Before prescribing sildenafil to someone taking ramipril, a UK prescriber will carry out a careful assessment to ensure the combination is safe [2]. They will ask about your current blood pressure readings and whether your blood pressure is well controlled on ramipril. If your blood pressure is too low (for example, systolic below 90 mmHg), sildenafil may not be suitable.

Your prescriber will also ask about any symptoms of low blood pressure you've experienced, such as dizziness when standing up, light-headedness, or fainting. They will review your heart health, including any history of heart attack, stroke, angina, heart failure, or other cardiovascular conditions. Sildenafil is not suitable if sexual activity itself is inadvisable due to your heart condition.

You'll be asked about all other medicines you take, because some drugs can interact more seriously with sildenafil. For example, if you're also taking an alpha-blocker (such as doxazosin or tamsulosin) for prostate symptoms, the risk of low blood pressure is higher, and your prescriber may start you on a lower dose of sildenafil. You must also declare any nitrate medicines (GTN spray, isosorbide mononitrate), nicorandil, or riociguat, as these are absolute contraindications with sildenafil [3].

The prescriber will consider your age, kidney and liver function, and any other health conditions. If everything is suitable, they will usually start you on the lowest effective dose of sildenafil (often 50mg) and advise you to monitor for any dizziness or light-headedness, especially when you first start treatment or if your ramipril dose changes.

What you need to know

• Sildenafil and ramipril can usually be taken together if your blood pressure is well controlled.
• Both medicines lower blood pressure, so your prescriber will check your heart health and BP readings first.
• Never take sildenafil with nitrates, nicorandil, riociguat, or poppers—this is dangerous.
• Watch for dizziness when standing up; sit or lie down if you feel light-headed.
• Declare all your medicines during your consultation so the prescriber can review the full picture.

Practical advice for taking sildenafil and ramipril safely

If you've been prescribed sildenafil while taking ramipril, there are several practical steps you can take to use both medicines safely. First, take sildenafil exactly as prescribed—usually 50mg or 100mg about one hour before sexual activity, and no more than once in 24 hours [3]. Do not take a higher dose than prescribed, as this increases the risk of side effects, including low blood pressure.

Be aware of how you feel when you stand up, especially in the first few hours after taking sildenafil. If you feel dizzy or light-headed, sit or lie down until it passes. Avoid sudden changes in posture, such as jumping out of bed quickly. Drinking alcohol can make dizziness worse and can also make it harder to get an erection, so it's best to limit alcohol when using sildenafil.

Continue taking your ramipril as prescribed by your doctor—do not stop or change the dose without medical advice, even if you experience mild dizziness. If you have persistent dizziness, fainting, or any chest pain, contact your GP or prescriber promptly. Keep your blood pressure monitored as advised by your doctor, and let them know if your readings change significantly.

If you start any new medicines, including over-the-counter treatments or herbal supplements, check with your pharmacist or doctor, as some can interact with sildenafil or ramipril. Grapefruit juice can increase sildenafil levels in your blood, so it's best to avoid it. Always declare all your current medicines during your online consultation at Cured Pharmacy, so the prescriber can review the full picture.

Starting treatment

When you first start sildenafil while on ramipril, your prescriber may recommend starting with a lower dose to see how you tolerate the combination. It's a good idea to try your first dose at a time when you can rest if needed, rather than before an important occasion. If you tolerate the initial dose well with no dizziness or other side effects, your prescriber may adjust the dose if needed for better effectiveness.

Warning signs and when to seek help

Most men taking sildenafil and ramipril together experience no serious problems, but it's important to know the warning signs that need urgent attention. If you develop chest pain or discomfort during or after sexual activity, stop what you're doing and seek medical help immediately. Do not take GTN or any nitrate medicine if you've taken sildenafil in the past 24 hours, as this can cause a dangerous drop in blood pressure—tell the paramedics or doctor that you've taken sildenafil [3].

Seek urgent medical help if you experience an erection that lasts longer than four hours (priapism), even if it's not painful. This is a medical emergency that requires treatment to prevent permanent damage. Sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing (sometimes with ringing in the ears or dizziness), are rare but serious side effects that require immediate medical attention.

If you feel severely dizzy, faint, or your heart is racing or pounding unusually, sit or lie down and seek medical advice. Persistent dizziness that doesn't improve, or fainting episodes, should be reported to your GP or prescriber, as your ramipril or sildenafil dose may need adjusting. Allergic reactions to sildenafil are rare but can include rash, swelling of the face or throat, or difficulty breathing—call 999 if this happens.

For less urgent concerns, such as mild headache, flushing, or indigestion (common side effects of sildenafil), you can usually manage these at home and discuss them with your pharmacist or prescriber if they persist. Never stop taking ramipril suddenly without medical advice, as this can cause your blood pressure to rise sharply.

When to get urgent help

• Chest pain during or after sexual activity—call 999 and tell them you've taken sildenafil
• Erection lasting longer than 4 hours (priapism)—go to A&E immediately
• Sudden loss of vision or hearing—seek urgent medical attention
• Severe dizziness, fainting, or heart racing—sit down and call 111 or your GP
• Allergic reaction (rash, swelling, difficulty breathing)—call 999

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

Other blood pressure medicines and ED treatment

Ramipril is just one of many blood pressure medicines, and the advice for combining sildenafil with other antihypertensives is similar: the combination is usually safe if your blood pressure is well controlled, but it must be checked by a prescriber [2]. Other ACE inhibitors (such as enalapril, lisinopril, or perindopril) work in the same way as ramipril, so the same precautions apply.

Angiotensin receptor blockers (ARBs), such as losartan, candesartan, or irbesartan, are another class of blood pressure medicine that work similarly to ACE inhibitors. The interaction with sildenafil is also additive, and your prescriber will check your blood pressure control before prescribing. Calcium channel blockers (amlodipine, felodipine, diltiazem, verapamil) can also add to the blood-pressure-lowering effect of sildenafil, but again, this is usually manageable.

Beta-blockers (such as bisoprolol, atenolol, or metoprolol) are commonly used for high blood pressure and heart conditions. There is no major direct interaction with sildenafil, but your overall cardiovascular health will be assessed. Diuretics (water tablets like bendroflumethiazide or furosemide) can also be taken with sildenafil, though they may contribute to dehydration or low blood pressure if not managed carefully.

Alpha-blockers (doxazosin, tamsulosin, alfuzosin) used for prostate symptoms carry a higher risk of low blood pressure when combined with sildenafil. If you take an alpha-blocker, your prescriber will usually start you on the lowest dose of sildenafil (25mg) and ensure you are stable on the alpha-blocker first [3]. Always declare every medicine you take during your consultation, including over-the-counter and herbal products.

Switching to a different ED medicine

If you find that sildenafil causes too much dizziness or doesn't suit you while taking ramipril, other PDE5 inhibitors may be an option. Tadalafil (Cialis) has a longer duration of action and may cause a slightly smaller peak drop in blood pressure, though the same precautions apply [4]. Vardenafil and avanafil are alternatives that work in a similar way [5][6]. Your prescriber can discuss which option might be best for you based on your individual circumstances and preferences.

Choose your treatment

Select from our recommended UK-licensed medications.

Answer quick questions

Select safe UK treatments. Quick answers.

Get it delivered fast

We will deliver direct to you as quickly as tomorrow.