Can You Take Sildenafil and Rivaroxaban Together?

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What Is Sildenafil and How Does It Work?

Sildenafil is the active ingredient in Viagra and is a type of medicine called a PDE5 inhibitor, licensed in the UK to treat erectile dysfunction (ED) [3]. It works by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Sildenafil does not cause an erection on its own—sexual stimulation is still needed.

Sildenafil is typically taken about one hour before sexual activity, with doses of 25mg, 50mg, or 100mg available [3]. The effect usually lasts for around four to six hours, and you should not take it more than once in 24 hours. Common side effects include headache, flushing, indigestion, and nasal congestion [3].

At Cured Pharmacy, sildenafil is available on prescription after a consultation with a UK-registered prescriber. The prescriber will check your medical history, current medicines, and whether sildenafil is suitable and safe for you.

What Is Rivaroxaban and Why Is It Prescribed?

Rivaroxaban (brand name Xarelto) is an anticoagulant—a medicine that helps prevent blood clots. It belongs to a class of drugs called direct oral anticoagulants (DOACs) and works by blocking a clotting protein called Factor Xa. Rivaroxaban is commonly prescribed to reduce the risk of stroke in people with atrial fibrillation (an irregular heartbeat), to treat or prevent deep vein thrombosis (DVT) and pulmonary embolism (PE), and after certain surgeries.

Because rivaroxaban reduces the blood's ability to clot, it increases the risk of bleeding. People taking rivaroxaban need to be cautious about injuries, dental work, and other medicines that might also affect bleeding or interact with the anticoagulant. Your doctor will monitor you regularly and advise on what to watch for.

If you are prescribed rivaroxaban, it is essential to tell every healthcare professional—including your ED prescriber—so they can assess whether other medicines are safe to use alongside it.

Do Sildenafil and Rivaroxaban Interact?

No major interaction between sildenafil and rivaroxaban is commonly reported in clinical practice or standard drug-interaction databases. Sildenafil does not significantly affect the way rivaroxaban works, and rivaroxaban does not substantially change sildenafil levels in the body. This means that, in general, the two medicines can be taken together under medical supervision.

However, both medicines can have effects that require careful consideration. Sildenafil can lower blood pressure slightly, and rivaroxaban increases bleeding risk. If you have underlying cardiovascular conditions or take other medicines that affect blood pressure or bleeding, your prescriber will need to review your full medication list and health status before approving sildenafil [3].

During your online consultation at Cured Pharmacy, you will be asked to list all your current medicines, including rivaroxaban. The prescriber will check for any potential issues and ensure that sildenafil is appropriate for you. Never stop or change your rivaroxaban dose without speaking to the doctor who prescribed it.

Why Your Prescriber Needs to Know About Rivaroxaban

Even though sildenafil and rivaroxaban do not have a direct drug-to-drug interaction, your prescriber must know you are taking an anticoagulant. This is because certain health conditions that require anticoagulation—such as recent stroke, heart valve problems, or clotting disorders—may also affect whether ED treatment is safe for you.

Your prescriber will also want to ensure that sexual activity itself is safe. If you have had a recent heart attack, stroke, or have unstable angina or severe heart failure, ED medicines may not be suitable [1][3]. Being open about all your medicines and medical history helps the prescriber make the safest decision for you.

What you need to know

• No major interaction is commonly reported between sildenafil and rivaroxaban
• Always tell your prescriber about all medicines including anticoagulants
• Your prescriber will review your cardiovascular health before approving sildenafil
• Never stop rivaroxaban without medical advice
• Seek urgent help for erections over four hours or sudden vision or hearing loss

What Your Prescriber Will Check Before Approving Sildenafil

When you request sildenafil through Cured Pharmacy, a UK-registered prescriber will review your online consultation answers carefully. They will check your current medicines (including rivaroxaban), your cardiovascular health, blood pressure, and any history of stroke, heart attack, or other serious conditions [2][3].

The prescriber will also confirm that you are not taking any medicines that must never be combined with sildenafil. These include nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, and recreational drugs known as 'poppers' (amyl or alkyl nitrites). Taking sildenafil with any of these can cause a dangerous drop in blood pressure [3].

If you are on other blood-pressure medicines or alpha-blockers (such as doxazosin or tamsulosin), the prescriber may start you on a lower dose of sildenafil and advise you to monitor for dizziness or light-headedness [3]. The consultation is designed to be thorough, so the prescriber can tailor treatment safely to your individual circumstances.

Starting on the Right Dose

For most men, the usual starting dose of sildenafil is 50mg, taken about one hour before sexual activity [3]. If you have other health conditions, take certain medicines, or are over 65, your prescriber may recommend starting with 25mg. The dose can be adjusted based on how well it works and any side effects you experience.

Because rivaroxaban itself does not alter sildenafil levels, the starting dose is usually the same as for men not taking anticoagulants. However, your overall health picture—including why you need rivaroxaban—will guide the prescriber's decision.

Practical Advice for Taking Sildenafil with Rivaroxaban

If your prescriber approves sildenafil while you are taking rivaroxaban, follow the dosing instructions carefully. Take sildenafil about one hour before you plan to have sex, and do not take more than one dose in 24 hours [3]. You can take it with or without food, though a heavy, fatty meal may delay how quickly it works.

Continue taking rivaroxaban exactly as your doctor prescribed. Do not skip doses or stop taking it without medical advice, as this could increase your risk of a stroke or blood clot. If you experience any unusual bleeding, bruising, or other side effects from either medicine, contact your GP or prescriber promptly.

Avoid drinking large amounts of alcohol when taking sildenafil, as alcohol can worsen erectile dysfunction and add to the blood-pressure-lowering effect, increasing the risk of dizziness [1][3]. Grapefruit juice can raise sildenafil levels slightly, so it is best to avoid it or drink only small amounts.

When to get urgent help

• Erection lasting longer than 4 hours (priapism)—go to A&E immediately
• Sudden loss of vision in one or both eyes—seek urgent medical help
• Sudden decrease or loss of hearing, possibly with ringing in the ears or dizziness
• Chest pain during or after sex—stop activity and seek medical advice; do not take nitrates
• Unusual bleeding (blood in urine or stools, vomiting blood, severe nosebleeds) while on rivaroxaban—contact your doctor or call 111

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

Warning Signs and When to Seek Urgent Help

While serious side effects from sildenafil are uncommon, you should know the warning signs that require urgent medical attention. If you develop an erection that lasts longer than four hours (priapism), go to A&E immediately, as this can cause permanent damage if not treated quickly [3].

Seek urgent help 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 [3]. These are rare but serious side effects. If you have chest pain during or after sex, stop and seek medical advice—do not take nitrate medicines (such as GTN spray) if you have used sildenafil in the past 24 hours, as the combination can be dangerous [3].

Because you are taking rivaroxaban, also watch for signs of unusual bleeding: blood in your urine or stools, vomiting blood, severe nosebleeds, or unexplained bruising. If any of these occur, contact your doctor or call 111 for advice. Always carry information about the medicines you take, so healthcare professionals can treat you safely in an emergency.

Reporting Side Effects

If you experience side effects from sildenafil or rivaroxaban, you can report them via the Yellow Card Scheme at yellowcard.mhra.gov.uk or by searching for the Yellow Card app. Reporting helps improve the safety information available for all patients.

You can also contact Cured Pharmacy or your GP if you have concerns about any side effects. Your prescriber can advise whether to continue, adjust the dose, or try a different treatment.