Sildenafil and Upadacitinib: Can You Take Them Together?

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Key takeaways

• No major interaction is commonly reported between sildenafil and upadacitinib, so they are generally safe to use together.
• Your prescriber will review all your medicines and health conditions during consultation to ensure sildenafil is suitable for you.
• Never take sildenafil with nitrates, nicorandil, riociguat, or poppers, as this can cause dangerous low blood pressure.
• Erectile dysfunction can be an early sign of heart disease or diabetes, so see your GP if you have new ED.
• Sildenafil is available on prescription at Cured Pharmacy following an online consultation with a UK-registered prescriber.

What is Sildenafil and How Does It Work?

Sildenafil is a medicine used to treat erectile dysfunction (ED), the difficulty in getting or keeping an erection firm enough for sex. It belongs to a group of medicines called phosphodiesterase type 5 (PDE5) inhibitors. Sildenafil works by relaxing the blood vessels in the penis, which allows more blood to flow into the area when you are sexually aroused, helping you achieve and maintain an erection [3].

Sildenafil is the active ingredient in Viagra and is available in doses of 25mg, 50mg, and 100mg. You typically take it about one hour before sexual activity, and it works only when you are sexually stimulated. The effect usually lasts for around four to six hours, though this varies between individuals. Sildenafil should not be taken more than once in 24 hours [3].

At Cured Pharmacy, sildenafil is available on prescription following an online consultation with a UK-registered prescriber. The consultation ensures the medicine is safe and appropriate for you, taking into account your health conditions and any other medicines you take.

What is Upadacitinib and What is It Used For?

Upadacitinib is a medicine used to treat several inflammatory conditions, including moderate to severe rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, atopic dermatitis (eczema), and ulcerative colitis. It belongs to a class of medicines called Janus kinase (JAK) inhibitors. Upadacitinib works by blocking certain enzymes in the body that contribute to inflammation, thereby reducing pain, swelling, and other symptoms of these conditions [12].

Upadacitinib is taken as a tablet once daily, usually at the same time each day, with or without food. The dose prescribed depends on the condition being treated and your individual response to the medicine. Because upadacitinib affects the immune system, it can increase the risk of infections, and your doctor will monitor you regularly while you are taking it.

If you have been prescribed upadacitinib and are experiencing erectile dysfunction, it is important to discuss this with your healthcare provider. ED can have many causes, including underlying health conditions, stress, or side effects from other medicines, and it is worth exploring treatment options that are safe to use alongside your current therapy.

At a glance

Can Sildenafil and Upadacitinib Be Taken Together?

Based on current clinical knowledge, there is no major interaction commonly reported between sildenafil and upadacitinib. These medicines work through different mechanisms in the body: sildenafil acts on blood vessels in the penis to improve erectile function, while upadacitinib targets the immune system to reduce inflammation. They do not share the same metabolic pathways in a way that would typically cause a significant interaction [3][12].

However, it is essential to remember that every person's medical situation is unique. Your prescriber will review your full medication list, health history, and any other relevant factors during your consultation to ensure that sildenafil is safe and suitable for you. This personalised assessment is a crucial part of prescribing any medicine, including treatments for erectile dysfunction.

If you are taking upadacitinib and are considering sildenafil, you should declare all your current medicines during the online consultation at Cured Pharmacy. This allows the prescriber to check for any potential issues and to recommend the most appropriate dose and treatment plan for your individual needs.

What Your Prescriber Will Check

During your consultation, the prescriber will ask about your cardiovascular health, blood pressure, and any other medicines you take. They will also check whether you have any conditions that make PDE5 inhibitors unsuitable, such as recent heart attack or stroke, severe heart failure, very low blood pressure, or use of nitrate medicines (which must never be combined with sildenafil). The prescriber will also consider whether any of your other medicines might interact with sildenafil, such as alpha-blockers or certain antifungal or antiviral drugs [3].

Other Medicines That Interact with Sildenafil and Upadacitinib

While sildenafil and upadacitinib do not have a known major interaction with each other, both medicines can interact with other drugs. For sildenafil, the most important interactions to be aware of are with nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, and recreational drugs known as 'poppers' (amyl or alkyl nitrites). Do not take sildenafil together with any of these, as the combination can cause a dangerous drop in blood pressure [3].

Sildenafil can also interact with alpha-blockers (used for high blood pressure or prostate problems), certain antifungal medicines (like ketoconazole or itraconazole), some antibiotics (such as clarithromycin), and HIV medicines (including ritonavir and cobicistat). These can raise the level of sildenafil in your blood, so your prescriber may need to adjust the dose. Grapefruit juice can have a similar effect and is best avoided [3].

Upadacitinib can interact with medicines that affect the immune system, such as other immunosuppressants or biological therapies, and with certain vaccines. It is also important to tell your doctor if you start any new medicine while taking upadacitinib, as some drugs can affect how well it works or increase the risk of side effects [12]. Always declare every medicine, supplement, or herbal product you use during your consultation.

Practical Advice for Taking Sildenafil with Upadacitinib

If your prescriber confirms that sildenafil is suitable for you while you are taking upadacitinib, there are some practical steps you can take to use it safely and effectively. Take sildenafil about one hour before you plan to have sex, on an empty stomach or after a light meal, as a heavy or high-fat meal can delay how quickly it works. Remember that sildenafil only works when you are sexually aroused; it does not cause an automatic erection [3].

Do not take more than one dose of sildenafil in 24 hours, and do not combine it with any other erectile dysfunction treatment or with nitrate medicines. If you experience side effects such as headache, flushing, indigestion, or a blocked nose, these are usually mild and temporary. However, if you develop chest pain during sex, a prolonged erection lasting more than four hours, or sudden loss of vision or hearing, seek urgent medical help [3].

Continue to take your upadacitinib exactly as prescribed by your doctor, and attend any monitoring appointments. If you notice any new symptoms or have concerns about either medicine, speak to your GP or pharmacist. Erectile dysfunction can sometimes be an early sign of cardiovascular disease or diabetes, so it is always worth discussing new ED with your doctor, even if you are already being treated for another condition [1][2].

Lifestyle Factors That Can Help

Lifestyle changes can also support erectile function and overall health. Maintaining a healthy weight, eating a balanced diet, exercising regularly, limiting alcohol, and stopping smoking can all improve ED and reduce the risk of cardiovascular disease. Managing stress and getting enough sleep are also important, as psychological factors can contribute to erectile difficulties [1][2].

How to Get Sildenafil and Upadacitinib Safely in the UK

Upadacitinib is a prescription-only medicine that is usually prescribed by a specialist, such as a rheumatologist or dermatologist, and is dispensed through hospital or community pharmacies. You should continue to take it as directed by your specialist and attend regular follow-up appointments to monitor your response and check for any side effects [12].

Sildenafil is also a prescription-only medicine for erectile dysfunction, though sildenafil 50mg is available as a pharmacy medicine (Viagra Connect) for men aged 18 and over after a consultation with a pharmacist. At Cured Pharmacy, you can request sildenafil on prescription through a confidential online consultation. A UK-registered prescriber will review your answers and, if appropriate, issue a prescription. Your medicine is then dispensed by our GPhC-registered pharmacy and delivered discreetly to your door.

When you complete your consultation, make sure to list all your current medicines, including upadacitinib, and any health conditions you have. This information is essential for the prescriber to assess whether sildenafil is safe and suitable for you. If you have any questions or are unsure about anything, our pharmacy team is here to help.

Why See Your GP About New Erectile Dysfunction

If you are experiencing erectile dysfunction for the first time, it is a good idea to see your GP. ED can be an early warning sign of underlying health problems such as heart disease, high blood pressure, or diabetes, and your doctor can carry out checks to identify and treat any contributing factors. Treating the underlying cause can sometimes improve erectile function and your overall health [1][2].

When to get urgent help

• An erection lasting more than 4 hours (priapism) – go to A&E immediately
• Sudden loss of vision or hearing – seek urgent medical help
• Chest pain during or after sex – call 999 and do not take more sildenafil
• Severe dizziness, fainting, or signs of a serious allergic reaction (swelling of face, lips, or throat, difficulty breathing) – call 999

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