Tadalafil and Apixaban: Can You Take Them Together?

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What Is Tadalafil and How Does It Work?

Tadalafil is a prescription medicine used to treat erectile dysfunction (ED) in men [4]. 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 [1]. Unlike some other ED treatments, tadalafil has a long duration of action—its effects can last up to 36 hours, which is why it is sometimes called the 'weekend pill' [4].

Tadalafil is available in two forms: on-demand tablets (usually 10mg or 20mg taken at least 30 minutes before sexual activity) and daily low-dose tablets (2.5mg or 5mg taken once a day) [4]. Both forms require sexual stimulation to work; tadalafil does not cause an erection on its own. It is the generic version of the branded medicine Cialis and is available at Cured Pharmacy following an online consultation with a UK prescriber.

What Is Apixaban and Why Is It Prescribed?

Apixaban is an anticoagulant (blood-thinning medicine) commonly prescribed to reduce the risk of stroke and blood clots in people with atrial fibrillation (an irregular heart rhythm) or to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE) [12]. It works by blocking a clotting protein called Factor Xa, which helps prevent dangerous clots from forming in your blood vessels.

Because apixaban affects how your blood clots, it is important that your doctor knows about all other medicines you take, including over-the-counter products and supplements. While apixaban does not directly interact with tadalafil in a way that makes either medicine less effective or more dangerous, your overall cardiovascular health and bleeding risk must be considered before starting any new treatment, including ED medicines [2].

Why You Might Be Taking Apixaban

Apixaban is usually prescribed for conditions that involve an increased risk of blood clots, such as atrial fibrillation, previous stroke, or clotting disorders. These conditions are often linked to cardiovascular disease, which is also a common underlying cause of erectile dysfunction [1][10]. If you have been prescribed apixaban, it is particularly important to discuss ED with your GP or prescriber, as it may be an early warning sign of heart or circulation problems that need further investigation [2].

Do Tadalafil and Apixaban Interact?

There is no major pharmacological interaction between tadalafil and apixaban [3][4]. This means that tadalafil does not significantly affect how apixaban works, and apixaban does not change the levels or effectiveness of tadalafil in your body. The two medicines work through different mechanisms and are processed differently by the liver, so they can usually be taken together safely.

However, both medicines can have effects on your cardiovascular system. Tadalafil can cause a small drop in blood pressure, and apixaban is prescribed for conditions that often involve heart or circulation problems [1][4]. For this reason, your prescriber will need to assess whether your heart and blood vessels are healthy enough for sexual activity and whether tadalafil is appropriate for you. This is a standard safety check for anyone requesting ED treatment, regardless of whether they take apixaban or other medicines [2].

What you need to know

• Tadalafil and apixaban have no major interaction and can usually be taken together safely
• Your prescriber will assess your heart health and all medicines before approving tadalafil
• Never take tadalafil with nitrates, nicorandil, riociguat, or poppers—this is dangerous
• Continue apixaban as prescribed; do not stop or change the dose without medical advice
• Seek urgent help for erections lasting over 4 hours or sudden vision or hearing loss

What Your Prescriber Will Check Before Approving Tadalafil and Apixaban Together

When you request tadalafil through Cured Pharmacy's online consultation, a UK-registered prescriber will review your full medical history and current medications, including apixaban [2]. They will check whether you have any conditions that make tadalafil unsuitable, such as recent heart attack or stroke, unstable angina, severe heart failure, very low blood pressure, or a history of sudden vision loss (NAION) [3][4].

Because apixaban is often prescribed for heart rhythm problems or clotting disorders, your prescriber will pay particular attention to your cardiovascular health. They will assess whether sexual activity is safe for you and whether any other medicines you take might interact with tadalafil [2]. For example, if you also take medicines for high blood pressure or an alpha-blocker for prostate symptoms, these can add to the blood-pressure-lowering effect of tadalafil and may require a lower starting dose or extra caution [3].

You should never take tadalafil if you are also using nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or recreational drugs called 'poppers' (amyl or alkyl nitrites), as the combination can cause a dangerous drop in blood pressure [3][4]. Always declare every medicine, supplement, and recreational substance you use during your consultation.

Other Medicines That May Affect Tadalafil

Some medicines can raise the level of tadalafil in your blood, increasing the risk of side effects. These include potent CYP3A4 inhibitors such as ritonavir, cobicistat (found in some HIV medicines), ketoconazole, itraconazole, and clarithromycin [4]. If you take any of these, your prescriber may recommend a lower dose of tadalafil or choose a different ED treatment. Conversely, medicines that speed up liver enzymes (such as rifampicin, carbamazepine, phenytoin, or St John's wort) can make tadalafil less effective [4]. Your prescriber will check all of these during your consultation.

Practical Advice for Taking Tadalafil and Apixaban Safely

If your prescriber approves tadalafil, take it exactly as directed. For on-demand tadalafil (10mg or 20mg), take one tablet at least 30 minutes before you plan to have sex; the effect can last up to 36 hours, but you should not take more than one dose in 24 hours [4]. For daily tadalafil (2.5mg or 5mg), take one tablet at the same time each day, regardless of when you plan to have sex [4]. Sexual stimulation is needed for tadalafil to work.

Continue taking apixaban exactly as your doctor prescribed. Do not stop or change the dose of apixaban without medical advice, as this could increase your risk of stroke or blood clots. If you experience any unusual bleeding or bruising while taking apixaban, contact your GP promptly. Common side effects of tadalafil include headache, indigestion, back pain, muscle aches, flushing, and a stuffy or runny nose; these are usually mild and temporary [4].

Avoid drinking large amounts of alcohol when taking tadalafil, as heavy drinking can make erectile dysfunction worse and add to the blood-pressure-lowering effect, leading to dizziness or fainting [3][4]. Grapefruit juice can raise tadalafil levels in your blood, so it is best to avoid it. If you develop chest pain during sex, stop immediately and seek urgent medical help; do not take nitrate medicines (such as GTN spray) if you have used tadalafil in the past 48 hours, as this combination is dangerous [3][4].

When to get urgent help

• Erection lasting more than 4 hours (priapism)—go to A&E immediately
• Sudden loss of vision in one or both eyes—seek urgent medical attention
• Chest pain during sex—stop activity, call 999, do not take nitrates if you have used tadalafil in the past 48 hours
• Severe dizziness, fainting, or very low blood pressure after taking tadalafil—call 999 or go to A&E
• Unusual or severe bleeding (blood in urine/stools, coughing up blood) while on apixaban—contact your GP or call 111

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

When to Seek Urgent Medical Help

Serious side effects from tadalafil are rare, but you should seek immediate medical attention if you experience an erection lasting more than four hours (priapism), sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing [3][4]. Priapism is a medical emergency that requires urgent treatment to prevent permanent damage to the penis.

If you develop chest pain, severe dizziness, or fainting after taking tadalafil, call 999 or go to A&E straight away. Do not take nitrate medicines if you have used tadalafil within the past 48 hours, as this can cause a life-threatening drop in blood pressure [3][4]. If you experience unusual or severe bleeding while taking apixaban (such as blood in your urine or stools, coughing up blood, or severe bruising), contact your GP or call 111 immediately, as this may indicate a problem with your anticoagulant therapy.

Remember that erectile dysfunction can be an early warning sign of cardiovascular disease or diabetes [1][10]. If you are experiencing ED for the first time, it is important to see your GP for a full assessment, even if you are already being treated for heart or circulation problems. Your GP can investigate the underlying cause and ensure you receive the most appropriate treatment [2].

How Cured Pharmacy Can Help

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering discreet, convenient access to ED treatments following a clinical consultation with a UK-registered prescriber. Our online assessment asks about your medical history, current medicines (including apixaban), and overall health to ensure tadalafil is safe and appropriate for you. If approved, your treatment is dispensed by our UK pharmacy and delivered discreetly to your door. We offer a range of ED medicines, including generic and branded tadalafil, to suit different needs and budgets.