Tadalafil and Apomorphine: Can They Be Taken Together?

Tadalafil and Apomorphine: Understanding the Interaction

Published: 18 October 2026

Many men wonder whether tadalafil and apomorphine can be taken together for erectile dysfunction. Apomorphine (previously marketed as Uprima) is a dopamine agonist that was once licensed in the UK for ED but is no longer widely available; tadalafil is a PDE5 inhibitor commonly prescribed for the condition. While no major dangerous interaction between these two medicines is commonly reported in the literature, combining treatments for the same condition requires careful prescriber assessment to avoid unnecessary side effects and ensure the most effective approach for you.

What Is Tadalafil and How Does It Work?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK for the treatment of erectile dysfunction [4]. It works by relaxing the smooth muscle in the blood vessels of the penis, allowing increased blood flow when you are sexually aroused. This helps you achieve and maintain an erection sufficient for sexual activity.

Tadalafil is available as an on-demand treatment (typically 10 mg or 20 mg taken at least 30 minutes before sex, with effects lasting up to 36 hours) or as a daily low-dose tablet (2.5 mg or 5 mg) [4]. Unlike some other ED medicines, tadalafil's long duration of action means you do not need to time intercourse as precisely. Sexual stimulation is still required for the medicine to work; it does not cause an automatic erection.

Common side effects include headache, indigestion, back pain, muscle aches, and flushing [4]. Tadalafil must not be taken with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor, as the combination can cause a dangerous fall in blood pressure.

What Is Apomorphine and How Does It Work?

Apomorphine is a dopamine agonist that was previously licensed in the UK under the brand name Uprima for the treatment of erectile dysfunction. Unlike PDE5 inhibitors such as tadalafil, apomorphine works centrally in the brain by stimulating dopamine receptors, which can trigger the erectile response [2].

Apomorphine was taken sublingually (dissolved under the tongue) and acted relatively quickly, usually within 20 minutes. However, it was withdrawn from the UK market in the mid-2000s due to limited effectiveness compared with PDE5 inhibitors and a higher rate of side effects, including nausea, vomiting, dizziness, and headache.

Although apomorphine is still used in some countries and for other medical conditions (such as Parkinson's disease), it is no longer a first-line or commonly available option for erectile dysfunction in the UK. If you have been prescribed apomorphine or are considering it, your prescriber will need to assess whether it is the most suitable treatment for your situation.

Why Apomorphine Is Rarely Used for ED Today

Clinical trials showed that apomorphine was less effective than PDE5 inhibitors for most men with erectile dysfunction, and the side-effect profile—particularly nausea—limited its tolerability [2]. As a result, tadalafil, sildenafil, and other PDE5 inhibitors have become the standard oral treatments for ED in the UK, supported by robust evidence and widespread clinical experience.

Do Tadalafil and Apomorphine Interact?

There is no well-documented major pharmacological interaction between tadalafil and apomorphine, as they work through different mechanisms: tadalafil acts peripherally on blood vessels in the penis, while apomorphine acts centrally in the brain [2][4]. Neither medicine is listed as a contraindication or significant interacting drug in the other's Summary of Product Characteristics.

However, combining two treatments for the same condition is not standard practice and requires careful prescriber oversight. Both medicines can cause side effects such as dizziness and low blood pressure, and taking them together may increase the risk of these effects. Your prescriber will assess your overall health, current medications, and the reasons for considering combination therapy before making a recommendation.

In practice, most men with erectile dysfunction in the UK are treated with a single PDE5 inhibitor, which is effective for the majority of patients [2]. If one treatment is not working well, your prescriber may adjust the dose, try a different PDE5 inhibitor, or explore other options such as vacuum devices, alprostadil, or referral to a specialist. Always discuss any plan to combine ED treatments with your prescriber or pharmacist; do not start, stop, or change doses on your own.

What Does Your Prescriber Check Before Combining Tadalafil and Apomorphine?

If you are considering using tadalafil and apomorphine together, your prescriber will take a detailed medical history and review all your current medicines. They will check for conditions that make either treatment 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) [2][4].

Your prescriber will also assess whether you are taking any medicines that interact with tadalafil, including nitrates, nicorandil, riociguat, alpha-blockers, or potent CYP3A4 inhibitors [4]. They will ask about your cardiovascular fitness, as sexual activity itself places demands on the heart. If you have significant heart disease, your GP or cardiologist may need to confirm that sexual activity is safe for you.

Because apomorphine can cause nausea, dizziness, and low blood pressure, and tadalafil can also lower blood pressure, your prescriber will weigh the potential benefits of combination therapy against the risk of additive side effects. In most cases, optimising a single PDE5 inhibitor or switching to a different one is the preferred approach before considering less common combinations.

Declaring All Your Medicines

It is essential to tell your prescriber about every medicine you take, including over-the-counter products, herbal remedies (such as St John's wort), and recreational substances (including poppers). Even medicines you take occasionally—such as GTN spray for angina—can interact dangerously with tadalafil. Honest disclosure ensures you receive safe, effective treatment tailored to your needs.

Practical Advice for Using Tadalafil and Apomorphine

If your prescriber has approved the use of both tadalafil and apomorphine, follow their instructions carefully regarding timing, dosing, and what to watch for. Do not exceed the prescribed dose of either medicine, and do not take them more frequently than advised. Keep a record of any side effects—such as dizziness, headache, nausea, or palpitations—and report them to your prescriber or pharmacist.

Avoid heavy alcohol when using ED treatments, as it can worsen erectile dysfunction and add to the blood-pressure-lowering effects of tadalafil [4]. Grapefruit juice can raise tadalafil levels in the blood and should be avoided. If you experience an erection lasting more than four hours (priapism), sudden loss of vision or hearing, or chest pain during sex, seek urgent medical help immediately.

Remember that erectile dysfunction can be an early warning sign of cardiovascular disease or diabetes [1]. If you have not already done so, see your GP for a full health check, including blood pressure, cholesterol, and blood sugar tests. Lifestyle changes—such as losing weight, stopping smoking, exercising regularly, and managing stress—can improve both your general health and your erectile function [1][2].

Alternatives to Combining Tadalafil and Apomorphine

For most men, a single PDE5 inhibitor is effective and well tolerated [2]. If tadalafil at the standard dose is not working as well as you hoped, your prescriber may suggest increasing the dose (if safe to do so), trying a different PDE5 inhibitor such as sildenafil, vardenafil, or avanafil, or reviewing factors that can reduce effectiveness—such as timing, food intake, or psychological stress.

If oral treatments are not suitable or effective, other options include alprostadil (available as a urethral cream or injection), vacuum erection devices, or referral to a specialist for further assessment [2][7]. Psychological factors—such as anxiety, depression, or relationship difficulties—often contribute to erectile dysfunction, and talking therapies or psychosexual counselling can be very helpful, either alone or alongside medical treatment.

At Cured Pharmacy, our UK-registered prescribers review every online consultation individually to recommend the most appropriate treatment for you. We offer a range of licensed ED medicines, including generic and branded tadalafil, at transparent prices. Prescription treatments are only supplied after a clinical assessment to ensure they are safe and suitable for your circumstances.

When to See Your GP

If you have new or worsening erectile dysfunction, make an appointment with your GP. ED can be an early sign of underlying health problems, including heart disease, diabetes, or hormonal imbalances [1]. Your GP can arrange tests, review your medicines, and refer you to a specialist if needed. Do not rely solely on online treatment without addressing the root cause.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 18 October 2026]
2. National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 18 October 2026]
3. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 18 October 2026]
4. Joint Formulary Committee. (n.d.). Alprostadil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/alprostadil/ [accessed 18 October 2026]

Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.