Tadalafil and Atomoxetine: Can You Take Them Together?

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Tadalafil and Atomoxetine: Understanding the Interaction

Published: 18 October 2026

Many men wonder whether tadalafil and atomoxetine can be taken together safely. Tadalafil is a medicine used to treat erectile dysfunction (ED), while atomoxetine (brand name Strattera) is prescribed for attention deficit hyperactivity disorder (ADHD). The good news is that no major direct interaction between these two medicines is commonly reported in clinical practice, but there are important cardiovascular considerations your prescriber will check before approving treatment.

What is tadalafil and how does it work?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction [4]. It works by relaxing the blood vessels in the penis, allowing increased blood flow when you are sexually aroused. 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]. The medicine only works when you are sexually stimulated; it does not cause an automatic erection. At Cured Pharmacy, tadalafil is available on prescription after an online consultation reviewed by a UK-registered prescriber.

Common side effects include headache, indigestion, back pain, muscle aches, and flushing [4]. These are usually mild and temporary. Because tadalafil lowers blood pressure slightly, it must not be taken with certain medicines such as nitrates, nicorandil, or riociguat, as the combination can cause a dangerous drop in blood pressure [4].

What is atomoxetine and what is it used for?

Atomoxetine is a selective noradrenaline reuptake inhibitor (NRI) used to treat ADHD in children, adolescents, and adults. It is marketed under the brand name Strattera in the UK. Unlike stimulant ADHD medicines such as methylphenidate, atomoxetine is not a controlled drug and works by increasing levels of noradrenaline in the brain, which helps improve concentration, attention, and impulse control.

Atomoxetine is usually taken once or twice daily, and it can take several weeks to reach its full effect. Common side effects include decreased appetite, nausea, dry mouth, dizziness, and sleep disturbances. Importantly, atomoxetine can affect heart rate and blood pressure—it may cause a small increase in both, particularly when treatment is first started or the dose is increased.

Because atomoxetine can influence cardiovascular function, prescribers routinely monitor blood pressure and heart rate during treatment. This cardiovascular effect is the main reason your prescriber will want to review your full medical history before approving tadalafil if you are already taking atomoxetine.

Does atomoxetine affect erectile function?

Some men taking atomoxetine report sexual side effects, including reduced libido or difficulty achieving erections. While these effects are not experienced by everyone, they are recognised in the medicine's safety information. If you have noticed changes in sexual function since starting atomoxetine, it is worth discussing this with your GP or psychiatrist, as adjusting the dose or timing of the medicine may help.

How do tadalafil and atomoxetine interact?

There is no major direct pharmacological interaction between tadalafil and atomoxetine that would make the combination unsafe in most people. Neither medicine significantly affects the metabolism of the other, and they work through different mechanisms in the body. However, both medicines can influence blood pressure and heart rate, which is why careful assessment is essential.

Tadalafil causes a mild lowering of blood pressure by relaxing blood vessels [4]. Atomoxetine, on the other hand, can cause a small increase in blood pressure and heart rate, particularly when treatment is started or the dose is changed. In theory, these opposing effects might partially balance each other out, but in practice the combination requires individual assessment because cardiovascular responses vary from person to person.

Your prescriber will check your current blood pressure, heart rate, and overall cardiovascular health before approving tadalafil. If your blood pressure or heart rate is poorly controlled on atomoxetine, or if you have underlying heart conditions, additional caution or monitoring may be needed. The key is that both medicines are being used under medical supervision, with regular review of your cardiovascular status.

What will your prescriber check before approving tadalafil and atomoxetine together?

When you request tadalafil through Cured Pharmacy's online consultation, you will be asked detailed questions about your current medicines, including atomoxetine. The UK-registered prescriber reviewing your consultation will check several important factors to ensure the combination is appropriate for you.

First, they will review your cardiovascular health, including any history of heart disease, high or low blood pressure, stroke, or chest pain. They will ask whether your blood pressure and heart rate are stable on atomoxetine, and whether you have had any recent cardiovascular symptoms such as dizziness, palpitations, or fainting. If your blood pressure or heart rate is not well controlled, the prescriber may recommend you see your GP for optimisation before starting tadalafil.

Second, the prescriber will check for any other medicines or health conditions that might make tadalafil unsuitable. This includes nitrates, nicorandil, riociguat, alpha-blockers, and certain antifungal or antiviral medicines [4]. They will also ask about any history of priapism (prolonged erection), eye problems such as non-arteritic anterior ischaemic optic neuropathy (NAION), severe liver or kidney disease, and whether sexual activity is safe for you given your overall health [4].

Starting on the lowest effective dose

If the prescriber approves tadalafil, they may recommend starting with the lowest effective dose (typically 10mg on-demand or 2.5mg daily) to minimise the risk of side effects such as dizziness or headache [4]. This cautious approach allows you and your prescriber to assess how you respond to the combination before considering a higher dose if needed.

Practical advice for taking tadalafil and atomoxetine safely

If your prescriber approves the combination of tadalafil and atomoxetine, there are several practical steps you can take to use both medicines safely and effectively. First, take each medicine exactly as prescribed. Do not adjust the dose or timing of either medicine without consulting your prescriber or GP. If you are taking on-demand tadalafil, remember it needs at least 30 minutes to start working, and sexual stimulation is required for it to be effective [4].

Monitor yourself for any new or worsening symptoms, particularly dizziness, light-headedness, palpitations, or chest discomfort. These could indicate that your blood pressure or heart rate is being affected by the combination. If you experience any of these symptoms, sit or lie down, avoid sudden movements, and contact your GP or NHS 111 for advice. Do not drive or operate machinery if you feel dizzy.

Avoid drinking large amounts of alcohol when taking tadalafil, as alcohol can worsen erectile dysfunction and add to the blood-pressure-lowering effect, increasing the risk of dizziness [4]. Grapefruit juice can raise tadalafil levels in the blood, so it is best to avoid it. If you are prescribed any new medicines by your GP or another healthcare professional, always tell them you are taking both tadalafil and atomoxetine so they can check for additional interactions.

Finally, attend any follow-up appointments or monitoring arranged by your GP or psychiatrist. Regular blood pressure and heart rate checks are important when you are taking atomoxetine, and your prescriber may want to review these more frequently if you start tadalafil. If your ADHD treatment changes—for example, if your atomoxetine dose is increased or you switch to a different medicine—inform your prescriber, as this may affect the suitability of tadalafil.

When to seek urgent medical help with tadalafil and atomoxetine

While serious side effects are uncommon, it is important to know the warning signs that require urgent medical attention. If you experience an erection lasting longer than four hours (priapism), go to A&E immediately or call 999. Priapism is a medical emergency that can cause permanent damage to the penis if not treated promptly [4].

Seek urgent help if you develop sudden loss of vision in one or both eyes, as this could be a sign of NAION, a rare but serious condition [4]. Similarly, sudden hearing loss or ringing in the ears requires immediate medical assessment. If you experience chest pain, severe dizziness, fainting, or an irregular or very fast heartbeat, call 999 or go to A&E, as these could indicate a serious cardiovascular problem.

If you develop severe headache, shortness of breath, or swelling of the face, lips, or throat, seek emergency help, as these could be signs of an allergic reaction or other serious adverse effect. Always err on the side of caution—if you are unsure whether a symptom is serious, contact NHS 111 or your GP for advice. Do not wait to see if symptoms resolve on their own.

Reporting side effects

If you experience any side effects from tadalafil or atomoxetine, even if they are not listed in the patient information leaflet, you can report them via the Yellow Card Scheme at yellowcard.mhra.gov.uk or by searching for 'Yellow Card' in the Google Play or Apple App Store. Reporting helps improve the safety information available for these medicines.

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. Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [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.

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