Tadalafil and Baricitinib: Can You Take Them Together?

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Key takeaways

• No major direct interaction between tadalafil and baricitinib is commonly reported
• Prescriber reviews all your medicines during consultation to ensure safety
• Continue baricitinib as directed by your specialist; no need to separate doses
• Never take tadalafil with nitrates, nicorandil, riociguat, or poppers
• Seek urgent help for erection lasting over four hours or sudden vision or hearing loss

What is tadalafil and baricitinib used for?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction (ED) [4]. It works by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually stimulated. Tadalafil is available as on-demand tablets (10 mg or 20 mg, taken at least 30 minutes before sexual activity, with effects lasting up to 36 hours) or as a daily low-dose option (2.5 mg or 5 mg) [4]. It does not cause an erection on its own; sexual stimulation is needed.

Baricitinib is a Janus kinase (JAK) inhibitor used to treat moderate to severe rheumatoid arthritis, atopic dermatitis, and alopecia areata [12]. It works by reducing inflammation and immune system activity. Baricitinib is taken as a daily tablet, usually at a dose of 2 mg or 4 mg, depending on the condition being treated. Because it affects the immune system, baricitinib requires careful monitoring by your rheumatologist or dermatologist.

Is there a direct interaction between tadalafil and baricitinib?

Based on current clinical evidence and prescribing information, there is no well-documented direct pharmacological interaction between tadalafil and baricitinib [4][12]. They work through completely different mechanisms in the body: tadalafil affects blood vessel relaxation in response to sexual stimulation, while baricitinib modulates immune and inflammatory pathways. Neither medicine is known to significantly alter the metabolism or effectiveness of the other.

That said, the absence of a major reported interaction does not mean the combination is automatically suitable for everyone. Both medicines can have side effects, and your overall health picture—including cardiovascular fitness, blood pressure, kidney function, and infection risk—must be assessed. This is why a thorough consultation with a prescriber is essential before starting tadalafil, especially if you are on long-term treatment for a chronic condition such as rheumatoid arthritis.

What your prescriber will check

During your online consultation at Cured Pharmacy, the prescriber will review your full medication list, including baricitinib, and ask about your cardiovascular health, blood pressure, and any history of heart disease, stroke, or liver and kidney problems [2]. They will also check that you are not taking any medicines that are absolutely contraindicated with tadalafil, such as nitrates (GTN spray, isosorbide mononitrate), nicorandil, riociguat, or recreational drugs known as 'poppers' [4]. If you are on an alpha-blocker for prostate symptoms or high blood pressure, the prescriber will ensure you are stable on that treatment and may recommend starting tadalafil at a lower dose.

At a glance

How tadalafil and baricitinib might affect you together

While tadalafil and baricitinib do not interact directly, it is important to be aware of how each medicine might affect you individually. Tadalafil can cause a mild drop in blood pressure, leading to dizziness, headache, flushing, or nasal congestion in some men [4]. These effects are usually mild and temporary. Baricitinib, on the other hand, can increase the risk of infections (because it suppresses the immune system), raise cholesterol levels, and in rare cases affect liver enzymes or blood counts [12].

If you experience unusual symptoms—such as severe dizziness, chest pain during sex, signs of infection (fever, persistent sore throat), or any new side effects after starting tadalafil—contact your GP or prescriber promptly. It is also important not to stop or change the dose of baricitinib without consulting your rheumatologist, as this could lead to a flare-up of your underlying condition. Always inform every healthcare professional involved in your care about all the medicines you are taking, including over-the-counter products and supplements.

Practical advice for taking tadalafil with baricitinib

If your prescriber confirms that tadalafil is suitable for you, take it exactly as directed. For on-demand use, swallow one 10 mg or 20 mg tablet at least 30 minutes before you plan to have sex; the effect can last up to 36 hours, so you do not need to rush [4]. For daily use, take one 2.5 mg or 5 mg tablet at the same time each day, regardless of when you plan to be sexually active. Sexual stimulation is always needed for tadalafil to work.

Continue taking baricitinib as prescribed by your specialist. There is no need to separate the timing of the two medicines, as they do not interfere with each other's absorption. Avoid drinking large amounts of alcohol, as this can worsen erectile dysfunction and increase the risk of dizziness or low blood pressure when combined with tadalafil [1]. Grapefruit juice may raise tadalafil levels in the blood, so it is best to avoid it or discuss it with your prescriber [4]. If you develop an erection lasting more than four hours, sudden loss of vision or hearing, or chest pain during sexual activity, seek urgent medical help immediately.

When to speak to your doctor

Erectile dysfunction can be an early warning sign of cardiovascular disease or diabetes, so if you have not already done so, see your GP for a full health check [1][2]. This is especially important if you have rheumatoid arthritis, as chronic inflammation is associated with a higher risk of heart disease. Your GP can assess your overall cardiovascular risk, check your blood pressure and cholesterol, and ensure that any underlying causes of ED are identified and managed. If tadalafil does not work for you, or if you experience troublesome side effects, your prescriber can discuss alternative PDE5 inhibitors (such as sildenafil, vardenafil, or avanafil) or refer you for specialist advice.

Other medicines that interact with tadalafil and baricitinib

While tadalafil and baricitinib do not interact with each other, both medicines can interact with other treatments. Tadalafil must never be taken with nitrates (used for angina), nicorandil, riociguat (for pulmonary hypertension), or recreational nitrites ('poppers'), as the combination can cause a dangerous drop in blood pressure [4]. Potent CYP3A4 inhibitors—such as ritonavir, cobicistat (found in some HIV medicines and in Paxlovid), ketoconazole, itraconazole, and clarithromycin—can raise tadalafil levels, requiring dose adjustment [4]. Your prescriber will check the summary of product characteristics (SmPC) if you are on any of these medicines.

Baricitinib is metabolised partly by the liver enzyme CYP3A4, and potent inhibitors or inducers of this enzyme may alter baricitinib levels [12]. However, dose adjustments are usually based on kidney function and the condition being treated, rather than drug interactions alone. If you are taking other immunosuppressants, biologics, or medicines that affect blood counts or liver function, your rheumatologist will monitor you closely. Always declare every medicine, supplement, and herbal product you use during your consultation, and never stop a prescribed medicine without professional advice.

Getting tadalafil safely at Cured Pharmacy

At Cured Pharmacy, all erectile dysfunction treatments—including tadalafil—are prescription-only and supplied only after a confidential online consultation reviewed by a UK-registered prescriber [2]. During the consultation, you will be asked about your medical history, current medicines (including baricitinib), cardiovascular health, and any symptoms of ED. The prescriber will ensure tadalafil is safe and appropriate for you, and if approved, your medicine will be dispensed by our GPhC-registered pharmacy (GPhC 9012511) and delivered discreetly to your door.

We offer a range of tadalafil options to suit different needs and budgets, including generic tadalafil from £7.95 (£6.36 with first-order code Ednew), branded Cialis from £12.00 (£9.60 with code Ednew), and Teva and Avarante brands [4]. If tadalafil is not suitable, or if you prefer a different PDE5 inhibitor, we also stock sildenafil (generic Viagra), vardenafil (generic Levitra), and Spedra (avanafil). Our pharmacists are here to answer any questions you may have about your treatment, and you can contact us at any time for advice. Remember, ED is common, treatable, and nothing to be embarrassed about—seeking help is a positive step towards better health and wellbeing [1].

Why choose Cured Pharmacy?

Cured Pharmacy is a fully regulated UK online pharmacy, registered with the General Pharmaceutical Council (GPhC 9012511). Every prescription is reviewed by a qualified UK prescriber, and our team of pharmacists is available to provide expert advice and support. We offer fast, discreet delivery, competitive pricing, and a straightforward online consultation process designed to make accessing ED treatment as easy and confidential as possible. Your health and safety are our top priorities, and we are committed to providing high-quality, patient-centred care.

When to get urgent help

• Erection lasting more than four hours (priapism)
• Sudden loss of vision or hearing
• Chest pain during sexual activity
• Severe dizziness or fainting after taking tadalafil
• Signs of serious infection (high fever, severe sore throat, unusual tiredness) while on baricitinib

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