Tadalafil and Bisoprolol: Can They Be Taken Together?

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Tadalafil and Bisoprolol: Understanding the Interaction

Published: 18 October 2026

Many men taking bisoprolol for high blood pressure or heart conditions wonder whether tadalafil and bisoprolol can be taken together safely. The good news is that this combination is not contraindicated, meaning tadalafil (generic Cialis) may be prescribed alongside bisoprolol, but your prescriber will need to assess your individual circumstances carefully. Both medicines can lower blood pressure, so a clinical review is essential to ensure the combination is appropriate for you.

What is bisoprolol and why is it prescribed?

Bisoprolol is a beta-blocker, a type of medicine commonly prescribed to treat high blood pressure (hypertension), angina (chest pain caused by reduced blood flow to the heart), and heart failure. It works by slowing your heart rate and reducing the force of your heartbeat, which lowers the strain on your heart and helps to reduce blood pressure.

Beta-blockers like bisoprolol are often taken long-term to manage cardiovascular conditions. Common brand names include Cardicor and Congescor, though many people take generic bisoprolol. The usual dose ranges from 1.25 mg to 10 mg once daily, depending on the condition being treated.

Because bisoprolol affects your cardiovascular system, it's important that any new medicine you take—including treatments for erectile dysfunction—is reviewed by a prescriber who understands your full medical history and current medication regimen.

What is tadalafil and how does it work?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction. It's the generic version of Cialis and works by relaxing the blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Tadalafil does not cause an erection on its own—sexual stimulation is still needed.

Tadalafil is available in two forms: on-demand tablets (usually 10 mg or 20 mg, taken at least 30 minutes before sexual activity, with effects lasting up to 36 hours) and daily low-dose tablets (2.5 mg or 5 mg, taken once a day to allow for spontaneity). The choice depends on your lifestyle and how often you anticipate sexual activity.

Because tadalafil also has a mild blood-pressure-lowering effect, it's crucial that your prescriber knows about all your current medicines, including bisoprolol, before starting treatment. At Cured Pharmacy, every prescription for tadalafil follows an online consultation reviewed by a UK-registered prescriber.

How tadalafil affects blood pressure

Tadalafil can cause a small, temporary drop in blood pressure—typically around 5–10 mmHg systolic and 3–5 mmHg diastolic in clinical trials. For most men, this is well tolerated and causes no symptoms. However, when combined with other blood-pressure-lowering medicines like bisoprolol, the effect can be additive, meaning your blood pressure may drop more than it would with either medicine alone.

This is why your prescriber will check your current blood pressure control, your dose of bisoprolol, and whether you have any history of dizziness or fainting before approving tadalafil. The goal is to ensure the combination is safe and unlikely to cause problematic low blood pressure (hypotension).

Can you take tadalafil and bisoprolol together?

Yes, tadalafil and bisoprolol can be taken together in many cases, but this combination requires careful prescriber assessment. Unlike nitrates, nicorandil, or riociguat—which are absolutely contraindicated with PDE5 inhibitors—bisoprolol is not a strict contraindication. However, because both medicines can lower blood pressure, there is a risk of additive effects that may cause dizziness, light-headedness, or fainting, especially when standing up quickly.

Your prescriber will review several factors: your current blood pressure readings, the dose of bisoprolol you take, whether your blood pressure is well controlled, any history of postural hypotension (dizziness on standing), and your overall cardiovascular health. If you have unstable angina, recent heart attack or stroke, or severe heart failure, tadalafil may not be suitable regardless of bisoprolol use.

If tadalafil is deemed appropriate, your prescriber may recommend starting with a lower dose (such as 5 mg or 10 mg on-demand, rather than 20 mg) to minimise the risk of low blood pressure. You should never adjust your bisoprolol dose or stop taking it without consulting your GP, as this could worsen your heart condition.

What does your prescriber check before approving tadalafil with bisoprolol?

During your online consultation at Cured Pharmacy, the prescriber will ask detailed questions about your cardiovascular health and current medicines. Key checks include: confirmation of your bisoprolol dose and how long you've been taking it; your most recent blood pressure readings (ideally measured at home or by your GP); whether you experience dizziness, light-headedness, or fainting; and any history of heart attack, stroke, angina, or heart failure.

The prescriber will also ask about other medicines you take, including over-the-counter products and supplements, because some can interact with tadalafil. For example, alpha-blockers (such as doxazosin or tamsulosin, often used for prostate symptoms) also lower blood pressure and require extra caution when combined with tadalafil. Potent CYP3A4 inhibitors (like ritonavir, ketoconazole, or clarithromycin) can raise tadalafil levels and may require dose adjustment.

If your blood pressure is well controlled on bisoprolol and you have no recent cardiovascular events or symptoms, tadalafil is often considered safe. However, the final decision rests with the prescriber, who may request that you check your blood pressure with your GP before starting treatment or recommend a lower starting dose.

Why beta-blockers and ED treatment need careful review

Beta-blockers like bisoprolol are sometimes associated with erectile dysfunction as a side effect, though this is not universal and the link is debated. Some men notice ED improves when their blood pressure is better controlled, while others find the beta-blocker itself contributes to the problem. Either way, treating ED with tadalafil while on bisoprolol is often possible and can significantly improve quality of life.

The key is ensuring your cardiovascular system can tolerate both the mild blood-pressure-lowering effect of tadalafil and the physical demands of sexual activity. Your prescriber may ask about your exercise tolerance—if you can climb two flights of stairs without chest pain or severe breathlessness, sexual activity is generally considered safe from a cardiovascular perspective.

Practical advice for taking tadalafil and bisoprolol safely

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

Continue taking your bisoprolol as prescribed by your GP—do not skip doses or stop taking it, as this could cause a rebound increase in blood pressure or heart rate. If you feel dizzy or light-headed after taking tadalafil, sit or lie down until the feeling passes, and avoid driving or operating machinery. Standing up slowly from sitting or lying can help prevent postural dizziness.

Avoid heavy alcohol when taking tadalafil, as alcohol can worsen erectile dysfunction and add to the blood-pressure-lowering effect, increasing the risk of dizziness. Grapefruit juice can raise tadalafil levels in your blood and should be avoided. If you develop chest pain during or after sexual activity, do not take nitrate medicines (such as GTN spray)—seek urgent medical help instead, as the combination of nitrates and tadalafil can cause a dangerous drop in blood pressure.

Warning signs and when to seek help with tadalafil and bisoprolol

Most men tolerate the combination of tadalafil and bisoprolol well, but you should be aware of warning signs that need prompt attention. If you experience severe dizziness, fainting, or a feeling that you might pass out, stop taking tadalafil and contact your GP or call 111 for advice. These symptoms may indicate that your blood pressure has dropped too low.

Seek emergency help (call 999 or go to A&E) if you develop chest pain during or after sex, as this could be a sign of angina or, rarely, a heart attack. Do not take GTN or other nitrate medicines if you have used tadalafil in the past 48 hours. Also seek urgent help if you have an erection lasting more than four hours (priapism), sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing—these are rare but serious side effects.

If you notice new or worsening symptoms such as increased breathlessness, swelling of your ankles, or irregular heartbeat, contact your GP, as these may be related to your heart condition rather than tadalafil. Always inform any healthcare professional treating you that you take both bisoprolol and tadalafil, especially in emergency situations.

Monitoring your blood pressure at home

If you're taking tadalafil and bisoprolol together, your GP or prescriber may recommend monitoring your blood pressure at home, especially when you first start treatment. Home blood pressure monitors are widely available from pharmacies and online. Measure your blood pressure at the same time each day, ideally in the morning before taking your medicines, and keep a record to share with your GP.

A typical target blood pressure for someone on bisoprolol is below 140/90 mmHg, though your GP may set a different target based on your individual circumstances. If your readings are consistently lower than 90/60 mmHg, or if you feel dizzy or unwell, contact your GP for advice—you may need a dose adjustment of bisoprolol or tadalafil.

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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