Tadalafil and Buprenorphine: Can They Be Taken 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. 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 [3][4]. Tadalafil does not cause an erection on its own—sexual stimulation is still needed.

Tadalafil is available as the branded medicine Cialis or as generic tadalafil. It can be taken on-demand (10 mg or 20 mg at least 30 minutes before sexual activity, with effects lasting up to 36 hours) or as a daily low dose (2.5 mg or 5 mg) for men who prefer spontaneity [4]. Because of its long duration of action, tadalafil is often called the 'weekend pill'.

Like all medicines, tadalafil can interact with other drugs, so it's essential that your prescriber knows about every medicine you take, including over-the-counter products, herbal remedies, and recreational substances. Some combinations—such as tadalafil with nitrates, nicorandil, riociguat, or poppers—are dangerous and must never be used together [4].

What Is Buprenorphine and Why Is It Prescribed?

Buprenorphine is a prescription medicine used mainly in two ways: as opioid substitution therapy to help people reduce or stop the use of illicit opioids such as heroin, and as a strong painkiller for moderate to severe chronic pain. It is a partial opioid agonist, meaning it activates opioid receptors in the brain but to a lesser extent than full agonists like morphine or heroin.

Common brand names include Subutex (buprenorphine alone) and Suboxone (buprenorphine combined with naloxone to reduce misuse). Buprenorphine is also available as patches (e.g. BuTrans) for pain relief. Because buprenorphine affects the central nervous system, it can cause side effects such as drowsiness, dizziness, low blood pressure, and constipation.

Men taking buprenorphine long-term may experience erectile dysfunction as a side effect, since opioids can lower testosterone levels and affect sexual function. If you are on buprenorphine and experiencing ED, it's important to discuss this with your GP or addiction specialist, as treating the underlying cause may help, and ED treatments like tadalafil may also be an option after a full assessment.

Does Buprenorphine Cause Erectile Dysfunction?

Yes, buprenorphine and other opioids can contribute to erectile dysfunction. Long-term opioid use is associated with reduced testosterone levels (a condition called opioid-induced androgen deficiency), which can lead to low libido, fatigue, and difficulty achieving or maintaining an erection. If you suspect your ED is linked to buprenorphine, speak to your prescriber—they may check your hormone levels and discuss whether dose adjustment, switching medication, or adding ED treatment is appropriate.

Can You Take Tadalafil and Buprenorphine Together?

There is no well-documented major direct interaction between tadalafil and buprenorphine, and the two medicines work on different systems in the body. Tadalafil acts on blood vessels in the penis, while buprenorphine acts on opioid receptors in the brain and spinal cord. However, both medicines can lower blood pressure and cause dizziness, so there is a theoretical risk that taking them together might add to these effects.

Your prescriber will review your full medical history and current medications during the online consultation to ensure tadalafil is safe for you. They will consider factors such as your blood pressure, heart health, other medicines you take, and any side effects you experience with buprenorphine. If you are stable on buprenorphine and have no other contraindications, tadalafil may be prescribed, often starting at a lower dose to monitor how you respond [4].

It is essential that you declare buprenorphine (and any other medicines, including over-the-counter drugs and supplements) during your consultation. Never take tadalafil if you are also using nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor, as these combinations can cause a dangerous drop in blood pressure [3][4]. Do not stop or change your buprenorphine dose without advice from the prescriber who manages your opioid treatment.

What you need to know

• No major direct interaction is commonly reported between tadalafil and buprenorphine, but both can lower blood pressure.
• Always declare buprenorphine and all other medicines during your online consultation so your prescriber can assess safety.
• Never take tadalafil with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor—this is dangerous.
• Buprenorphine can contribute to erectile dysfunction by lowering testosterone; speak to your GP if you suspect this.
• Start tadalafil at a lower dose if approved, stand up slowly, and avoid heavy alcohol to reduce dizziness risk.

What Does Your Prescriber Check Before Approving Tadalafil?

When you request tadalafil through Cured Pharmacy, a UK-registered prescriber reviews your online consultation answers to ensure the medicine is safe and suitable for you. They will check your current medications (including buprenorphine), medical history, blood pressure, heart health, and any history of stroke, liver or kidney problems, or eye conditions [2][4].

If you take buprenorphine, the prescriber will consider whether you experience dizziness or low blood pressure as a side effect, and whether adding tadalafil might increase this risk. They may recommend starting with a lower dose of tadalafil (for example, 10 mg instead of 20 mg) and advising you to take it at a time when you can monitor how you feel. If you also take other medicines that lower blood pressure—such as alpha-blockers for prostate symptoms—extra caution is needed, and the prescriber must ensure you are stable on those treatments first [4].

The prescriber will also check that you do not have any absolute contraindications to tadalafil, such as recent heart attack or stroke, severe heart failure, very low blood pressure, or use of nitrates or nicorandil. If tadalafil is not suitable, they may suggest alternative ED treatments or recommend you see your GP for further assessment [2][4].

Starting Tadalafil While on Buprenorphine

If approved, you will usually be advised to start with the lowest effective dose of tadalafil and take it when you are at home and can rest if you feel dizzy. Avoid heavy alcohol, as this can worsen dizziness and make ED worse. If you experience any unusual symptoms—such as severe dizziness, fainting, chest pain, or an erection lasting more than four hours—seek medical help immediately. Your prescriber may arrange a follow-up to check how you are getting on.

Practical Advice for Using Tadalafil with Buprenorphine

If your prescriber approves tadalafil, take it exactly as directed. On-demand tadalafil (10 mg or 20 mg) should be taken at least 30 minutes before sexual activity, and you should not take more than one dose in 24 hours [4]. Daily tadalafil (2.5 mg or 5 mg) is taken once a day at the same time, regardless of when you plan to have sex. Do not take both on-demand and daily tadalafil together.

Because both buprenorphine and tadalafil can cause dizziness or low blood pressure, stand up slowly from sitting or lying down, especially when you first start tadalafil or if your buprenorphine dose has recently changed. Avoid drinking large amounts of alcohol, as this can increase the risk of dizziness and make it harder to get an erection. Grapefruit juice can raise tadalafil levels in your blood, so it's best to avoid it [4].

If you experience side effects such as headache, indigestion, back pain, or flushing, these are common with tadalafil and usually mild. However, if you develop chest pain during sex, stop and seek urgent medical help—do not take nitrate medicines (GTN spray) if you have used tadalafil in the past 48 hours, as this combination is dangerous [4]. If you have an erection lasting more than four hours, or sudden loss of vision or hearing, go to A&E immediately.

When to get urgent help

• Erection lasting more than 4 hours (priapism)—go to A&E immediately to prevent permanent damage
• Sudden loss of vision or hearing—stop tadalafil and seek urgent medical help
• Chest pain during or after sex—stop activity, sit down, and call 999; do not take GTN if you have used tadalafil in the past 48 hours
• Severe dizziness, fainting, or very low blood pressure—lie down and seek same-day medical advice
• Allergic reaction (rash, swelling of face or throat, difficulty breathing)—call 999 immediately

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

Other ED Treatment Options at Cured Pharmacy

Tadalafil is just one of several PDE5 inhibitors available for erectile dysfunction. Cured Pharmacy also offers sildenafil (generic Viagra), vardenafil (generic Levitra), and avanafil (Spedra), all of which require a prescription after an online consultation [3][5][6]. Each medicine works in a similar way but differs in how quickly it starts to work and how long it lasts.

Sildenafil (25 mg, 50 mg, or 100 mg) is taken about one hour before sex and lasts for around four to six hours. Vardenafil (5 mg, 10 mg, or 20 mg) works in about 25 to 60 minutes, and avanafil (50 mg, 100 mg, or 200 mg) is the fastest-acting, often effective within 15 to 30 minutes [5][6]. If tadalafil is not suitable or you prefer a shorter-acting option, your prescriber can discuss alternatives.

All PDE5 inhibitors have similar interactions and contraindications, so the same caution applies if you take buprenorphine or other medicines. Your prescriber will help you choose the most appropriate treatment based on your health, lifestyle, and preferences. Remember, ED can be an early warning sign of heart disease or diabetes, so if you have not already done so, see your GP for a full health check [1][2].

When to See Your GP

If you have new or worsening erectile dysfunction, it's important to see your GP, as ED can be a sign of underlying health problems such as diabetes, high blood pressure, or heart disease [1][2]. Your GP can also review your buprenorphine treatment and check whether it might be contributing to your ED, and discuss options such as hormone testing or referral to a specialist if needed. Online ED treatment through Cured Pharmacy is a convenient option once any serious underlying causes have been ruled out.

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