Tadalafil and Capsaicin Cream: Can You Use Them Together?

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At a glance

What is tadalafil and how does it work?

Tadalafil is a prescription medicine used to treat erectile dysfunction in men. It belongs to a group of medicines called PDE5 inhibitors, which work by relaxing blood vessels in the penis, allowing more blood to flow in when you're sexually aroused [4]. Tadalafil is the active ingredient in branded Cialis and is available as a generic medicine at lower cost.

Tadalafil comes in two forms: on-demand tablets (10mg or 20mg) taken at least 30 minutes before sex, with effects lasting up to 36 hours, and daily tablets (2.5mg or 5mg) taken once a day [4]. All forms require sexual stimulation to work—they don't cause an automatic erection. Tadalafil is only available on prescription after a clinical assessment by a UK-registered prescriber, who will check your medical history, current medicines, and whether the treatment is safe for you.

What is capsaicin cream and what is it used for?

Capsaicin cream is a topical (applied to the skin) treatment that contains capsaicin, the active ingredient found in chilli peppers. It's used to relieve pain, particularly from conditions such as osteoarthritis, muscle strains, back pain, and nerve pain (neuropathy). Capsaicin works by reducing the amount of a chemical called substance P in nerve endings, which helps to decrease pain signals sent to the brain.

Capsaicin cream is applied directly to the affected area of skin, usually three or four times a day. It can cause a warming or burning sensation when first applied, which usually lessens with continued use. The cream is absorbed through the skin and works locally at the site of application—it does not enter the bloodstream in significant amounts, which is an important factor when considering interactions with other medicines.

Because capsaicin cream acts locally on the skin and is not significantly absorbed into the bloodstream, it does not typically interact with medicines taken by mouth, such as tadalafil. However, you should always tell your prescriber about all treatments you're using, including over-the-counter creams and gels.

How capsaicin cream differs from oral medicines

Unlike tablets or capsules that are swallowed and absorbed into the bloodstream, capsaicin cream is designed to work where it's applied. This means it doesn't travel through your body in the same way as oral medicines, and it's much less likely to affect how other medicines work or to be affected by them. This is why topical treatments like capsaicin cream generally have fewer drug interactions than medicines taken by mouth.

Can you use tadalafil and capsaicin cream together?

There is no known major interaction between tadalafil and capsaicin cream. Because capsaicin cream is applied to the skin and works locally without significant absorption into the bloodstream, it does not affect how tadalafil works in your body, and tadalafil does not affect how capsaicin cream relieves pain [4].

However, it's still important to tell your prescriber about all medicines and treatments you're using, including topical creams, during your online consultation. This allows them to check your full medication list and ensure that tadalafil is safe for you based on your individual circumstances. While capsaicin cream itself is not a concern, your prescriber needs to know about any other medicines you take for pain or other conditions.

If you're using capsaicin cream for chronic pain, your prescriber may also want to understand the underlying condition and whether you're taking any other pain relief medicines, as some of these (such as certain blood pressure medicines) can interact with tadalafil. The consultation ensures a complete safety check tailored to you.

What you need to know

• No known interaction exists between tadalafil and capsaicin cream—they can be used together safely
• Capsaicin cream works locally on the skin and does not affect how tadalafil works
• Always tell your prescriber about all medicines and creams you use during your consultation
• Never take tadalafil with nitrates, nicorandil, riociguat, or poppers—this can be dangerous
• Tadalafil is only available on prescription after a clinical assessment by a UK prescriber

What does your prescriber check before prescribing tadalafil?

Before prescribing tadalafil, your prescriber will review your medical history and current medicines to ensure the treatment is safe for you. They will specifically check for medicines that must never be taken with tadalafil, including nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, and amyl or alkyl nitrites (poppers) [4]. Taking tadalafil with any of these can cause a dangerous drop in blood pressure.

Your prescriber will also check for medicines that may require a dose adjustment, such as alpha-blockers (for prostate or blood pressure problems), potent CYP3A4 inhibitors (including some HIV medicines and antifungals), and other blood pressure medicines [4]. They'll ask about your heart health, as tadalafil is not suitable when sexual activity is inadvisable, such as after a recent heart attack or stroke, or if you have unstable angina or severe heart failure.

During the consultation, you'll be asked to list all your current medicines, including over-the-counter treatments, supplements, and topical creams like capsaicin. This comprehensive review ensures that tadalafil is the right choice for you and that it won't interact with anything else you're taking. If you have any concerns about a specific medicine or treatment, you can discuss these during your consultation.

Why you should mention all your medicines

Even if a medicine seems unrelated to erectile dysfunction, it's important to mention it. Some medicines can affect how tadalafil works, how long it stays in your body, or whether it's safe for you to take. Your prescriber is trained to spot potential interactions and will adjust your treatment plan if needed. Never stop or change a prescribed medicine without speaking to your doctor or pharmacist first.

Medicines that do interact with tadalafil

While capsaicin cream does not interact with tadalafil, there are several important medicines that do. You must never take tadalafil with nitrates (GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, or amyl/alkyl nitrites (poppers) [4]. Combining tadalafil with any of these can cause a severe and potentially dangerous drop in blood pressure.

Alpha-blockers, used for prostate problems or high blood pressure (such as doxazosin, tamsulosin, alfuzosin), can also lower blood pressure when taken with tadalafil, leading to dizziness or fainting [4]. If you take an alpha-blocker, your prescriber will ensure you're stable on it and will start you on the lowest dose of tadalafil. Potent CYP3A4 inhibitors, including some HIV medicines (ritonavir, cobicistat), antifungals (ketoconazole, itraconazole), and antibiotics (clarithromycin), can raise tadalafil levels in your blood, requiring dose adjustments [4].

Other blood pressure medicines can add to the blood-pressure-lowering effect of tadalafil, which is usually manageable but must be checked by your prescriber. Grapefruit juice can also raise tadalafil levels and should be avoided. Heavy alcohol can worsen erectile dysfunction and increase the risk of side effects such as dizziness and low blood pressure.

What to do if you're prescribed a new medicine

If your GP or another doctor prescribes a new medicine while you're taking tadalafil, tell them you're using it for erectile dysfunction. Similarly, if you're starting tadalafil and are prescribed a new medicine later, check with your pharmacist or prescriber whether it's safe to take together. This is especially important for heart medicines, blood pressure tablets, and antibiotics.

When to get urgent help

• Erection lasting more than 4 hours (priapism)—go to A&E immediately
• Sudden loss of vision or hearing—seek urgent medical help
• Chest pain during sex—stop and call 999 if it doesn't go away quickly
• Severe dizziness or fainting after taking tadalafil—seek same-day medical advice

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

Practical advice for using tadalafil safely

To use tadalafil safely, always take it exactly as prescribed. On-demand tadalafil (10mg or 20mg) should be taken at least 30 minutes before sexual activity, and the effect can last up to 36 hours [4]. Daily tadalafil (2.5mg or 5mg) is taken once a day at the same time, regardless of when you plan to have sex. Never take more than one dose in 24 hours, and never take tadalafil with another PDE5 inhibitor (such as sildenafil or vardenafil).

Store tadalafil in a cool, dry place away from direct sunlight and out of reach of children. If you experience side effects such as headache, indigestion, back pain, or flushing, these are usually mild and temporary [4]. However, seek urgent medical help if you have an erection lasting more than four hours (priapism), sudden loss of vision or hearing, or chest pain during sex.

If you're using capsaicin cream or any other topical treatment, continue to use it as directed. There's no need to change your pain relief routine because you're taking tadalafil. If you have any questions or concerns about using tadalafil alongside other treatments, speak to your prescriber or pharmacist—they're there to help you use your medicines safely and effectively.