Tadalafil and Cilostazol: Can You Take Them Together?

Tadalafil and Cilostazol: Understanding the Interaction

Published: 19 October 2026

If you've been prescribed cilostazol for circulation problems and are considering tadalafil for erectile dysfunction, you may wonder whether tadalafil and cilostazol can be taken together safely. The good news is that there is no absolute contraindication between these two medicines, but there are important considerations your prescriber will assess. Both medicines can affect blood pressure and blood flow, so careful monitoring and dose adjustment may be needed to ensure your safety.

What is tadalafil and cilostazol used for?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction (ED) and, at lower doses, benign prostatic hyperplasia [4]. It works by relaxing blood vessels in the penis, allowing increased blood flow when you're sexually stimulated. Tadalafil is available as on-demand tablets (10mg or 20mg, taken at least 30 minutes before sex, with effects lasting up to 36 hours) or as a daily low-dose option (2.5mg or 5mg) [4]. It does not cause an erection by itself—sexual stimulation is still required.

Cilostazol is an antiplatelet medicine and vasodilator prescribed to improve walking distance in people with intermittent claudication—leg pain caused by poor circulation [12]. It works by widening blood vessels and preventing platelets from clumping together, which improves blood flow to the legs. Cilostazol is typically taken twice daily, and it also has mild effects on blood pressure because it relaxes blood vessel walls.

Because both medicines influence blood flow and can lower blood pressure, your prescriber will carefully review whether the combination is appropriate for you, taking into account your overall cardiovascular health, other medicines, and any history of heart or circulation problems.

How do tadalafil and cilostazol interact?

Tadalafil and cilostazol do not have a direct pharmacological interaction that makes them absolutely contraindicated, but both medicines can cause blood vessels to relax and may lower blood pressure [4][12]. When taken together, there is a theoretical risk that their blood-pressure-lowering effects could add up, potentially leading to dizziness, light-headedness, or fainting, especially when standing up quickly.

Cilostazol is also metabolised partly by the liver enzyme CYP3A4, the same enzyme that breaks down tadalafil [4][12]. This means that in theory, one medicine could slightly affect the levels of the other in your bloodstream, although this interaction is not usually considered clinically significant at standard doses. Your prescriber will take this into account when deciding on the safest dose of tadalafil for you.

It's important to note that tadalafil is absolutely contraindicated with nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, and recreational drugs known as 'poppers' because these combinations can cause a dangerous drop in blood pressure [3][4]. Cilostazol is not in any of these categories, so the combination with tadalafil is not forbidden—but it does require careful prescriber assessment and monitoring, particularly if you have existing heart or blood-pressure conditions.

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

When you request tadalafil through an online consultation at Cured Pharmacy, our UK-registered prescribers will review your full medical history and current medicines, including cilostazol [2]. They will assess your cardiovascular health, including any history of heart attack, stroke, angina, heart failure, or abnormal blood pressure. If you are taking cilostazol, it suggests you have peripheral arterial disease, which can be associated with a higher risk of heart problems, so this context is especially important.

Your prescriber will check whether you are on any other medicines that lower blood pressure (such as antihypertensives or alpha-blockers like tamsulosin or doxazosin), as these can add to the blood-pressure-lowering effect of tadalafil [4]. They will also confirm that you are not taking any medicines that are absolutely contraindicated with PDE5 inhibitors, such as nitrates or nicorandil. If you are stable on cilostazol and your blood pressure is well controlled, your prescriber may approve tadalafil, often starting at a lower dose (such as 10mg on-demand) to minimise any risk of dizziness or low blood pressure.

You should always declare every medicine you take—prescription, over-the-counter, herbal, and recreational—during your consultation. Never stop or change your cilostazol or any other prescribed medicine without speaking to your GP or specialist, as this could worsen your circulation symptoms or increase your risk of cardiovascular events.

Starting on a lower dose

If your prescriber approves tadalafil while you are taking cilostazol, they may recommend starting with the lowest effective dose—typically 10mg on-demand—and monitoring how you feel [4]. This cautious approach helps to identify any dizziness, light-headedness, or other side effects early. If you tolerate the lower dose well and it is effective, your prescriber may continue at that dose or, if needed and safe, consider a higher dose after reviewing your response.

Practical advice for taking tadalafil and cilostazol safely

If your prescriber has approved tadalafil alongside cilostazol, take each medicine exactly as directed. Cilostazol is usually taken twice daily, 30 minutes before or two hours after food, while tadalafil on-demand tablets (10mg or 20mg) are taken at least 30 minutes before sexual activity, with effects lasting up to 36 hours [4][12]. You can take tadalafil with or without food, although a very heavy or high-fat meal may delay its effect slightly.

Be mindful of your blood pressure, especially in the first few days after starting tadalafil. Stand up slowly from sitting or lying down to reduce the risk of dizziness or fainting. Avoid drinking large amounts of alcohol, as this can worsen erectile dysfunction, increase the risk of low blood pressure, and make side effects more likely [1][4]. Grapefruit juice can raise tadalafil levels in your blood and should be avoided or limited.

If you experience persistent dizziness, light-headedness, fainting, chest pain during sex, or any other worrying symptoms, stop taking tadalafil and contact your GP or call NHS 111 for advice. Do not take more than one dose of tadalafil in 24 hours, and never take tadalafil together with another PDE5 inhibitor (such as sildenafil or vardenafil) or with nitrates, nicorandil, or poppers, as these combinations are dangerous [3][4].

Monitoring and follow-up

Your GP or specialist may want to monitor your blood pressure and overall cardiovascular health more closely if you are taking both cilostazol and tadalafil. Attend all scheduled appointments and report any new symptoms promptly. If your cilostazol dose changes or you start any new medicine, inform your prescriber before your next tadalafil order, as this may affect the safety or suitability of continuing ED treatment.

Warning signs and when to seek urgent help with tadalafil and cilostazol

Most men taking tadalafil and cilostazol together will not experience serious problems, but it is important to recognise warning signs that need urgent medical attention. If you develop chest pain or discomfort during or after sex, do not use GTN spray or any nitrate medicine—tell the paramedics or A&E doctor that you have taken tadalafil, as nitrates can cause a dangerous drop in blood pressure when combined with PDE5 inhibitors [3][4]. Call 999 immediately if you have chest pain.

Seek emergency help if you experience sudden loss of vision in one or both eyes, as this may be a sign of non-arteritic anterior ischaemic optic neuropathy (NAION), a rare but serious condition [4]. Similarly, sudden hearing loss or ringing in the ears requires urgent assessment. If you have an erection lasting longer than four hours (priapism), go to A&E straight away, as this can cause permanent damage if not treated promptly [4].

Contact your GP or NHS 111 the same day if you feel persistently dizzy, faint, or unwell after starting tadalafil, or if you notice swelling of your face, lips, or throat, which could indicate an allergic reaction. Always keep your prescriber and GP informed of any side effects or concerns, and do not hesitate to seek help if something does not feel right.

How to access tadalafil safely at Cured Pharmacy

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering convenient access to erectile dysfunction treatments, including tadalafil, after a clinical consultation with a UK-registered prescriber [2]. To request tadalafil, complete our online health questionnaire, declaring all your current medicines (including cilostazol), medical conditions, and any history of heart or circulation problems. Our prescribers will review your answers and, if appropriate, approve your treatment.

We stock a range of tadalafil options to suit different needs and budgets. Generic tadalafil tablets are available from £7.95 (or £6.36 for your first order with code Ednew), Tadalafil 20mg (Teva) from £9.99 (£7.99 with code Ednew), Avarante (tadalafil) 10mg from £11.49 (£9.19 with code Ednew), and branded Cialis from £12.00 (£9.60 with code Ednew). All prices include the prescriber consultation and delivery. If tadalafil is not suitable for you, our prescribers can discuss alternative ED treatments, such as sildenafil, vardenafil, or avanafil.

Remember, erectile dysfunction 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]. Treating ED is important, but so is understanding and managing any underlying health conditions. Our service complements, rather than replaces, your GP care, and we encourage you to keep your doctor informed of any treatments you receive from us.

Other ED treatment options

If tadalafil is not suitable or you prefer a different option, Cured Pharmacy also offers sildenafil (from £0.45, or £0.36 with code Ednew), vardenafil (from £16.95, or £13.56 with code Ednew), and Spedra (avanafil, from £20.95, or £16.76 with code Ednew). Each PDE5 inhibitor has a slightly different onset and duration of action, and your prescriber can help you choose the best option based on your lifestyle, other medicines, and medical history [2][3][5][6].

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 19 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 19 October 2026]
3. Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 19 October 2026]
4. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 19 October 2026]
5. Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 19 October 2026]
6. Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 19 October 2026]
7. Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [accessed 19 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.