Tadalafil and Citalopram: Can They Be Taken Together?

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Key takeaways

• Tadalafil and citalopram can usually be taken together with no major interaction
• Both medicines can lower blood pressure slightly; prescriber checks your full health history
• Do not stop citalopram without medical advice; continue as prescribed
• Tadalafil can help treat erectile dysfunction caused by SSRI antidepressants
• Avoid heavy alcohol and grapefruit juice while taking tadalafil

What is tadalafil and citalopram used for?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction (ED). It works by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused. 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 tablet (2.5mg or 5mg). It requires sexual stimulation to work and does not increase desire [4].

Citalopram is a selective serotonin reuptake inhibitor (SSRI) antidepressant commonly prescribed for depression and anxiety disorders. It works by increasing levels of serotonin, a chemical messenger in the brain that helps regulate mood. Citalopram is usually taken once daily and can take several weeks to show its full effect. Like other SSRIs, citalopram can sometimes cause sexual side effects, including reduced libido or difficulty achieving erection or orgasm, which is one reason men taking it may seek ED treatment.

Can you take tadalafil and citalopram together?

Yes, tadalafil and citalopram can usually be taken together. No major drug interaction is commonly reported between these two medicines, and many men use them in combination without problems. Citalopram does not significantly affect the way tadalafil is broken down in the body, and tadalafil does not interfere with the antidepressant action of citalopram.

However, both medicines can have effects on blood pressure. Tadalafil can cause a small drop in blood pressure, and citalopram may occasionally affect blood pressure as well. When used together, there is a theoretical possibility of an additive blood-pressure-lowering effect, which could lead to dizziness or light-headedness in some people. This is why your prescriber will check your full medication list, blood pressure, and cardiovascular health during your online consultation before approving tadalafil.

It is also worth noting that SSRIs like citalopram can themselves contribute to erectile dysfunction or other sexual side effects. If you started experiencing ED after beginning citalopram, mention this during your consultation, as your GP may be able to adjust your antidepressant or explore other options alongside ED treatment.

What your prescriber checks

During your online consultation at Cured Pharmacy, the prescriber will ask about all your current medicines, including citalopram, to check for any interactions or contraindications. They will review your cardiovascular health, blood pressure, and any other conditions that might affect the safe use of tadalafil. You should never stop or change your citalopram dose without speaking to the doctor who prescribed it, as stopping antidepressants suddenly can cause withdrawal symptoms.

At a glance

How does the interaction between tadalafil and citalopram work?

Tadalafil is primarily broken down in the liver by enzymes called CYP3A4. Citalopram is metabolised by different enzymes (mainly CYP2C19, CYP3A4, and CYP2D6) and is not a strong inhibitor or inducer of CYP3A4. This means citalopram does not significantly raise or lower tadalafil levels in the blood, and the two medicines do not interfere with each other's metabolism in a clinically important way.

The main consideration is the potential for both medicines to lower blood pressure slightly. Tadalafil relaxes blood vessels throughout the body (not just in the penis), which can cause a modest drop in blood pressure. Citalopram can occasionally affect blood pressure, particularly when you first start taking it or change dose. When combined, the blood-pressure-lowering effects might add together, which is why it is important to start on the lowest effective dose of tadalafil and monitor for symptoms such as dizziness, especially when standing up.

If you experience dizziness, light-headedness, or fainting after taking tadalafil and citalopram together, sit or lie down and contact your GP or pharmacist for advice. These symptoms are usually mild and manageable, but your prescriber may adjust your dose or timing of medication if needed.

Practical advice for taking tadalafil with citalopram

If you are prescribed tadalafil while taking citalopram, start with the lowest effective dose (usually 10mg on-demand or 2.5mg daily) to see how you respond. Take tadalafil as directed—on-demand tablets should be taken at least 30 minutes before sexual activity, while daily tablets are taken at the same time each day regardless of when you plan to have sex. Continue taking your citalopram exactly as prescribed by your doctor; do not stop or change the dose without medical advice.

Avoid drinking large amounts of alcohol when using 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 the blood and should be avoided. If you feel dizzy or light-headed, especially when standing up, take your time and sit down if needed. This is more likely when you first start tadalafil or if your citalopram dose has recently changed.

Keep your GP informed about all your medicines. If your citalopram dose changes or you start any new medication, let your prescriber know during your next consultation. If you experience any unusual symptoms, persistent side effects, or if tadalafil does not seem to be working, contact your pharmacist or GP for advice.

When to seek medical advice

Seek urgent medical help if you experience chest pain during sex, an erection lasting more than four hours (priapism), or sudden loss of vision or hearing while taking tadalafil. Contact your GP if you have persistent dizziness, fainting, or any new or worsening symptoms after starting tadalafil. If you think your erectile dysfunction may be related to citalopram or another medicine, discuss this with your GP, as they may be able to adjust your treatment.

Other medicines and tadalafil: what you need to know

While tadalafil and citalopram can usually be taken together, there are some medicines that must never be combined with tadalafil. Do not take tadalafil if you use nitrates (such as GTN spray, isosorbide mononitrate, or isosorbide dinitrate), nicorandil, riociguat, or recreational drugs called 'poppers' (amyl or alkyl nitrites). Combining tadalafil with any of these can cause a dangerous drop in blood pressure [4].

If you take alpha-blockers for prostate problems or high blood pressure (such as tamsulosin, doxazosin, or alfuzosin), you should be stable on the alpha-blocker before starting tadalafil, and your prescriber will usually recommend the lowest dose of tadalafil to reduce the risk of low blood pressure. Some medicines that strongly inhibit the enzyme CYP3A4—such as ritonavir, cobicistat, ketoconazole, itraconazole, or clarithromycin—can raise tadalafil levels, and your prescriber may need to adjust your dose or avoid the combination.

Always tell your prescriber about every medicine you take, including over-the-counter medicines, herbal remedies (such as St John's wort), and supplements. The online consultation at Cured Pharmacy includes a full medication review to check for interactions and ensure tadalafil is safe for you.

Tadalafil and citalopram: addressing sexual side effects of antidepressants

Sexual side effects are common with SSRI antidepressants like citalopram and can include reduced sex drive, difficulty getting or maintaining an erection, delayed ejaculation, or difficulty reaching orgasm. These side effects affect many men and can be distressing, but they are recognised and treatable. If you started experiencing erectile dysfunction after beginning citalopram, it is worth discussing with your GP, as there may be options to adjust your antidepressant or add treatment for ED [1].

Tadalafil can help improve erectile function in men taking SSRIs, allowing you to continue your antidepressant treatment while addressing the sexual side effects. Some men find that the sexual side effects of citalopram lessen over time, while others benefit from ongoing ED treatment. It is important not to stop your antidepressant suddenly, as this can cause withdrawal symptoms and a return of depression or anxiety. Instead, work with your GP and prescriber to find a combination that supports both your mental health and sexual wellbeing.

Erectile dysfunction can also be an early sign of other health conditions, such as heart disease or diabetes, so if you have new or worsening ED, see your GP for a full assessment [2]. Treating the underlying cause, alongside using tadalafil if appropriate, can improve your overall health and quality of life.

How Cured Pharmacy can help

Cured Pharmacy is a GPhC-registered online pharmacy offering a confidential, UK-prescriber-led consultation for erectile dysfunction treatment. After you complete a short online questionnaire, a qualified prescriber will review your answers, check for interactions with citalopram and any other medicines you take, and approve treatment if it is safe and suitable for you. Your medication is then dispensed by our pharmacy and delivered discreetly to your door. If you have any questions or concerns, our pharmacist team is available to help.

When to get urgent help

• Chest pain during or after sex—call 999 and do not take more tadalafil
• Erection lasting more than 4 hours (priapism)—go to A&E immediately
• Sudden loss of vision or hearing—stop tadalafil and seek urgent medical help
• Severe dizziness or fainting—sit or lie down and contact your GP the same day

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

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