Tadalafil and Empagliflozin: Can You Take Them Together?

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Key takeaways

• No major interaction is commonly reported between tadalafil and empagliflozin.
• Both medicines can lower blood pressure mildly; your prescriber checks this is safe for you.
• Declare all diabetes and blood-pressure medicines during your tadalafil consultation.
• Seek urgent help for erections lasting over four hours or sudden vision or hearing loss.
• Tadalafil is prescription-only and supplied after a UK prescriber reviews your health and medicines.

What is tadalafil and empagliflozin used for?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed to treat erectile dysfunction (ED) in men [4]. 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 (10 mg or 20 mg, taken at least 30 minutes before sex, with effects lasting up to 36 hours) or as a daily low-dose tablet (2.5 mg or 5 mg) [4]. It does not work without sexual stimulation and does not cure ED, but it can help many men achieve and maintain an erection suitable for sexual activity.

Empagliflozin (brand name Jardiance) is an SGLT2 inhibitor used to treat type 2 diabetes and certain heart and kidney conditions [12]. It works by helping your kidneys remove glucose from your bloodstream through your urine, which lowers blood sugar levels. Empagliflozin is taken once daily, usually in the morning, and is often prescribed alongside other diabetes medicines or as part of a broader plan to protect your heart and kidneys. Both tadalafil and empagliflozin are prescription-only medicines in the UK.

Is there an interaction between tadalafil and empagliflozin?

No major interaction is commonly reported between tadalafil and empagliflozin [3][4][12]. They work through different mechanisms in the body: tadalafil acts on blood vessels in the penis, while empagliflozin acts on the kidneys to lower blood sugar. Neither medicine is known to significantly affect the levels or activity of the other in your system.

However, both medicines can individually lower blood pressure to some extent. Tadalafil relaxes blood vessels, which may cause a mild drop in blood pressure, and empagliflozin can also have a modest blood-pressure-lowering effect, particularly in people with high blood pressure or those taking other blood-pressure medicines [4][12]. When taken together, this combined effect is usually well tolerated, but your prescriber will check your blood pressure, other medicines, and overall health to ensure the combination is safe for you.

It is important to declare all your current medicines—including empagliflozin and any other diabetes or blood-pressure treatments—during your consultation. Your prescriber or pharmacist will review your full medication list and medical history to identify any individual risks and advise on the safest dose and timing for tadalafil.

How the medicines work in your body

Tadalafil blocks an enzyme called PDE5, which normally breaks down a substance that keeps blood vessels relaxed. By blocking PDE5, tadalafil helps blood vessels in the penis stay open longer, improving blood flow during sexual arousal [4]. Empagliflozin blocks a protein in the kidneys called SGLT2, which normally reabsorbs glucose back into the blood. By blocking SGLT2, empagliflozin allows excess glucose to leave your body in your urine, lowering blood sugar and reducing strain on your heart and kidneys [12]. Because these mechanisms are separate, the medicines do not interfere with each other's primary actions.

At a glance

What does your prescriber check before approving tadalafil and empagliflozin together?

Before prescribing tadalafil to someone taking empagliflozin, a UK prescriber will review your full medical history and current medicines [2][4]. They will check your blood pressure, as both medicines can lower it; if your blood pressure is already very low or you experience frequent dizziness, tadalafil may not be suitable. They will also ask about any heart conditions, because sexual activity itself places demands on your heart, and tadalafil is not suitable if sexual activity is inadvisable (for example, after a recent heart attack or stroke, or if you have unstable angina or severe heart failure) [4].

Your prescriber will ask about all other medicines you take, including any for diabetes, blood pressure, or heart disease. Certain combinations are dangerous: you must never take tadalafil with nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or amyl/alkyl nitrites (poppers), as this can cause a life-threatening drop in blood pressure [4]. If you take an alpha-blocker (such as doxazosin or tamsulosin), you should be stable on that medicine and start tadalafil at the lowest dose, as the combination can cause dizziness [4].

The prescriber will also consider your diabetes control and any complications. Erectile dysfunction is more common in men with diabetes, and good blood-sugar control (supported by medicines like empagliflozin) can improve ED over time [1][2]. If you have diabetic retinopathy or a history of sudden vision loss (NAION), your prescriber will assess whether tadalafil is appropriate, as PDE5 inhibitors are contraindicated in some inherited retinal disorders and previous NAION [4].

Practical advice for taking tadalafil with empagliflozin

If your prescriber approves tadalafil, you can usually take it at a different time of day from empagliflozin, though there is no strict requirement to separate them. Empagliflozin is typically taken once daily in the morning, while tadalafil on-demand tablets are taken at least 30 minutes before planned sexual activity (or daily low-dose tadalafil is taken at the same time each day) [4][12]. Taking tadalafil on an empty stomach or after a light meal may help it work more quickly, though it can be taken with or without food.

Monitor for dizziness or light-headedness, especially when you first start tadalafil or if your dose is increased. Stand up slowly from sitting or lying down, and avoid heavy alcohol, which can worsen dizziness and make erectile dysfunction worse [4]. Grapefruit juice can raise tadalafil levels in your blood, so it is best to avoid it while using tadalafil. If you experience persistent dizziness, fainting, or any unusual symptoms, contact your GP or pharmacist.

Continue taking empagliflozin exactly as prescribed by your doctor. Do not stop or change your diabetes medicine without medical advice, even if you start tadalafil. Keep all your follow-up appointments for diabetes monitoring, and report any new symptoms or concerns. If you develop a urinary tract infection (a known side effect of empagliflozin) or any genital discomfort, see your GP, as these conditions may need treatment and could affect your use of tadalafil [12].

What to do if you miss a dose

If you take daily low-dose tadalafil and miss a dose, take it as soon as you remember, unless it is almost time for your next dose—in that case, skip the missed dose and continue as normal. Never take a double dose to make up for a forgotten one [4]. For on-demand tadalafil, you only take it when needed before sexual activity, so there is no regular schedule to miss. If you miss a dose of empagliflozin, take it as soon as you remember on the same day; if it is already the next day, skip the missed dose and take your next dose at the usual time [12]. Do not take two doses of empagliflozin on the same day.

Warning signs and when to seek help with tadalafil and empagliflozin

Most men taking tadalafil and empagliflozin together do not experience serious problems, but you should know the warning signs that need urgent attention. If you have an erection lasting more than four hours (priapism), go to A&E immediately or call 999, as this can cause permanent damage to the penis [4]. Sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing (sometimes with ringing in the ears or dizziness), requires immediate medical help, as these are rare but serious side effects of PDE5 inhibitors [4].

If you develop chest pain during or after sexual activity, stop and seek urgent medical help. Do not take nitrate medicines (such as GTN spray) if you have used tadalafil in the past 48 hours, as the combination can be dangerous [4]. Tell the paramedics or doctor that you have taken tadalafil. If you experience severe dizziness, fainting, or a very fast or irregular heartbeat, contact your GP urgently or call 111 for advice.

Empagliflozin can rarely cause serious side effects, including diabetic ketoacidosis (even if your blood sugar is not very high), severe dehydration, or serious genital or perineal infections (Fournier's gangrene) [12]. Seek urgent help if you have unusual tiredness, nausea, vomiting, difficulty breathing, confusion, severe pain or swelling in the genital or perineal area, or fever with genital symptoms. Always carry information about your diabetes and medicines, and inform any healthcare professional treating you that you take both tadalafil and empagliflozin.

How to get tadalafil safely online in the UK

Tadalafil is a prescription-only medicine in the UK, which means it can only be supplied after a consultation with a qualified prescriber [4]. At Cured Pharmacy (GPhC 9012511), you complete a short online health questionnaire that is reviewed by a UK-registered prescriber. You will be asked about your medical history, current medicines (including empagliflozin and any other diabetes or blood-pressure treatments), and any heart or circulation problems. The prescriber will check that tadalafil is safe and suitable for you, and if approved, your medicine is dispensed by our pharmacy and delivered discreetly to your door.

We offer a range of tadalafil options, including generic tadalafil from £7.95 (£6.36 with first-order code Ednew), branded Cialis from £12.00 (£9.60 with code Ednew), and Teva and Avarante brands. All our tadalafil products are genuine, UK-licensed medicines. If tadalafil is not suitable for you, our prescribers can consider other PDE5 inhibitors such as sildenafil (generic Viagra, from £0.45), vardenafil (generic Levitra, £16.95), or avanafil (Spedra, £20.95), depending on your individual needs and medical history.

If you have not seen a GP about your erectile dysfunction, we strongly encourage you to do so, especially if ED is a new problem. Erectile dysfunction can be an early warning sign of heart disease, diabetes, or other health conditions, and your GP can arrange tests and address any underlying causes [1][2]. Online prescribing services like ours are a convenient option for ongoing treatment once ED has been assessed, but they are not a substitute for a full medical review when needed.

Why choose Cured Pharmacy for your ED treatment

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) with experienced UK prescribers and pharmacists. Every prescription is reviewed individually, and we check for interactions with all your current medicines, including empagliflozin and other diabetes or heart treatments. Our service is confidential, with discreet packaging and fast delivery across the UK. If you have questions about your treatment or experience any side effects, our pharmacy team is available to help. We are committed to safe, evidence-based care and will only supply tadalafil when it is clinically appropriate for you.

When to get urgent help

• Erection lasting more than 4 hours (priapism) – go to A&E or call 999 immediately
• Sudden loss of vision or hearing – seek urgent medical help
• Chest pain during or after sex – stop activity, call 999, do not take nitrates
• Severe dizziness, fainting, or very fast heartbeat – contact GP urgently or call 111
• Signs of diabetic ketoacidosis (unusual tiredness, nausea, vomiting, difficulty breathing) – seek urgent medical help

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

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