Tadalafil and Enalapril: Can You Take Them Together?

Tadalafil and Enalapril: Understanding the Interaction

Published: 20 October 2026

Many men taking tadalafil and enalapril together wonder whether it is safe to combine these medicines. Tadalafil (the active ingredient in Cialis) is a treatment for erectile dysfunction, while enalapril is an ACE inhibitor used to manage high blood pressure and heart conditions. The good news is that tadalafil and enalapril can usually be taken together, but there are important safety considerations because both medicines can lower blood pressure.

What is tadalafil and how does it work?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction (ED). It works by relaxing the blood vessels in the penis, allowing increased blood flow when you are sexually aroused [4]. Unlike some other ED treatments, tadalafil has a long duration of action—its effects can last up to 36 hours, which is why it is sometimes called 'the weekend pill'.

Tadalafil is available in two forms: on-demand tablets (10mg or 20mg taken at least 30 minutes before sexual activity) and daily tablets (2.5mg or 5mg taken once a day) [4]. Both require sexual stimulation to work; tadalafil does not cause an automatic erection. At Cured Pharmacy, tadalafil is available on prescription after an online consultation with a UK-registered prescriber, starting from £7.95 for generic tadalafil.

Because tadalafil works by dilating blood vessels, it has a mild blood-pressure-lowering effect throughout the body, not just in the penis. This is an important consideration when combining it with other medicines that also affect blood pressure, such as enalapril [4].

What is enalapril and why is it prescribed?

Enalapril belongs to a class of medicines called ACE inhibitors (angiotensin-converting enzyme inhibitors). It is commonly prescribed to treat high blood pressure (hypertension), heart failure, and to protect the kidneys in people with diabetes [12]. Enalapril works by blocking an enzyme that produces a substance which narrows blood vessels, so your blood vessels relax and widen, reducing blood pressure and making it easier for your heart to pump blood.

Many men with erectile dysfunction also have cardiovascular conditions or high blood pressure, so it is not uncommon to be prescribed both enalapril and an ED treatment like tadalafil [1]. In fact, high blood pressure and the conditions it is linked to—such as diabetes and heart disease—are among the most common physical causes of ED [10].

Enalapril is usually taken once or twice a day, and it is important to take it regularly as prescribed, even if you feel well. Stopping enalapril suddenly or missing doses can cause your blood pressure to rise, which may increase your risk of heart attack or stroke.

Can enalapril itself cause erectile dysfunction?

Some blood pressure medicines, particularly older types such as beta-blockers and thiazide diuretics, have been associated with erectile dysfunction as a side effect. However, ACE inhibitors like enalapril are generally considered to have a lower risk of causing ED, and in some cases may even improve erectile function by improving blood flow [2]. If you have noticed changes in your erections after starting enalapril, it is worth discussing with your GP, but do not stop taking your blood pressure medicine without medical advice.

How do tadalafil and enalapril interact?

Tadalafil and enalapril can be taken together, but both medicines lower blood pressure, so there is a potential for an additive effect [4]. This means that when taken at the same time, they may cause a greater drop in blood pressure than either medicine would on its own. For most men, this interaction is manageable and does not cause problems, but it can occasionally lead to symptoms such as dizziness, light-headedness, or fainting, especially when standing up quickly.

The mechanism is straightforward: enalapril relaxes and widens your blood vessels to reduce blood pressure, while tadalafil also causes blood vessels to dilate (particularly in the penis, but to a lesser extent throughout the body). When both effects occur together, your blood pressure may drop more than expected [4]. This is not the same as the dangerous interaction that occurs with nitrates (such as GTN spray) and tadalafil, which is absolutely contraindicated; the interaction with enalapril is much milder and can usually be managed safely.

It is important to note that tadalafil is not suitable for everyone. Men with very low blood pressure (hypotension), recent heart attack or stroke, unstable angina, or severe heart failure should not take tadalafil, as sexual activity itself may not be advisable [4]. Your prescriber will check your full medical history and current medicines during the consultation to ensure tadalafil is safe for you.

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

When you request tadalafil through Cured Pharmacy's online consultation, a UK-registered prescriber will review your medical history, current medicines, and blood pressure to ensure it is safe to prescribe. If you are taking enalapril or another ACE inhibitor, the prescriber will specifically check whether your blood pressure is stable and well-controlled, and whether you have any symptoms of low blood pressure such as dizziness or fainting.

The prescriber will also confirm that you are not taking any medicines that are contraindicated with tadalafil. These include nitrates (GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, and amyl or alkyl nitrites (poppers). If you are taking any of these, you must not take tadalafil, as the combination can cause a dangerous and potentially life-threatening drop in blood pressure [4].

Other medicines that require careful checking include alpha-blockers (such as doxazosin or tamsulosin, often prescribed for prostate problems), potent CYP3A4 inhibitors (such as ritonavir, ketoconazole, or clarithromycin), and other blood-pressure-lowering medicines. If you are on an alpha-blocker, you should be stable on that medicine before starting tadalafil, and you will usually be started on the lowest dose [4]. Always declare every medicine you take—including over-the-counter products, herbal remedies, and recreational drugs—during your consultation.

Starting on a lower dose

If you are taking enalapril and other blood pressure medicines, or if you have any concerns about low blood pressure, your prescriber may start you on a lower dose of tadalafil (such as 10mg on-demand or 2.5mg daily) to minimise the risk of side effects [4]. You can then adjust the dose if needed, under medical supervision. Never increase your dose without consulting your prescriber.

Practical advice for taking tadalafil and enalapril safely

If your prescriber has approved tadalafil while you are taking enalapril, there are some practical steps you can take to use both medicines safely. First, take both medicines exactly as prescribed. Do not take more tadalafil than recommended, and do not skip doses of enalapril. If you are using on-demand tadalafil, take it at least 30 minutes before sexual activity; if you are on daily tadalafil, take it at the same time each day [4].

Be aware of the signs of low blood pressure, particularly when you first start tadalafil or if your enalapril dose is changed. Symptoms can include dizziness, light-headedness, blurred vision, feeling faint, or fainting, especially when you stand up quickly. If you experience these symptoms, sit or lie down until they pass, and mention them to your GP or pharmacist. Avoid drinking large amounts of alcohol, as this can make low blood pressure worse and also reduce the effectiveness of tadalafil [4].

Stay well hydrated, especially in hot weather or if you are exercising, as dehydration can lower blood pressure further. Avoid grapefruit and grapefruit juice while taking tadalafil, as they can increase the level of tadalafil in your blood and raise the risk of side effects [4]. If you feel unwell or experience chest pain during sexual activity, stop and seek medical help immediately. If you have an erection lasting more than four hours (priapism), or sudden loss of vision or hearing, call 999 or go to A&E straight away [4].

When to seek medical advice about tadalafil and enalapril

Most men taking tadalafil and enalapril together do not experience significant problems, but it is important to know when to seek help. Contact your GP or pharmacist if you develop new or worsening dizziness, fainting, or symptoms of low blood pressure after starting tadalafil. Do not stop taking enalapril without medical advice, as this can cause your blood pressure to rise suddenly.

If tadalafil does not work for you, or if you experience troublesome side effects such as headache, indigestion, back pain, or nasal congestion, speak to your prescriber. There may be alternative ED treatments that suit you better, such as sildenafil (Viagra), vardenafil (Levitra), or avanafil (Spedra), or your dose may need adjusting [3][5][6]. Never take more than one PDE5 inhibitor at the same time, and never take tadalafil more frequently than once a day (for on-demand use) [4].

Remember that erectile dysfunction can be an early warning sign of cardiovascular disease or diabetes, so if you have not already done so, it is worth seeing your GP for a full health check [1][2]. Treating the underlying cause—such as improving blood pressure control, managing diabetes, losing weight, stopping smoking, or reducing alcohol—can improve your erections as well as your overall health. Your GP can also review all your medicines to check whether any might be contributing to ED.

Ordering tadalafil from Cured Pharmacy

At Cured Pharmacy, you can request tadalafil through a confidential online consultation. A UK-registered prescriber will review your answers, including your use of enalapril and any other medicines, and approve your order if it is safe and appropriate. Tadalafil is available from £7.95, with a first-order discount using code Ednew (£6.36). All medicines are dispensed by our GPhC-registered pharmacy and delivered discreetly to your door.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 20 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 20 October 2026]
3. Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 20 October 2026]
4. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 20 October 2026]
5. Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 20 October 2026]
6. Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 20 October 2026]
7. Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. Journal of Urology, 151(1), 54–61. https://pubmed.ncbi.nlm.nih.gov/8254833/ [accessed 20 October 2026]
8. Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [accessed 20 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.