Tadalafil and Escitalopram: Can You Take Them Together?

Tadalafil and Escitalopram: Understanding the Interaction

Published: 20 October 2026

Many men wonder whether tadalafil and escitalopram can be taken together safely. Tadalafil (Cialis) is a prescription medicine used to treat erectile dysfunction, while escitalopram (Cipralex, Lexapro) is a selective serotonin reuptake inhibitor (SSRI) antidepressant commonly prescribed for depression and anxiety. The good news is that these two medicines do not have a major direct interaction, but there are important considerations your prescriber will check before you start treatment.

What Is Tadalafil and How Does It Work?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK for erectile dysfunction [4]. It works by relaxing the blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Unlike some ED medicines, 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' [4].

Tadalafil is available in two forms: on-demand tablets (10mg or 20mg taken at least 30 minutes before sexual activity) and daily low-dose tablets (2.5mg or 5mg taken once a day) [4]. Both require sexual stimulation to work—tadalafil does not cause an automatic erection. It is available as generic tadalafil and under the brand name Cialis.

At Cured Pharmacy, tadalafil is a prescription-only medicine. After you complete an online consultation, a UK-registered prescriber will review your medical history, current medicines, and health conditions to ensure tadalafil is safe and suitable for you.

What Is Escitalopram and Why Is It Prescribed?

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) antidepressant. It is commonly prescribed in the UK for depression, generalised anxiety disorder, social anxiety disorder, panic disorder, and obsessive-compulsive disorder. Escitalopram works by increasing the levels of serotonin—a chemical messenger in the brain that helps regulate mood—by preventing its reabsorption into nerve cells.

SSRIs like escitalopram are generally well tolerated, but they can cause side effects. One common side effect that affects many men is sexual dysfunction, including reduced libido, difficulty achieving or maintaining an erection, and delayed ejaculation. This can be distressing, and some men may seek treatment for erectile dysfunction while continuing their antidepressant therapy.

It is important never to stop taking escitalopram or reduce your dose without speaking to your GP or psychiatrist, even if you experience sexual side effects. Stopping suddenly can lead to withdrawal symptoms and a return of your original symptoms. Your doctor can discuss options such as adjusting the dose, switching to a different antidepressant, or adding treatment for erectile dysfunction.

Can Escitalopram Cause Erectile Dysfunction?

Yes, escitalopram and other SSRIs are known to cause sexual side effects in a significant proportion of men [1]. These can include reduced sexual desire, difficulty getting or keeping an erection, and problems with ejaculation. The exact mechanism is not fully understood, but it is thought to involve changes in serotonin levels and their effects on other neurotransmitters and hormones involved in sexual function. If you are experiencing erectile dysfunction and take escitalopram, it is worth discussing with your GP whether the antidepressant might be contributing, and whether ED treatment could help.

Tadalafil and Escitalopram: Is There a Direct Interaction?

There is no major direct pharmacological interaction between tadalafil and escitalopram that would make the combination unsafe [4]. Escitalopram does not significantly affect the way tadalafil is broken down in the body, and tadalafil does not interfere with how escitalopram works. This means that, in most cases, men taking escitalopram can be prescribed tadalafil for erectile dysfunction after a proper medical assessment.

However, your prescriber will still need to review your full medical history and all current medicines during the consultation. This is because erectile dysfunction can have multiple causes—including psychological factors, cardiovascular disease, diabetes, and medication side effects—and it is important to identify and address any underlying issues [1][2]. Your prescriber will also check that you do not have any conditions that make PDE5 inhibitors like tadalafil unsuitable, such as recent heart attack or stroke, severe heart failure, very low blood pressure, or use of nitrate medicines.

If you are taking escitalopram and considering tadalafil, you should declare this during your online consultation. The prescriber will ensure the combination is appropriate for you and may start you on a lower dose to assess how you respond.

What Your Prescriber Checks Before Prescribing Tadalafil and Escitalopram Together

When you request tadalafil and you are already taking escitalopram, the UK prescriber will carry out a thorough assessment. They will ask about your cardiovascular health, including blood pressure, any history of heart disease, stroke, or angina, and whether you experience chest pain, dizziness, or fainting [2]. This is because PDE5 inhibitors like tadalafil can lower blood pressure slightly, and sexual activity itself places demands on the heart.

The prescriber will also check all your other medicines. Tadalafil must never be taken with nitrates (such as GTN spray, isosorbide mononitrate, or isosorbide dinitrate), nicorandil, riociguat, or recreational drugs called 'poppers' (amyl or alkyl nitrites), as the combination can cause a dangerous drop in blood pressure [4]. If you take alpha-blockers for prostate symptoms or high blood pressure (such as tamsulosin or doxazosin), you may still be able to use tadalafil, but you must be stable on the alpha-blocker and will usually start on the lowest dose of tadalafil.

Your prescriber will also consider whether your erectile dysfunction might be related to escitalopram itself, or to the underlying condition it treats (depression and anxiety can both affect sexual function). In some cases, they may suggest discussing with your GP whether a change in antidepressant or dose adjustment might help, alongside or instead of ED treatment. The goal is to find a safe, effective solution that supports both your mental and sexual health.

Medicines That Must Not Be Taken With Tadalafil

Do not take tadalafil if you use nitrates (GTN spray, isosorbide mononitrate, isosorbide dinitrate), nicorandil, riociguat, or 'poppers' (amyl/alkyl nitrites) [4]. Do not take tadalafil at the same time as another PDE5 inhibitor (sildenafil, vardenafil, or avanafil). The combination can cause a severe and potentially life-threatening fall in blood pressure. Always tell your prescriber about every medicine you take, including over-the-counter products and recreational substances.

Practical Advice for Taking Tadalafil and Escitalopram Safely

If you are prescribed tadalafil while taking escitalopram, follow the dosing instructions carefully. On-demand tadalafil (10mg or 20mg) should be taken at least 30 minutes before sexual activity, and you should not take more than one dose in 24 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. Both forms require sexual stimulation to work—tadalafil will not cause an erection on its own.

Continue taking your escitalopram exactly as prescribed by your doctor. Do not stop, reduce, or change the dose without medical advice, even if you experience side effects. If you feel that escitalopram is affecting your sexual function, speak to your GP—they may be able to adjust your treatment or suggest additional strategies to help.

Avoid drinking large amounts of alcohol when using tadalafil, as alcohol can worsen erectile dysfunction and increase the risk of dizziness or low blood pressure [4]. Grapefruit juice can raise tadalafil levels in the blood, so it is best to avoid it. If you experience side effects such as headache, indigestion, back pain, or flushing, these are usually mild and temporary. However, if you develop chest pain during sex, an erection lasting more than four hours, or sudden loss of vision or hearing, seek urgent medical help.

Other Antidepressants and Tadalafil: What About SSRIs and SNRIs?

Escitalopram is one of several SSRIs commonly prescribed in the UK. Other SSRIs include citalopram, sertraline, fluoxetine, and paroxetine. Like escitalopram, these medicines can cause sexual side effects, including erectile dysfunction. There is no major direct interaction between tadalafil and other SSRIs, and the same principles apply: your prescriber will review your full medical history and current medicines to ensure tadalafil is safe for you.

Serotonin-noradrenaline reuptake inhibitors (SNRIs) such as venlafaxine and duloxetine are another class of antidepressant that can also affect sexual function. Again, no major direct interaction with tadalafil is commonly reported, but a full consultation is essential. Your prescriber will check your cardiovascular health, blood pressure, and all other medicines, and will ensure you are not taking anything that could interact dangerously with tadalafil.

If you are taking any antidepressant and experience erectile dysfunction, it is worth discussing with your GP. In some cases, switching to a different antidepressant (such as mirtazapine or bupropion, which may have fewer sexual side effects) or adjusting the dose can help. Your GP can also refer you for talking therapies or specialist support if needed. Tadalafil and other PDE5 inhibitors can be an effective option for managing ED while you continue your mental health treatment, but the decision should always be made with professional guidance [1][2].

When to Speak to Your GP

If you are experiencing erectile dysfunction for the first time, or if it is getting worse, see your GP for a full assessment [1]. ED can be an early warning sign of cardiovascular disease, diabetes, or other health conditions that need treatment. Your GP can carry out tests, review your medicines, and discuss the best options for you. If you are already taking escitalopram or another antidepressant, your GP can help you understand whether it might be contributing to your symptoms and whether ED treatment, a change in antidepressant, or other support would be most helpful.

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.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [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.