Tadalafil and Etoricoxib: Can You Take Them Together?

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What is tadalafil and how does it work?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction [4]. It works by relaxing the blood vessels in the penis, allowing increased blood flow when you are sexually aroused. 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' [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 generic tadalafil and the branded version (Cialis) are available at Cured Pharmacy after an online consultation with a UK prescriber. It is important to remember that tadalafil requires sexual stimulation to work—it does not cause an automatic erection.

Because tadalafil relaxes blood vessels, it can cause a small drop in blood pressure. This is usually mild and well-tolerated, but it becomes important when tadalafil is combined with other medicines that also affect blood pressure [4].

What is etoricoxib and what is it used for?

Etoricoxib is a non-steroidal anti-inflammatory drug (NSAID) from the COX-2 inhibitor family, prescribed to relieve pain and inflammation in conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute gout. It is marketed under the brand name Arcoxia in the UK. Etoricoxib works by blocking the COX-2 enzyme, which reduces the production of chemicals in the body that cause pain and swelling.

Unlike traditional NSAIDs such as ibuprofen or naproxen, COX-2 inhibitors are designed to be gentler on the stomach lining. However, etoricoxib can still affect the cardiovascular system. It may cause a small increase in blood pressure in some people and has been associated with a slightly increased risk of heart attack or stroke, particularly at higher doses or with long-term use. For this reason, etoricoxib is not suitable for everyone, especially those with uncontrolled high blood pressure or established heart disease.

Your GP or specialist will have weighed the benefits and risks before prescribing etoricoxib. If you are taking it regularly, your blood pressure should be monitored, and you should use the lowest effective dose for the shortest time necessary.

When to get urgent help

• Chest pain during or after sexual activity—call 999 or go to A&E immediately
• An erection lasting more than 4 hours (priapism)—seek emergency treatment to prevent permanent damage
• Sudden loss of vision or hearing—stop tadalafil and seek urgent medical advice
• Severe dizziness, fainting, or collapse—call 999 or go to A&E
• Signs of allergic reaction (swelling of face, lips, tongue, or throat, difficulty breathing)—call 999

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

Can you take tadalafil and etoricoxib together?

There is no direct pharmacological interaction between tadalafil and etoricoxib that makes the combination absolutely unsafe. Neither medicine significantly affects the metabolism of the other, so etoricoxib will not raise or lower tadalafil levels in your bloodstream, and vice versa. However, both medicines can influence your cardiovascular system, which is why the combination requires careful assessment.

Tadalafil can lower blood pressure slightly by relaxing blood vessels [4], while etoricoxib may raise blood pressure in some individuals. The net effect on your blood pressure will depend on your individual response, your baseline blood pressure, and any other medicines you are taking. For most men with well-controlled blood pressure and no significant heart problems, the combination is likely to be safe, but it must be reviewed by a prescriber.

When you request tadalafil through Cured Pharmacy's online consultation, you will be asked to list all your current medicines, including etoricoxib. The prescriber will check your medical history, blood pressure, and cardiovascular risk factors before deciding whether tadalafil is suitable for you. If you have high blood pressure, heart disease, or have recently had a heart attack or stroke, extra caution is needed, and your GP may need to be involved in the decision.

What your prescriber will check

During your consultation, the prescriber will ask about your current blood pressure readings, any history of heart disease, stroke, or circulation problems, and whether you experience chest pain, dizziness, or fainting. They will also review all your medicines to check for any other interactions. If you are taking etoricoxib for a chronic condition such as arthritis, it suggests you may have other health issues that need to be considered alongside ED treatment.

The prescriber may recommend starting tadalafil at a lower dose (for example, 10mg on-demand rather than 20mg) to minimise the risk of side effects. They may also advise monitoring your blood pressure at home or arranging a review with your GP if there are any concerns. Honest and complete answers during the consultation are essential for your safety.

How tadalafil and etoricoxib may affect your blood pressure

Tadalafil's blood-pressure-lowering effect is usually modest. In clinical trials, the average drop in blood pressure was small and not considered clinically significant for most men [4]. However, some people are more sensitive, and the effect can be more pronounced if you are also taking other medicines that lower blood pressure, such as antihypertensives, or if you drink a lot of alcohol.

Etoricoxib, on the other hand, can cause a small increase in blood pressure, particularly in people who already have high blood pressure or are at risk of it. This effect is thought to be due to COX-2 inhibitors affecting the balance of substances in the body that regulate blood vessel tone and fluid retention. If you are taking etoricoxib long-term, your GP should be monitoring your blood pressure regularly.

When both medicines are used together, the effects on blood pressure may partially offset each other, or one effect may dominate depending on your individual physiology. The key is that your overall cardiovascular health is stable. If you notice new symptoms such as dizziness, light-headedness, fainting, or chest discomfort after starting tadalafil while on etoricoxib, stop taking tadalafil and contact your GP or pharmacist promptly.

At a glance

Practical advice for taking tadalafil and etoricoxib safely

If your prescriber approves the combination of tadalafil and etoricoxib, there are several practical steps you can take to use both medicines safely. First, take each medicine exactly as prescribed—do not increase the dose of tadalafil or take it more often than recommended. If you are using on-demand tadalafil, take it at least 30 minutes before sexual activity and no more than once in 24 hours [4].

Monitor how you feel, especially when you first start tadalafil or if your etoricoxib dose changes. Pay attention to any dizziness, light-headedness, or unusual fatigue, particularly when standing up quickly. If you have a home blood pressure monitor, checking your blood pressure occasionally can provide reassurance and help you spot any trends. Keep a record to share with your GP or pharmacist.

Avoid drinking large amounts of alcohol when taking tadalafil, as alcohol can add to the blood-pressure-lowering effect and make dizziness more likely. It can also worsen erectile dysfunction [1]. Grapefruit juice should be limited, as it can raise tadalafil levels in the blood. If you develop any new symptoms or your arthritis treatment changes, let your prescriber know during your next consultation or contact Cured Pharmacy for advice.

When to seek medical advice

Seek urgent medical help if you experience chest pain during or after sexual activity, as this could be a sign of a heart problem. Do not take another dose of tadalafil and call 999 or go to A&E. Similarly, if you have an erection lasting more than four hours (priapism), you need emergency treatment to prevent permanent damage [4].

Contact your GP or pharmacist promptly if you notice sudden vision or hearing loss, severe dizziness or fainting, swelling of the ankles or legs (which could indicate fluid retention from etoricoxib), or any other unexpected symptoms. Your GP may want to review your medicines and check your blood pressure and kidney function, especially if you are taking etoricoxib long-term.

Other medicines and interactions with tadalafil and etoricoxib

Beyond the interaction between tadalafil and etoricoxib themselves, it is important to consider other medicines you may be taking. Tadalafil must never be taken with nitrates (such as GTN spray, isosorbide mononitrate, or isosorbide dinitrate), nicorandil, riociguat, or recreational drugs known as 'poppers' (amyl or alkyl nitrites), as the combination can cause a dangerous drop in blood pressure [4]. Do not take tadalafil together with another PDE5 inhibitor such as sildenafil or vardenafil.

If you are taking alpha-blockers for prostate symptoms (such as tamsulosin, doxazosin, or alfuzosin), there is an increased risk of low blood pressure and dizziness when combined with tadalafil. You should be stable on the alpha-blocker before starting tadalafil, and your prescriber will usually recommend the lowest dose of tadalafil initially [4]. Potent CYP3A4 inhibitors—such as ritonavir, cobicistat (found in some HIV medicines), ketoconazole, itraconazole, or clarithromycin—can raise tadalafil levels, requiring dose adjustments [4].

Etoricoxib can interact with several medicines too. It may increase blood levels of the blood-thinner warfarin, requiring closer monitoring of your INR. It can reduce the effectiveness of some blood pressure medicines and may increase the risk of kidney problems if taken with ACE inhibitors, diuretics, or ciclosporin. Always declare every medicine, supplement, and herbal remedy you are taking during your consultation. The prescriber and pharmacist will check for interactions across your entire medication list, not just tadalafil and etoricoxib in isolation.

Reporting side effects

If you experience side effects from tadalafil, etoricoxib, or any other medicine, you can report them via the Yellow Card Scheme at https://yellowcard.mhra.gov.uk or by searching for 'Yellow Card' in the Google Play or Apple App Store. Reporting helps improve the safety information available for all patients. You can also discuss any concerns with the pharmacist team at Cured Pharmacy or your GP.

In summary

• Tadalafil and etoricoxib can usually be taken together if your blood pressure and heart health are stable.
• Both medicines can affect blood pressure, so your prescriber will assess your individual risk before approving the combination.
• Always declare all your current medicines during the online consultation, including painkillers and anti-inflammatory drugs.
• Report dizziness, chest pain, or any unusual symptoms to your GP or pharmacist promptly.
• Never take tadalafil with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor.

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