Tadalafil and Evolocumab: Can You Take Them Together?

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Tadalafil and Evolocumab: Understanding the Interaction

Published: 21 October 2026

Many men wonder whether tadalafil and evolocumab can be taken together safely. The good news is that no major interaction is commonly reported between tadalafil (a PDE5 inhibitor used for erectile dysfunction) and evolocumab (a PCSK9 inhibitor used to lower cholesterol). However, your prescriber will still review all your current medicines during your consultation to ensure treatment is appropriate for you.

What is tadalafil and evolocumab 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 [3][4]. Tadalafil is available as the branded medicine Cialis or as a generic version, and can be taken either on-demand (10 mg or 20 mg at least 30 minutes before sex, with effects lasting up to 36 hours) or as a daily low dose (2.5 mg or 5 mg) [4].

Evolocumab (brand name Repatha) is a PCSK9 inhibitor, a type of injectable medicine used to lower LDL cholesterol in people at high risk of cardiovascular disease [12]. It is typically prescribed when statins alone do not achieve cholesterol targets, or when statins cannot be tolerated. Evolocumab is given as a subcutaneous injection, usually once every two weeks or once a month, and works by helping the liver remove more cholesterol from the blood.

Both medicines address important aspects of cardiovascular health. High cholesterol is a risk factor for heart disease, and erectile dysfunction can be an early warning sign of cardiovascular problems [1][2]. If you have been prescribed evolocumab, it is important that you continue taking it as directed by your doctor, even when starting treatment for ED.

Is there an interaction between tadalafil and evolocumab?

No clinically significant interaction is commonly reported between tadalafil and evolocumab. These medicines work through completely different mechanisms in the body. Tadalafil acts on an enzyme (PDE5) in the smooth muscle of blood vessels, while evolocumab is a monoclonal antibody that targets a protein (PCSK9) involved in cholesterol metabolism [4][12]. They do not affect each other's breakdown or effectiveness.

Tadalafil is primarily metabolised by the liver enzyme CYP3A4, and evolocumab is broken down through protein degradation pathways, not by liver enzymes [4][12]. This means evolocumab does not alter tadalafil levels in your blood, and tadalafil does not interfere with how evolocumab lowers your cholesterol.

That said, your prescriber will still review your full medication list during your consultation. This is because some other medicines you may be taking alongside evolocumab—such as certain blood pressure tablets or other heart medicines—can interact with tadalafil [3][4]. The online consultation at Cured Pharmacy ensures that a UK-registered prescriber checks every medicine you are currently taking before approving your treatment.

Why your prescriber checks all your medicines

Even though tadalafil and evolocumab do not interact with each other, people taking evolocumab often have other cardiovascular conditions and may be on multiple medicines. For example, you might also be taking a statin, a blood pressure medicine, or aspirin. Some of these can have interactions with tadalafil that need to be managed [3][4]. Your prescriber will check for any contraindicated medicines (such as nitrates, which must never be taken with tadalafil) and will adjust your dose if needed, for example if you are on an alpha-blocker like tamsulosin or doxazosin.

What does your prescriber check before prescribing tadalafil?

Before tadalafil is prescribed, your clinician will ask about your medical history, current medicines, and cardiovascular health. Tadalafil can lower blood pressure slightly, so it is important to check that you are not taking any medicines that could cause a dangerous drop in blood pressure when combined with a PDE5 inhibitor [3][4].

Medicines that must never be taken with tadalafil include nitrates (such as GTN spray, isosorbide mononitrate, or isosorbide dinitrate), nicorandil, riociguat, and recreational drugs known as 'poppers' (amyl or alkyl nitrites). Taking tadalafil with any of these can cause a severe and potentially life-threatening fall in blood pressure [3][4]. If you use any of these, do not take tadalafil.

Your prescriber will also check whether you take alpha-blockers (such as tamsulosin, doxazosin, or alfuzosin) for an enlarged prostate or high blood pressure. These can add to the blood-pressure-lowering effect of tadalafil, so you should be stable on your alpha-blocker and start on the lowest dose of tadalafil [4]. Other blood pressure medicines, including ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers, are usually safe to take with tadalafil, but your prescriber will review them to ensure the combination is appropriate for you.

Finally, your prescriber will ask about any heart conditions. Tadalafil is not suitable if sexual activity is inadvisable—for example, if you have had a recent heart attack or stroke, have unstable angina, or have severe heart failure [4]. If you have been prescribed evolocumab, it suggests you have cardiovascular risk factors, so a careful assessment is especially important.

Practical advice for taking tadalafil and evolocumab together

If you have been prescribed both tadalafil and evolocumab, you can take them together without concern about a direct interaction. Continue your evolocumab injections exactly as your doctor has instructed—usually once every two weeks or once a month—and take your tadalafil as directed for erectile dysfunction [4][12].

For on-demand tadalafil (10 mg or 20 mg), take one tablet at least 30 minutes before you plan to have sex. The effect can last up to 36 hours, so you do not need to time it precisely. Do not take more than one dose in 24 hours [4]. If you are on daily tadalafil (2.5 mg or 5 mg), take one tablet at the same time each day, regardless of when you plan to have sex.

Avoid drinking large amounts of alcohol when taking tadalafil, as heavy drinking can make erectile dysfunction worse and increase the risk of dizziness or low blood pressure [3][4]. Grapefruit juice can raise tadalafil levels in your blood, so it is best to avoid it. If you experience dizziness or light-headedness, especially when standing up, sit or lie down until it passes, and mention it to your prescriber at your next review.

Do not stop or change your evolocumab or any other prescribed medicine without speaking to your doctor. If you develop any new symptoms or are prescribed a new medicine by another healthcare professional, let your prescriber know before taking your next dose of tadalafil.

What to do if you are prescribed a new medicine

If your GP or specialist prescribes a new medicine while you are taking tadalafil, always check with your pharmacist or prescriber before starting it. Some medicines—particularly certain antibiotics (like clarithromycin), antifungals (like ketoconazole or itraconazole), or HIV medicines (like ritonavir or cobicistat)—can raise tadalafil levels and increase the risk of side effects [4]. Your prescriber may need to adjust your tadalafil dose or advise you to pause treatment temporarily.

Side effects and warning signs with tadalafil and evolocumab

Common side effects of tadalafil include headache, indigestion, back pain, muscle aches, flushing, and a blocked or runny nose [4]. These are usually mild and short-lived. Evolocumab can cause injection-site reactions (redness, pain, or bruising), flu-like symptoms, or back pain [12]. Side effects from one medicine do not usually make side effects from the other worse.

Serious side effects with tadalafil are rare but require urgent medical attention. Seek immediate help (call 999 or go to A&E) if you experience an erection lasting more than four hours (priapism), sudden loss of vision in one or both eyes, sudden decrease or loss of hearing, or chest pain during sex [3][4]. If you have chest pain, do not take nitrates to relieve it—tell the healthcare professional that you have taken tadalafil.

Evolocumab is generally well tolerated, but very rarely it can cause serious allergic reactions. Seek urgent help if you develop signs of a severe allergic reaction, such as difficulty breathing, swelling of the face or throat, or a severe rash [12]. If you have any concerns about side effects from either medicine, contact your GP, pharmacist, or NHS 111 for advice.

How to get tadalafil safely from Cured Pharmacy

Tadalafil is a prescription-only medicine in the UK, which means it can only be supplied after a clinical assessment by a UK-registered prescriber [4]. At Cured Pharmacy (GPhC 9012511), you complete a short online consultation that asks about your medical history, current medicines (including evolocumab), and any heart or blood pressure conditions. A UK prescriber reviews your answers and, if appropriate, approves your treatment.

Cured Pharmacy offers a range of tadalafil options, including generic tadalafil from £7.95 for a pack (first order with code Ednew: £6.36), Tadalafil 20 mg (Teva) at £9.99 (first order: £7.99), Avarante (tadalafil) 10 mg at £11.49 (first order: £9.19), and branded Cialis at £12.00 (first order: £9.60). All prices include the prescriber review and delivery. Your medicine is dispensed by our UK pharmacists and delivered discreetly to your door.

If you have any questions about taking tadalafil with evolocumab or any other medicine, our pharmacy team is here to help. You can contact us through the website or speak to a pharmacist by phone. We are committed to providing safe, effective treatment and supporting you at every step.

Why see your GP about erectile dysfunction

If you are experiencing erectile dysfunction for the first time, it is important to see your GP for a full assessment [1][2]. ED can be an early warning sign of cardiovascular disease, diabetes, or other health conditions that need investigation and treatment. Your GP can check your blood pressure, cholesterol, blood sugar, and hormone levels, and discuss lifestyle changes that may help. Online pharmacies like Cured Pharmacy can provide convenient treatment once a diagnosis has been made, but your GP plays a vital role in your overall health.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 21 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 21 October 2026]
3. Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 21 October 2026]
4. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 21 October 2026]
5. Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [accessed 21 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.

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