Tadalafil and Formoterol: Can You Take Them Together?

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At a glance

What is Tadalafil and How Does It Work?

Tadalafil is a prescription medicine used to treat erectile dysfunction (ED) in men. It belongs to a group of medicines called PDE5 inhibitors, which work by relaxing the blood vessels in the penis, allowing more blood to flow in when you're 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's sometimes called the 'weekend pill'.

Tadalafil is available in two forms: on-demand tablets (usually 10mg or 20mg) taken at least 30 minutes before sexual activity, and daily low-dose tablets (2.5mg or 5mg) for men who prefer spontaneity [4]. Both require sexual stimulation to work—tadalafil won't cause an erection on its own. At Cured Pharmacy, tadalafil is available on prescription after an online consultation with a UK-registered prescriber, starting from £7.95 for generic tadalafil.

It's important to understand that tadalafil also lowers blood pressure slightly as a side effect of how it works. This is usually mild and well-tolerated, but it becomes relevant when considering other medicines you take, including those for respiratory conditions.

What is Formoterol and Why is It Prescribed?

Formoterol is a long-acting beta-2 agonist (LABA) used to manage asthma and COPD. It works by relaxing the muscles around the airways in your lungs, making it easier to breathe. Formoterol is usually inhaled and is often combined with an inhaled corticosteroid (such as budesonide or beclometasone) in combination inhalers like Symbicort or Fostair.

Unlike short-acting 'reliever' inhalers (such as salbutamol), formoterol is a 'preventer' medicine taken regularly—usually twice a day—to keep your airways open and reduce the risk of asthma attacks or COPD flare-ups. Some formulations can also be used as a reliever when needed, but this depends on the specific product and your doctor's instructions.

Formoterol can occasionally cause side effects such as a faster heart rate, tremor, or headache, particularly when you first start using it or if the dose is increased. These effects are usually mild and settle down, but they're worth being aware of when considering other medicines that might also affect your heart rate or blood pressure.

Do Tadalafil and Formoterol Interact?

There is no major direct interaction commonly reported between tadalafil and formoterol. They work on different systems in the body: tadalafil primarily affects blood vessels (particularly in the penis), while formoterol acts on the airways in the lungs. Neither medicine is listed as a contraindication for the other in UK prescribing guidance [4].

However, both medicines can have cardiovascular effects. Tadalafil lowers blood pressure slightly, and formoterol can occasionally increase heart rate or cause palpitations, especially at higher doses or when first started. In most people, these effects are mild and don't cause problems when the medicines are used together, but your prescriber will want to check your overall cardiovascular health before approving tadalafil.

It's also worth noting that if you take other medicines for asthma, COPD, or other conditions alongside formoterol, your prescriber will review all of them during your consultation. Some medicines—such as certain blood pressure tablets or antifungals—can interact with tadalafil, so a full medication review is essential for safe prescribing.

What Your Prescriber Will Check

When you request tadalafil through Cured Pharmacy's online consultation, you'll be asked to list all your current medicines, including inhalers. The prescriber will check whether you have any cardiovascular conditions (such as angina, recent heart attack, or severe heart failure) that might make sexual activity inadvisable [2]. They'll also confirm you're not taking any medicines that are contraindicated with tadalafil, such as nitrates (GTN spray, isosorbide mononitrate), nicorandil, riociguat, or 'poppers' (amyl nitrites)—these combinations can cause a dangerous drop in blood pressure and must never be used together [4].

If you're stable on formoterol and have no other concerning cardiovascular issues, tadalafil is usually suitable. The prescriber may start you on a lower dose if you have other risk factors, and they'll advise you to watch for any unusual symptoms such as dizziness, chest pain, or a very fast or irregular heartbeat.

What you need to know

• No major direct interaction is commonly reported between tadalafil and formoterol inhalers
• Your prescriber will check your cardiovascular health and all current medicines before approving tadalafil
• Continue your asthma or COPD inhalers as prescribed—never stop without medical advice
• Watch for dizziness or chest pain and seek advice if these occur
• Some antibiotics and other medicines can interact with tadalafil—always declare all treatments

Practical Advice for Taking Tadalafil and Formoterol Together

If your prescriber approves tadalafil, continue using your formoterol inhaler exactly as prescribed—don't stop or change the dose without medical advice. Formoterol is a preventer medicine, and stopping it suddenly can lead to worsening asthma or COPD symptoms.

When you first start tadalafil, pay attention to how you feel. If you notice dizziness, light-headedness (especially when standing up), chest discomfort, or an unusually fast or irregular heartbeat, stop taking tadalafil and contact your GP or pharmacist for advice. These symptoms are uncommon but can indicate that the combination is affecting your blood pressure or heart rate more than expected.

Avoid heavy alcohol when using tadalafil, as alcohol can worsen erectile dysfunction, increase the risk of side effects such as dizziness and headache, and add to the blood-pressure-lowering effect [4]. Grapefruit juice can also raise tadalafil levels in your blood, so it's best to avoid it. If you develop a chest infection or your asthma worsens and you're prescribed additional medicines (such as antibiotics or oral steroids), let the prescriber know you're taking tadalafil, as some antibiotics (like clarithromycin) can interact with it.

When to Seek Urgent Help

Seek immediate medical help (call 999 or go to A&E) if you experience an erection lasting more than four hours (priapism), sudden loss of vision or hearing, or chest pain during or after sex. Priapism is a medical emergency that requires urgent treatment to prevent permanent damage. Chest pain during sex may indicate a heart problem and needs immediate assessment [1][4].

If you experience severe dizziness, fainting, or a very fast or irregular heartbeat after taking tadalafil, stop the medicine and seek same-day medical advice from your GP or NHS 111. These symptoms are rare but can indicate an interaction or an underlying condition that needs attention.

Other Medicines and Conditions to Discuss

While formoterol itself does not have a major interaction with tadalafil, other medicines you may be taking do. If you use an alpha-blocker for an enlarged prostate (such as tamsulosin, doxazosin, or alfuzosin), there is a risk of low blood pressure and dizziness when combined with tadalafil [4]. You should be stable on the alpha-blocker before starting tadalafil, and your prescriber will usually recommend the lowest dose of tadalafil to start.

If you take medicines that are potent CYP3A4 inhibitors—such as ritonavir, cobicistat (found in some HIV medicines), ketoconazole, itraconazole, or clarithromycin—these can raise tadalafil levels in your blood, increasing the risk of side effects. Your prescriber may need to reduce the maximum dose of tadalafil or advise against it altogether [4]. Conversely, CYP3A4 inducers like rifampicin, carbamazepine, phenytoin, or St John's wort can make tadalafil less effective.

If you have cardiovascular conditions such as unstable angina, severe heart failure, very low blood pressure, or you've had a recent heart attack or stroke, tadalafil may not be suitable, as sexual activity itself can put strain on the heart [2]. Always declare all your medical conditions and medicines during the online consultation so the prescriber can make a safe decision.

When to get urgent help

• Erection lasting more than 4 hours (priapism)—call 999 or go to A&E immediately
• Sudden loss of vision or hearing—seek emergency medical help
• Chest pain during or after sex—call 999; do not take more tadalafil
• Severe dizziness, fainting, or very fast/irregular heartbeat—stop tadalafil and seek same-day GP or NHS 111 advice

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

How to Get Tadalafil Safely at Cured Pharmacy

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering a range of erectile dysfunction treatments on prescription. To request tadalafil, you'll complete a short online consultation that asks about your health, current medicines (including formoterol and any other inhalers), and any conditions that might affect suitability. A UK-registered prescriber will review your answers, and if tadalafil is appropriate, your medicine will be dispensed and posted discreetly to your home.

We stock several tadalafil options, including generic tadalafil from £7.95, branded Cialis from £12.00, and Teva tadalafil 20mg from £9.99. First-time customers can use the code Ednew for a discount (for example, generic tadalafil drops to £6.36). All prices include the consultation and delivery. If tadalafil isn't suitable, the prescriber may suggest an alternative such as sildenafil (from £0.45), vardenafil (from £16.95), or avanafil (Spedra, from £20.95).

Remember, erectile dysfunction can be an early warning sign of cardiovascular disease or diabetes, so if you're experiencing ED for the first time, it's worth seeing your GP for a check-up [1][2]. Online pharmacies like Cured are a convenient option for ongoing treatment once you've had an initial assessment, but they complement—rather than replace—your GP's care.

What Happens During the Consultation

The online consultation will ask about your age, general health, blood pressure, cardiovascular history, and all current medicines. You'll be asked specifically whether you take nitrates, nicorandil, riociguat, alpha-blockers, or any other medicines that might interact with tadalafil. You'll also be asked about any allergies, previous reactions to ED medicines, and whether you've had conditions such as priapism, NAION (sudden vision loss), or severe kidney or liver disease.

If the prescriber needs more information or feels a face-to-face review is necessary, they'll let you know and may suggest you see your GP. This is a safety measure to ensure you get the right treatment. If approved, your tadalafil will usually be dispatched the same day (if ordered before the cut-off time) in plain, unmarked packaging.