Tadalafil and Inclisiran: Can You Take Them Together?

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What is tadalafil and inclisiran used for?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction (ED) in adult men [3][4]. It works by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Tadalafil is available as on-demand tablets (10 mg or 20 mg taken at least 30 minutes before sexual activity, with effects lasting up to 36 hours) or as a daily low-dose option (2.5 mg or 5 mg taken once a day) [4]. Sexual stimulation is still required for the medicine to work.

Inclisiran is a small interfering RNA (siRNA) medicine used to lower LDL cholesterol (often called 'bad' cholesterol) in adults with high cholesterol or mixed dyslipidaemia [12]. It is given as a subcutaneous injection by a healthcare professional, usually twice in the first year (at the start and after three months) and then every six months. Inclisiran works by reducing the production of a protein called PCSK9 in the liver, which in turn helps the liver remove more LDL cholesterol from the blood. It is typically prescribed alongside a statin and dietary changes for people at high cardiovascular risk.

Both medicines are prescription-only in the UK. Tadalafil requires an online or face-to-face consultation with a prescriber to ensure it is safe and suitable for you, while inclisiran is initiated and administered by specialist clinics or GP practices under careful monitoring.

How do tadalafil and inclisiran interact in the body?

Tadalafil and inclisiran work through entirely separate biological pathways, which is why no significant interaction has been identified between them. Tadalafil acts on an enzyme called phosphodiesterase type 5 (PDE5) found mainly in the smooth muscle of blood vessels in the penis, lungs and other tissues [3][4]. By blocking PDE5, tadalafil allows blood vessels to relax and widen, improving blood flow to the penis during sexual arousal. It is metabolised primarily by the liver enzyme CYP3A4.

Inclisiran, on the other hand, is a targeted RNA therapy that works inside liver cells to reduce the production of PCSK9, a protein that normally breaks down LDL receptors [12]. By lowering PCSK9 levels, inclisiran helps the liver clear more LDL cholesterol from the bloodstream. Because it acts on gene expression within liver cells and is not metabolised by the same liver enzymes as tadalafil, there is no pharmacokinetic (drug-level) interaction between the two medicines.

Neither medicine affects the blood levels or effectiveness of the other. Inclisiran does not influence the CYP3A4 enzyme system, so it will not raise or lower tadalafil levels in your body. Similarly, tadalafil does not interfere with the RNA mechanism by which inclisiran works. This means the two can generally be used together without one altering the action of the other.

What about blood pressure effects?

Tadalafil can cause a mild, temporary drop in blood pressure because it relaxes blood vessels [4]. This is usually well tolerated, but it is important to consider if you are taking other medicines that also lower blood pressure. Inclisiran itself does not directly lower blood pressure; its primary effect is on cholesterol levels. However, many people taking inclisiran are also on other cardiovascular medicines such as statins, ACE inhibitors, beta-blockers or calcium-channel blockers, which can affect blood pressure. Your prescriber will review all your current medicines during your consultation to ensure the combination is safe for you.

When to get urgent help

• Erection lasting more than 4 hours (priapism)—go to A&E immediately to prevent permanent damage
• Sudden loss of vision in one or both eyes—stop tadalafil and seek urgent medical advice
• Chest pain during or after sex—call 999; do not use nitrates if you have taken tadalafil in the last 48 hours
• Sudden loss of hearing, ringing in ears or severe dizziness—stop tadalafil and contact your doctor urgently
• Severe 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.

What does your prescriber check before prescribing tadalafil and inclisiran together?

Before prescribing tadalafil, your doctor or pharmacist prescriber will take a full medical history and review all your current medicines [2][4]. This is essential to identify any contraindications or interactions. They will specifically check that you are not taking nitrates (such as GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, or recreational drugs called 'poppers' (amyl or alkyl nitrites), as combining any of these with tadalafil can cause a dangerous drop in blood pressure. You must never take tadalafil with these medicines.

Your prescriber will also ask about your cardiovascular health, including any history of heart attack, stroke, angina, heart failure, or very low blood pressure, as tadalafil may not be suitable if sexual activity itself is inadvisable [2][4]. They will review whether you take alpha-blockers (such as doxazosin or tamsulosin) for prostate symptoms or high blood pressure, as these can add to the blood-pressure-lowering effect of tadalafil; if you do, you will usually be started on the lowest dose of tadalafil and monitored carefully.

If you are taking inclisiran, your prescriber will note this but will not usually need to adjust your tadalafil dose because of it. However, they will consider the full picture of your cardiovascular medicines and overall heart health. Inclisiran is typically prescribed to people with established cardiovascular disease or high cholesterol, so your prescriber may want to ensure your heart condition is stable and that sexual activity is safe for you. Always declare every medicine you take, including over-the-counter products and supplements, during your consultation.

Are there any warning signs to watch for when taking tadalafil and inclisiran?

Most men tolerate tadalafil well, but it is important to be aware of potential side effects and warning signs [4]. Common side effects of tadalafil include headache, indigestion, back pain, muscle aches, flushing and a blocked or runny nose. These are usually mild and temporary. Inclisiran can cause injection-site reactions (redness, pain or swelling at the injection site) and, less commonly, mild allergic reactions [12]. Neither medicine typically causes serious problems when used as directed.

However, you should seek urgent medical help if you experience an erection lasting more than four hours (priapism), as this can cause permanent damage to the penis if not treated promptly [4]. Stop taking tadalafil and get immediate medical advice if you have sudden loss of vision in one or both eyes, as this may be a sign of a rare condition called non-arteritic anterior ischaemic optic neuropathy (NAION). Sudden decrease or loss of hearing, sometimes with ringing in the ears or dizziness, also requires urgent attention.

If you develop chest pain during or after sexual activity, do not use nitrates to relieve it if you have taken tadalafil within the last 48 hours; instead, call 999 immediately [4]. Severe dizziness, fainting or a very fast or irregular heartbeat should also prompt you to seek help. Because inclisiran is given by a healthcare professional, any concerns about injection reactions or allergic symptoms should be reported to your doctor or the clinic administering the treatment.

What if I take other heart or blood pressure medicines?

Many people taking inclisiran are also on statins, ACE inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, or calcium-channel blockers for cardiovascular protection [2]. Tadalafil can add to the blood-pressure-lowering effect of these medicines, which may cause dizziness or light-headedness, especially when standing up quickly. This is usually manageable, but it is essential to declare all your medicines during your consultation so your prescriber can assess the overall risk and choose the right starting dose. If you feel dizzy or faint after taking tadalafil, sit or lie down until the symptoms pass, and let your prescriber know at your next review.

At a glance

Practical advice for taking tadalafil with inclisiran

If you have been prescribed both tadalafil and inclisiran, you can take them as directed without needing to separate the doses or avoid certain times of day. Inclisiran is given as an injection every six months (after the initial loading doses), so it is not something you take daily [12]. Tadalafil can be taken either on-demand (10 mg or 20 mg at least 30 minutes before sexual activity, with effects lasting up to 36 hours) or as a daily low dose (2.5 mg or 5 mg once a day) [4]. Follow your prescriber's instructions for your specific regimen.

You can take tadalafil with or without food, although a very large or high-fat meal may delay how quickly it starts to work [4]. Avoid drinking excessive alcohol, as this can make erectile dysfunction worse and increase the risk of side effects such as dizziness, headache and low blood pressure. Grapefruit juice can raise tadalafil levels in the blood and should be avoided or limited. Sexual stimulation is still required for tadalafil to work; it does not cause an automatic erection.

Keep all your regular appointments for inclisiran injections and cholesterol monitoring, as this is an important part of managing your cardiovascular risk. If you start any new medicine or your health changes (for example, if you have a heart attack, stroke, or are prescribed a nitrate), tell your doctor or pharmacist immediately, as this may affect whether tadalafil is still safe for you. Do not stop or change the dose of any prescribed medicine without professional advice.

Getting tadalafil and inclisiran: what you need to know

Inclisiran is a specialist medicine usually initiated by a hospital consultant, lipid clinic or GP with a special interest in cardiovascular disease [12]. It is given as an injection by a healthcare professional, so you will not administer it yourself at home. Your doctor will arrange regular blood tests to monitor your cholesterol levels and check how well the treatment is working. Inclisiran is typically used alongside a statin and lifestyle changes (healthy diet, regular exercise, not smoking) to reduce your risk of heart attack and stroke.

Tadalafil is available on prescription from your GP, a specialist clinic, or a registered online pharmacy such as Cured Pharmacy after a clinical consultation [4]. At Cured Pharmacy, you complete a short online questionnaire that is reviewed by a UK-registered prescriber (doctor or pharmacist prescriber). If the treatment is suitable and safe for you, your medicine is dispensed by our GPhC-registered pharmacy and delivered discreetly to your home. All consultations are confidential, and you can ask questions at any stage.

Cured Pharmacy offers a range of tadalafil options, including generic tadalafil from £7.95 (or £6.36 with first-order code Ednew), branded Cialis from £12.00 (£9.60 with code Ednew), and other strengths and brands to suit your needs. Because tadalafil and inclisiran do not interact, you can safely order tadalafil online if you are already receiving inclisiran injections, provided you declare all your medicines and health conditions during the consultation. If you have any concerns or questions about your treatment, our pharmacy team is here to help.

When to see your GP about erectile dysfunction

If you are experiencing erectile dysfunction for the first time, it is a good idea to see your GP for a check-up [1][2]. ED can be an early warning sign of underlying health problems such as heart disease, diabetes, high blood pressure or high cholesterol. Your GP can arrange blood tests and a cardiovascular assessment to identify and treat any contributing factors. Managing these conditions not only improves your overall health but can also improve erectile function. Your GP can also discuss treatment options, including lifestyle changes, psychological support and prescription medicines like tadalafil.

In summary

• No major interaction is reported between tadalafil and inclisiran; they can usually be taken together safely.
• Tadalafil works on blood vessels in the penis; inclisiran lowers cholesterol in the liver—different mechanisms.
• Your prescriber reviews all medicines, especially nitrates and alpha-blockers, to ensure tadalafil is safe.
• Seek urgent help for erections lasting over 4 hours, sudden vision or hearing loss, or chest pain during sex.
• Declare all cardiovascular medicines during your consultation, as some can add to blood-pressure effects.

Frequently Asked Questions