Tadalafil and Malarone: Can You Take Them Together?

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Key takeaways

• No major interaction between tadalafil and Malarone is commonly reported—they can usually be taken together safely.
• A UK prescriber reviews your full medication list during consultation to confirm the combination is appropriate for you.
• Take Malarone daily with food; tadalafil on-demand at least 30 minutes before sex or daily at the same time each day.
• Seek urgent help for erection lasting over four hours, sudden vision or hearing loss, or severe chest pain.
• Tadalafil is available from £7.95 at Cured Pharmacy after an online consultation with a UK prescriber.

What is tadalafil and how does it work?

Tadalafil is a prescription medicine used to treat erectile dysfunction (ED) in men [3][4]. It belongs to a group of medicines called PDE5 inhibitors, which work by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Tadalafil does not cause an erection on its own—sexual stimulation is still needed for it to work [1].

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 taken once a day). The on-demand dose can remain effective for up to 36 hours, which is why tadalafil is sometimes called 'the weekend pill' [4]. At Cured Pharmacy, tadalafil is available from £7.95 after an online consultation with a UK prescriber.

Common side effects include headache, indigestion, back pain, muscle aches, flushing and nasal congestion [4]. These are usually mild and temporary. Tadalafil is not suitable for everyone, particularly men taking nitrates for angina, those with severe heart or liver problems, or anyone who has recently had a stroke or heart attack [3][4].

What is Malarone and when is it prescribed?

Malarone is a prescription antimalarial medicine containing two active ingredients: atovaquone and proguanil hydrochloride [12]. It is used both to prevent and to treat malaria, a serious and sometimes life-threatening infection spread by mosquitoes in tropical and subtropical regions. Malarone is one of several antimalarial options available and is often chosen for short trips because it only needs to be started one or two days before travel.

For malaria prevention, Malarone is usually taken once daily, starting one to two days before entering a malaria-risk area, throughout your stay, and for seven days after leaving [12]. The tablets should be taken at the same time each day with food or a milky drink to improve absorption. Common side effects include headache, nausea, stomach upset and dizziness.

Malarone is generally well tolerated, but it is not suitable for everyone. Your doctor will check whether it is appropriate based on your kidney function, other medical conditions, and any medicines you are already taking. If you are planning travel and also use erectile dysfunction treatment, it is important to declare both medicines during your consultations.

At a glance

Is there an interaction between tadalafil and Malarone?

No major interaction between tadalafil and Malarone is commonly reported in clinical practice or major drug interaction databases. Malarone (atovaquone/proguanil) does not significantly affect the liver enzymes (CYP3A4) that break down tadalafil, and tadalafil does not interfere with the way Malarone works against malaria parasites. This means the two medicines can usually be taken together without one reducing the effectiveness of the other or causing harmful side effects.

However, it is essential to understand that 'no major interaction reported' does not mean the combination is automatically safe for everyone. Both medicines can occasionally cause dizziness or headache, and taking them together might make these side effects more noticeable in some people. Your prescriber will review your full medical history, current medications, and travel plans to ensure the combination is appropriate for you.

If you are prescribed tadalafil and Malarone together, take each medicine exactly as directed. Do not increase the dose of either medicine without consulting your prescriber. If you experience unusual symptoms—such as severe dizziness, chest pain, prolonged erection (lasting more than four hours), or sudden vision or hearing loss—seek medical help immediately, even if you are abroad.

How tadalafil is processed in the body

Tadalafil is broken down mainly by an enzyme in the liver called CYP3A4 [4]. Medicines that strongly inhibit (block) this enzyme—such as ritonavir, ketoconazole, itraconazole, clarithromycin, or Paxlovid—can raise tadalafil levels in the blood, increasing the risk of side effects. In these cases, your prescriber will reduce the maximum dose of tadalafil or advise against using it altogether [4]. Conversely, medicines that speed up CYP3A4 (such as rifampicin, carbamazepine, phenytoin, or St John's wort) can lower tadalafil levels and make it less effective. Malarone does not have a significant effect on CYP3A4, which is why the combination is generally considered safe from a pharmacokinetic perspective.

What does your prescriber check before approving tadalafil and Malarone together?

When you request tadalafil through Cured Pharmacy's online consultation, a UK-registered prescriber will review your medical history, current medications (including Malarone), and overall health. They will check that you do not have any conditions that make tadalafil unsafe, such as recent heart attack or stroke, unstable angina, severe heart failure, very low blood pressure, or use of nitrate medicines (GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, or recreational drugs called 'poppers' [3][4]. These combinations can cause a dangerous drop in blood pressure and must never be used together.

Your prescriber will also check for medicines that can interact with tadalafil, including alpha-blockers (such as tamsulosin or doxazosin, often used for prostate symptoms), other blood-pressure medicines, and potent CYP3A4 inhibitors [4]. If you are taking Malarone, the prescriber will note this but will usually be reassured that no major interaction is expected. They may ask about your travel plans, as certain health conditions (such as severe dehydration or altitude sickness) can affect both erectile function and the safety of ED medicines.

It is vital to answer all questions honestly and to list every medicine, supplement, and herbal remedy you are taking, even if bought over the counter or online. Do not assume that because a product is 'natural' it is safe to combine with prescription medicines. If your circumstances change—for example, if you are prescribed a new medicine while abroad—contact your prescriber or a local doctor for advice before continuing tadalafil.

Starting tadalafil while taking Malarone

If you are already taking Malarone for malaria prevention and wish to start tadalafil, complete the online consultation at Cured Pharmacy and declare Malarone in the medication list. The prescriber will confirm that the combination is appropriate and, if approved, will issue a prescription for the lowest effective dose of tadalafil. You can then take both medicines as directed. If you are new to tadalafil, it is sensible to try it at home before travelling, so you know how your body responds and can manage any side effects in a familiar environment.

Practical advice for taking tadalafil and Malarone together

If you have been prescribed both tadalafil and Malarone, take Malarone once daily with food or a milky drink at the same time each day, as directed by your doctor [12]. Tadalafil can be taken with or without food; if you are using the on-demand form, take it at least 30 minutes before planned sexual activity (effects can last up to 36 hours). If you are using daily tadalafil, take it at the same time each day, which can be at a different time from your Malarone dose if that is more convenient.

Avoid drinking large amounts of alcohol while taking tadalafil, as alcohol can worsen erectile dysfunction and increase the risk of dizziness and low blood pressure [3]. Grapefruit juice can raise tadalafil levels and should be avoided [4]. Stay well hydrated, especially in hot climates, as dehydration can contribute to dizziness and headaches. If you experience side effects from either medicine, do not stop taking Malarone (as this would leave you unprotected against malaria) or adjust the dose of tadalafil without medical advice.

Carry both medicines in their original packaging with the prescription label, as customs officials in some countries may ask to see proof that the medicines are legally prescribed. Keep a note of your prescriber's contact details and consider taking a copy of your prescription or a letter from your doctor. If you need urgent medical help abroad, inform the treating doctor that you are taking both tadalafil and Malarone.

When to seek medical help and other ED treatment options

Seek emergency 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, severe chest pain, or signs of a serious allergic reaction (such as swelling of the face, lips or throat, or difficulty breathing) [3][4]. If you develop severe side effects from Malarone—such as high fever, severe stomach pain, yellowing of the skin or eyes, or dark urine—stop taking it and seek medical advice immediately, even if you are abroad.

If tadalafil and Malarone together cause troublesome side effects, or if you find tadalafil is not effective for you, other erectile dysfunction treatments are available. Cured Pharmacy offers sildenafil (generic Viagra) from £0.45, vardenafil (generic Levitra) from £16.95, and avanafil (Spedra) from £20.95, all after an online consultation with a UK prescriber. Each medicine works in a slightly different way and may suit you better. Your prescriber can discuss the options and help you find the most appropriate treatment.

Remember that erectile dysfunction can be an early warning sign of heart disease or diabetes [1][2]. If you are experiencing ED for the first time, or if it is getting worse, see your GP for a full health check. Lifestyle changes—such as losing weight, exercising regularly, stopping smoking, and reducing alcohol—can improve erectile function and overall health [1][2]. ED treatment works best as part of a holistic approach to your wellbeing.

Alternatives to oral ED medicines

If oral ED medicines are not suitable or effective, other options include Vitaros (alprostadil cream applied to the tip of the penis) and Caverject (alprostadil injection into the penis), both available on prescription [7]. Eroxon is a topical gel medical device that can be bought without prescription. Vacuum erection devices and penile implants are also available through specialist services. Your GP or a specialist can discuss these alternatives if needed.

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 or hearing—stop tadalafil and seek urgent medical help
• Severe chest pain during or after sex—call 999; do not take more tadalafil
• Signs of serious allergic reaction (swelling of face, lips, throat, or difficulty breathing)—call 999
• Severe stomach pain, high fever, or yellowing of skin/eyes while on Malarone—seek medical help immediately

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