Tadalafil and Maraviroc: Can They Be Taken Together?

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What is tadalafil and maraviroc used for?

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 blood vessels in the penis, allowing increased blood flow when you are sexually aroused [3][4]. Tadalafil is the active ingredient in Cialis and is available in on-demand doses (10mg or 20mg, taken at least 30 minutes before sex, with effects lasting up to 36 hours) or as a daily low dose (2.5mg or 5mg) [4].

Maraviroc is an antiretroviral medicine used to treat HIV-1 infection in adults. It works by blocking a protein called CCR5 on the surface of certain immune cells, which the virus uses to enter and infect those cells [12]. Maraviroc is typically taken twice daily as part of combination antiretroviral therapy. It does not cure HIV but helps control the virus and maintain immune function.

Both medicines are prescription-only in the UK. Tadalafil requires a clinical assessment to ensure it is safe for you, particularly if you have heart conditions, take other medicines, or have certain health problems. Maraviroc is prescribed and monitored by HIV specialists.

Can you take tadalafil and maraviroc together?

Yes, tadalafil and maraviroc can generally be taken together. Maraviroc is not a potent inhibitor of the liver enzyme (CYP3A4) that breaks down tadalafil, so it does not significantly raise tadalafil levels in the body [4][12]. This means the usual doses of tadalafil are typically appropriate for men taking maraviroc.

However, it is essential that your prescriber knows you are taking maraviroc and reviews all your other HIV medicines during your consultation. Some antiretroviral drugs—particularly ritonavir, cobicistat (found in boosted regimens), and certain protease inhibitors—are potent CYP3A4 inhibitors and do interact with tadalafil, requiring dose adjustments [4]. Your prescriber will check the Summary of Product Characteristics (SmPC) for your specific combination to ensure safety.

Never start, stop, or change the dose of any prescribed medicine, including your HIV treatment, without consulting your doctor or pharmacist. If you are prescribed tadalafil, take it exactly as directed and inform your prescriber of any new medicines you start.

Why some HIV medicines do interact with tadalafil

Tadalafil is broken down in the liver by an enzyme called CYP3A4. Some HIV medicines—especially ritonavir, cobicistat, and certain protease inhibitors—strongly inhibit this enzyme, which can cause tadalafil to build up in your body and increase the risk of side effects such as headache, flushing, dizziness, or a drop in blood pressure [4]. In these cases, your prescriber will reduce the maximum dose of tadalafil or advise you to take it less frequently. Maraviroc does not have this effect, so dose adjustment is not usually needed when taking maraviroc alone with tadalafil.

When to get urgent help

• Erection lasting more than 4 hours (priapism) – go to A&E immediately
• Sudden loss of vision in one or both eyes – stop tadalafil and seek urgent medical help
• Sudden decrease or loss of hearing, sometimes with ringing in the ears or dizziness
• Chest pain during or after sex – do not take nitrates; call 999
• Severe dizziness or fainting – sit or lie down and seek medical advice

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

What your prescriber checks before prescribing tadalafil

Before prescribing tadalafil, your prescriber will review your full medical history and current medicines. They will ask about your heart health, blood pressure, any history of stroke or heart attack, liver or kidney function, and whether you have conditions such as diabetes or high cholesterol [2][4]. These factors can affect whether tadalafil is safe for you and which dose is appropriate.

You must tell your prescriber about all medicines you take, including prescription drugs, over-the-counter products, and herbal supplements. This includes your HIV treatment regimen. Certain medicines must never be taken with tadalafil, including nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, and recreational drugs called 'poppers' (amyl or alkyl nitrites), as the combination can cause a dangerous fall in blood pressure [4].

Your prescriber will also check whether you take alpha-blockers (such as tamsulosin or doxazosin) for prostate symptoms or blood pressure, as these can add to the blood-pressure-lowering effect of tadalafil and cause dizziness. If you are stable on an alpha-blocker, you can usually take tadalafil, but you will start on the lowest dose [4]. Other blood-pressure medicines and some antifungals or antibiotics may also require dose adjustments.

How to take tadalafil safely with maraviroc

If your prescriber confirms that tadalafil is suitable for you, follow the dosing instructions carefully. For on-demand tadalafil (10mg or 20mg), take one tablet at least 30 minutes before you plan to have sex; the effect can last up to 36 hours, so you should not take more than one dose in 24 hours [4]. For daily tadalafil (2.5mg or 5mg), take one tablet at the same time each day, regardless of when you plan to have sex.

Tadalafil works only when you are sexually aroused; it will not cause an erection on its own. You can take it with or without food, though a very heavy or high-fat meal may delay how quickly it works. Avoid drinking large amounts of alcohol, as this can make it harder to get an erection and may increase the risk of dizziness or low blood pressure [4].

Continue taking your maraviroc and other HIV medicines exactly as prescribed by your HIV specialist. Do not skip doses or stop treatment. If you start any new medicine (including over-the-counter products or antibiotics), tell both your HIV doctor and the prescriber of your ED treatment, as some medicines can interact. Grapefruit juice can raise tadalafil levels slightly, so it is best to avoid it or drink only small amounts.

What to do if you experience side effects

Common side effects of tadalafil include headache, indigestion, back pain, muscle aches, flushing, and a stuffy or runny nose [4]. These are usually mild and go away on their own. If side effects are troublesome or persistent, speak to your prescriber; a lower dose may help. Seek urgent medical help if you develop an erection lasting more than four hours (priapism), sudden loss of vision or hearing, or chest pain during sex. If you feel dizzy or faint, sit or lie down and avoid driving or operating machinery until you feel better.

At a glance

Other medicines and tadalafil: what you need to know

In addition to maraviroc, your prescriber will check all your other medicines for interactions. As mentioned, some HIV drugs—particularly ritonavir, cobicistat, and boosted protease inhibitors—can raise tadalafil levels and require dose adjustments [4]. Other potent CYP3A4 inhibitors, such as ketoconazole, itraconazole, and clarithromycin, have the same effect.

Conversely, CYP3A4 inducers such as rifampicin (sometimes used to treat tuberculosis in people with HIV), carbamazepine, phenytoin, and St John's wort can reduce tadalafil levels and make it less effective [4]. If you need to take any of these medicines, your prescriber may suggest an alternative ED treatment or adjust your dose.

Alpha-blockers, other blood-pressure medicines, and some antidepressants can add to the blood-pressure-lowering effect of tadalafil. Your prescriber will assess whether the combination is safe and may start you on a lower dose. Always declare every medicine you take, including vitamins, supplements, and anything you buy without a prescription. Never take another PDE5 inhibitor (such as sildenafil or vardenafil) at the same time as tadalafil.

Getting tadalafil through Cured Pharmacy

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering a convenient, confidential service for erectile dysfunction treatment. After you complete an online consultation, a UK-registered prescriber will review your answers, medical history, and current medicines—including maraviroc and any other HIV treatment—to ensure tadalafil is safe and appropriate for you [2].

If approved, your medicine is dispensed by our pharmacy team and delivered discreetly to your door. We stock a range of ED treatments, including generic tadalafil from £7.95 (or £6.36 for first orders with code Ednew), branded Cialis from £12.00 (£9.60 with code Ednew), and other options such as sildenafil, vardenafil, and avanafil. You can also speak to our pharmacists if you have questions about your treatment.

We encourage anyone experiencing new or worsening erectile dysfunction to see their GP, as ED can be an early sign of underlying health conditions such as heart disease or diabetes [1][2]. Our service is designed to provide ongoing treatment once a diagnosis has been made and you know which medicine works for you. All prescriptions are issued only after a clinical assessment by a qualified UK prescriber.

Why choose an online pharmacy for ED treatment?

Many men find it easier to discuss erectile dysfunction online rather than face-to-face. Our consultation is straightforward, confidential, and reviewed by experienced prescribers who understand the importance of checking for interactions, especially if you take medicines for other conditions such as HIV. Online pharmacies like Cured offer the same clinical standards as high-street pharmacies, with the added convenience of home delivery and discreet packaging. You can reorder easily when you need more treatment, and our team is always available to answer questions.

In summary

• Tadalafil and maraviroc can generally be taken together without dose adjustment.
• Some HIV medicines like ritonavir or cobicistat do interact and require lower tadalafil doses.
• Always declare all your HIV medicines during your ED consultation.
• Never take tadalafil with nitrates, nicorandil, riociguat, or poppers.
• Seek urgent help if you have an erection lasting over four hours or sudden vision loss.

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