Tadalafil and Mirabegron: Can You Take Them Together?

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What Is Tadalafil and How Does It Work?

Tadalafil is the generic name for Cialis, a medicine licensed in the UK to treat erectile dysfunction (ED). It belongs to a group of medicines called PDE5 inhibitors, which work by relaxing blood vessels in the penis, allowing more blood to flow in when you are sexually aroused [3][4].

Tadalafil is available in two forms: on-demand tablets (10mg or 20mg) taken at least 30 minutes before sex, with effects lasting up to 36 hours, and daily tablets (2.5mg or 5mg) taken once a day at the same time. Both require sexual stimulation to work—tadalafil does not cause an automatic erection [4].

Because tadalafil affects blood vessels throughout the body, it can interact with other medicines that lower blood pressure or are processed by the same liver enzymes. This is why a full medication review is essential before starting treatment [4].

What Is Mirabegron and Why Is It Prescribed?

Mirabegron is a prescription medicine used to treat overactive bladder syndrome, a condition that causes a sudden, urgent need to urinate and may lead to leakage. It is sold under the brand name Betmiga in the UK. Mirabegron works by relaxing the bladder muscle, increasing the bladder's capacity to hold urine and reducing the frequency and urgency of urination [12].

Unlike older overactive bladder medicines (anticholinergics such as oxybutynin or tolterodine), mirabegron works through a different mechanism—it stimulates beta-3 receptors in the bladder wall. This makes it a useful alternative for people who experience side effects from anticholinergics, such as dry mouth or constipation [12].

Mirabegron is usually taken once daily as a prolonged-release tablet. It can cause a small increase in blood pressure in some people, so your doctor will monitor your blood pressure during treatment. It is also processed by certain liver enzymes, which means it can interact with some other medicines [12].

Common Uses of Mirabegron

Mirabegron is prescribed for adults with symptoms of overactive bladder, including urgency (a sudden, strong need to urinate), increased frequency (needing to urinate more than eight times in 24 hours), and urgency incontinence (leaking urine because you cannot reach the toilet in time). It is often used when lifestyle changes alone have not been enough to control symptoms [12].

When to get urgent help

• Chest pain during or after sex—stop activity and call 999; do not take nitrates if you have used tadalafil in the last 48 hours
• 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 attention
• Severe dizziness, fainting, or signs of very low blood pressure—lie down and call 111 or 999 if symptoms are severe
• Allergic reaction (swelling of face, lips, tongue, or throat, difficulty breathing)—call 999 immediately

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

Can You Take Tadalafil and Mirabegron Together?

No major interaction between tadalafil and mirabegron is commonly reported in UK prescribing guidance. This means that, for most men, taking these two medicines together is not expected to cause significant problems. However, every person's situation is different, and your prescriber will review your full medical history and all current medicines during your consultation [3][4][12].

Mirabegron can cause a small increase in blood pressure in some people, while tadalafil can lower blood pressure slightly. In theory, these effects might balance out, but the overall impact depends on your individual response, other medicines you take, and any underlying health conditions. Your prescriber will consider whether the combination is appropriate for you [4][12].

It is important to declare all medicines you are taking—including over-the-counter products, herbal remedies, and supplements—when you request tadalafil. Do not stop or change any prescribed medicine, including mirabegron, without speaking to your doctor or pharmacist first.

How the Interaction Between Tadalafil and Mirabegron Works

Tadalafil works by blocking an enzyme called phosphodiesterase type 5 (PDE5), which leads to relaxation of blood vessels and improved blood flow to the penis. Because blood vessels throughout the body are affected, tadalafil can cause a small drop in blood pressure, which is usually well tolerated but can cause dizziness in some men, especially when standing up quickly [4].

Mirabegron, on the other hand, relaxes the bladder muscle by stimulating beta-3 receptors. A known side effect of mirabegron is a small increase in blood pressure, which is why regular monitoring is recommended during treatment. The blood-pressure effects of mirabegron and tadalafil may counteract each other to some extent, but this is not guaranteed and varies from person to person [12].

Both medicines are processed (metabolised) by liver enzymes, but they use different pathways. Tadalafil is mainly broken down by an enzyme called CYP3A4, while mirabegron is processed by CYP3A4 and CYP2D6. Because they share the CYP3A4 pathway, taking them together could, in theory, slightly raise the level of one or both medicines in the blood, but this is not usually clinically significant. Your prescriber will assess whether any dose adjustment is needed [4][12].

What Your Body Does With These Medicines

When you take tadalafil, it is absorbed into your bloodstream and travels to the liver, where enzymes break it down over time. The effects of on-demand tadalafil can last up to 36 hours because the medicine is cleared from the body slowly. Mirabegron is also absorbed and processed by the liver, with effects lasting throughout the day when taken once daily. Because both medicines are in your system at the same time, your prescriber checks that the combination is safe for you [4][12].

At a glance

What Your Prescriber Checks Before Approving Tadalafil and Mirabegron

When you request tadalafil through Cured Pharmacy, a UK-registered prescriber reviews your online consultation to ensure the medicine is safe and suitable for you. If you are already taking mirabegron, the prescriber will check your blood pressure history, any other medicines you take, and whether you have any conditions that might make the combination unsuitable [2][4].

The prescriber will ask about your cardiovascular health, including any history of heart attack, stroke, angina, or heart failure. Tadalafil is not suitable if sexual activity is inadvisable due to your heart condition, or if you have very low blood pressure. If you take medicines for high blood pressure alongside mirabegron, the prescriber will consider the overall effect on your blood pressure [4].

You will also be asked about any other medicines that could interact with tadalafil, such as nitrates (used for angina), alpha-blockers (used for prostate or blood pressure problems), or potent CYP3A4 inhibitors (such as some HIV medicines or antifungals). The prescriber may recommend starting on a lower dose of tadalafil or adjusting the timing of your doses to minimise any risk [3][4].

Practical Advice for Taking Tadalafil and Mirabegron Safely

If your prescriber approves tadalafil while you are taking mirabegron, follow the dosing instructions carefully. Take tadalafil exactly as prescribed—either on-demand (at least 30 minutes before sex) or daily (at the same time each day). Continue taking mirabegron as your doctor has directed, usually once daily with water [4][12].

Monitor for any unusual symptoms, especially dizziness, light-headedness, or fainting, which could indicate low blood pressure. If you feel dizzy when standing up, get up slowly from sitting or lying down. Avoid drinking large amounts of alcohol, as this can worsen dizziness and make erectile dysfunction worse [4].

If you experience chest pain during sex, stop immediately and seek urgent medical help. Do not take nitrate medicines (such as GTN spray) to relieve chest pain if you have taken tadalafil within the last 48 hours, as the combination can cause a dangerous drop in blood pressure. Other warning signs that need urgent attention include an erection lasting more than four hours, sudden loss of vision or hearing, or severe dizziness [4].

Keep all your doctors and pharmacists informed about both medicines. If you are prescribed a new medicine by your GP or a specialist, mention that you are taking both tadalafil and mirabegron so they can check for any additional interactions. Never stop taking mirabegron without your doctor's advice, even if your ED treatment is working well.

When to Seek Advice

Contact your GP or pharmacist if you develop new symptoms after starting tadalafil, such as persistent headaches, flushing, indigestion, or back pain. These are common side effects of tadalafil and often settle with time, but your healthcare professional can advise whether any action is needed. If you notice a change in your urinary symptoms while taking both medicines, speak to your doctor, as your mirabegron dose may need reviewing [4][12].

In summary

• No major interaction between tadalafil and mirabegron is commonly reported in UK guidance.
• Mirabegron may raise blood pressure slightly; tadalafil may lower it slightly.
• Your prescriber reviews your full medication list and blood pressure history before approving tadalafil.
• Declare all medicines during your consultation and do not stop mirabegron without medical advice.
• Seek urgent help for chest pain during sex, erection lasting over 4 hours, or sudden vision or hearing loss.

Frequently Asked Questions