Tadalafil and Nortriptyline: Can You Take Them Together?
Learn about the interaction, what your prescriber checks, and how to use both medicines safely.
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Tadalafil and Nortriptyline: Understanding the Interaction
Published: 24 October 2026
Many men wonder whether tadalafil and nortriptyline can be taken together safely. The good news is that no major interaction is commonly reported between tadalafil (a medicine for erectile dysfunction) and nortriptyline (a tricyclic antidepressant used for depression, nerve pain, and migraine prevention). However, both medicines can affect blood pressure and heart rhythm, so your prescriber will review your full medical history and current medicines during your consultation to ensure the combination is suitable for you.
Stand up slowly
Both tadalafil and nortriptyline can lower blood pressure. To avoid dizziness or fainting, stand up slowly from sitting or lying down, especially when you first start taking them together.
What is tadalafil and nortriptyline used for?
Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction (ED) [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 (10mg or 20mg, taken at least 30 minutes before sex, with effects lasting up to 36 hours) or as a daily low-dose tablet (2.5mg or 5mg). It is the active ingredient in branded Cialis and is also available as a generic medicine at lower cost.
Nortriptyline is a tricyclic antidepressant (TCA) prescribed for depression, neuropathic (nerve) pain, and the prevention of migraine headaches. It works by increasing levels of certain chemicals in the brain, such as serotonin and noradrenaline, which help improve mood and reduce pain signals. Nortriptyline is usually taken once daily, often at bedtime because it can cause drowsiness. Like other tricyclic antidepressants, it can have side effects including dry mouth, constipation, and changes in heart rhythm.
Both medicines are prescription-only in the UK. Tadalafil requires a consultation with a prescriber who will check your medical history, current medicines, and cardiovascular health. Nortriptyline is prescribed by your GP or specialist, and it is important that your ED prescriber knows you are taking it so they can assess the combination safely.
Is there an interaction between tadalafil and nortriptyline?
No major interaction is commonly reported between tadalafil and nortriptyline, and many men take both medicines together without problems. However, both can affect your cardiovascular system in different ways, so your prescriber will need to check that the combination is safe for you individually [4].
Tadalafil lowers blood pressure slightly by relaxing blood vessels. Nortriptyline, like other tricyclic antidepressants, can cause postural hypotension (a drop in blood pressure when you stand up), dizziness, and changes in heart rhythm, particularly at higher doses or when you first start taking it. When taken together, there is a theoretical risk that these blood-pressure-lowering effects could add up, leading to dizziness, light-headedness, or fainting, especially when standing up quickly.
Additionally, tricyclic antidepressants can sometimes contribute to erectile dysfunction as a side effect, although this is not common with nortriptyline. Your prescriber will consider your overall health, the doses of both medicines, and any other conditions or medicines you have. If you experience dizziness, fainting, or an unusually fast or irregular heartbeat after taking tadalafil and nortriptyline together, contact your GP or pharmacist for advice.
How the interaction works (in plain English)
Tadalafil works by blocking an enzyme called PDE5, which allows blood vessels in the penis to relax and widen. This same relaxation effect can occur in blood vessels elsewhere in the body, leading to a small drop in blood pressure. Nortriptyline affects the nervous system and can interfere with the body's ability to regulate blood pressure, particularly when you change position (such as standing up from sitting or lying down). When both medicines are present, the combined effect on blood pressure may be more noticeable in some people, especially if you are also taking other blood-pressure medicines or have heart problems. Your prescriber will assess your individual risk and may start you on a lower dose of tadalafil if needed.
When to get urgent help
- An erection lasting more than 4 hours (priapism) – go to A&E immediately
- Sudden loss of vision or hearing – stop tadalafil and seek urgent medical help
- Chest pain during or after sex – stop activity, call 999, do not take more tadalafil
- Severe dizziness, fainting, or a very fast or irregular heartbeat – seek same-day medical advice
- Allergic reaction (swelling of face, lips, tongue, or 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 nortriptyline together?
When you request tadalafil through an online consultation at Cured Pharmacy, you will be asked to list all your current medicines, including nortriptyline. The prescriber will review your medical history, focusing on your cardiovascular health, blood pressure, and any history of heart disease, stroke, or fainting episodes [2][4].
The prescriber will check whether you are taking any medicines that are absolutely contraindicated with tadalafil, such as nitrates (GTN spray, isosorbide mononitrate), nicorandil, riociguat, or recreational drugs called 'poppers' (amyl or alkyl nitrites). These combinations can cause a dangerous drop in blood pressure and must never be used together. Nortriptyline is not in this category, but the prescriber will still assess whether the combination is suitable for you.
You will also be asked about other medicines that can interact with tadalafil, such as alpha-blockers (e.g. tamsulosin, doxazosin), other blood-pressure medicines, and potent CYP3A4 inhibitors (e.g. ritonavir, ketoconazole). If you are taking multiple medicines that lower blood pressure, the prescriber may recommend starting with the lowest dose of tadalafil (10mg on-demand or 2.5mg daily) and monitoring how you respond. It is essential to answer all questions honestly and completely so the prescriber can make a safe decision.
Practical advice for taking tadalafil with nortriptyline
If your prescriber approves the combination of tadalafil and nortriptyline, there are some practical steps you can take to use both medicines safely. First, take each medicine exactly as prescribed. Do not increase the dose of tadalafil without consulting your prescriber, even if you feel the effect is not strong enough. Starting with a lower dose allows your body to adjust and reduces the risk of side effects.
Be aware of the risk of dizziness or light-headedness, particularly when you stand up quickly. This is more likely if you have just started nortriptyline, recently increased the dose, or are also taking other blood-pressure medicines. Stand up slowly from sitting or lying down, and sit down again if you feel dizzy. Avoid heavy alcohol, as it can worsen dizziness and make erectile dysfunction worse.
If you experience any unusual symptoms after taking tadalafil and nortriptyline together—such as severe dizziness, fainting, chest pain, a rapid or irregular heartbeat, or an erection lasting more than four hours—seek medical help immediately. Do not stop taking nortriptyline suddenly without speaking to your GP, as this can cause withdrawal symptoms. Always inform any healthcare professional you see (including your dentist or a hospital doctor) that you are taking both medicines.
What to do if you feel dizzy or unwell
If you feel dizzy, light-headed, or faint after taking tadalafil and nortriptyline, sit or lie down immediately and wait for the feeling to pass. Drink water and avoid sudden movements. If the dizziness is severe, does not go away, or is accompanied by chest pain, difficulty breathing, or a very fast or irregular heartbeat, call 999 or go to A&E. If you have milder dizziness that happens repeatedly, contact your GP or the prescriber who issued your tadalafil to discuss whether a lower dose or a different ED treatment might be more suitable.
At a glance
Are there other medicines I should tell my prescriber about?
Yes. When you complete your online consultation for tadalafil, you must declare every medicine you take, including prescription medicines, over-the-counter medicines, herbal remedies, and recreational drugs. Some medicines have serious interactions with tadalafil and must never be taken together [3][4].
Never take tadalafil if you use nitrates (such as GTN spray, isosorbide mononitrate, or isosorbide dinitrate for angina), nicorandil, riociguat (for pulmonary hypertension), or recreational drugs called 'poppers' (amyl or alkyl nitrites). The combination can cause a life-threatening drop in blood pressure. If you take alpha-blockers (e.g. tamsulosin, doxazosin, alfuzosin) for an enlarged prostate or high blood pressure, you must tell your prescriber; you should be stable on the alpha-blocker and will usually start on the lowest dose of tadalafil.
Potent CYP3A4 inhibitors (such as ritonavir, cobicistat, Paxlovid, ketoconazole, itraconazole, or clarithromycin) can raise tadalafil levels in your blood, increasing the risk of side effects. Your prescriber will adjust the dose or advise whether tadalafil is suitable. CYP3A4 inducers (such as rifampicin, carbamazepine, phenytoin, or St John's wort) can make tadalafil less effective. Other blood-pressure medicines can add to the blood-pressure-lowering effect of tadalafil, so your prescriber will review all of them. Do not stop or change any prescribed medicine without advice from your GP or prescriber.
How to get tadalafil safely online with nortriptyline
At Cured Pharmacy, a GPhC-registered online pharmacy (GPhC 9012511), you can request tadalafil through a confidential online consultation. The consultation is reviewed by a UK-registered prescriber who will check your medical history, current medicines (including nortriptyline), and cardiovascular health to ensure tadalafil is safe and suitable for you [2][4].
If approved, your medicine is dispensed by our UK pharmacy and delivered discreetly to your home. We offer a range of ED treatments, including generic tadalafil from £7.95 (or £6.36 for your first order with code Ednew), branded Cialis, and other PDE5 inhibitors such as sildenafil, vardenafil, and avanafil. All prices include the consultation, prescription, and delivery. You can choose on-demand tadalafil (10mg or 20mg) or daily tadalafil (2.5mg or 5mg), depending on your preference and the prescriber's recommendation.
It is important to answer all questions in the consultation honestly and completely. If you are taking nortriptyline or any other medicine, declare it. The prescriber may ask follow-up questions or request information from your GP to ensure your safety. If you have any concerns or questions about taking tadalafil and nortriptyline together, you can contact our pharmacy team for advice. Remember, if you have new or worsening erectile dysfunction, see your GP, as ED can be an early sign of heart disease or diabetes [1].
Why see your GP about new erectile dysfunction
Erectile dysfunction is common and treatable, but it can also be an early warning sign of underlying health problems such as heart disease, diabetes, high blood pressure, or high cholesterol [1][10]. If you have noticed new or worsening ED, it is important to see your GP for a check-up. Your GP can assess your overall health, check your blood pressure and blood sugar, and discuss any lifestyle changes (such as stopping smoking, losing weight, or reducing alcohol) that may help. Treating the underlying cause can improve your erections and your long-term health. Online ED services like Cured Pharmacy are a convenient option once you have had an initial assessment, but they are not a substitute for seeing your GP if you have new symptoms or other health concerns.
In summary
- No major interaction is commonly reported between tadalafil and nortriptyline.
- Both medicines can affect blood pressure; your prescriber will check your heart health.
- Stand up slowly to avoid dizziness and limit alcohol intake.
- Always declare all medicines during your online consultation.
- Seek urgent help if you have severe dizziness, chest pain, or an erection lasting over four hours.
Scientific References
- NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 24 October 2026]
- National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 24 October 2026]
- Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 24 October 2026]
- Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 24 October 2026]
- Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. Journal of Urology, 151(1), 54–61. https://pubmed.ncbi.nlm.nih.gov/8254833/ [accessed 24 October 2026]
Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.
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Medically reviewed by
Tarun Kumar, Superintendent Pharmacist (GPhC 2233073)