Tadalafil and Poppers: Never Take Them Together

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At a glance

What is tadalafil and how does it work?

Tadalafil is a prescription medicine licensed in the UK to treat erectile dysfunction (ED) in men [4]. It belongs to a group of medicines called PDE5 inhibitors, which work by relaxing the blood vessels in the penis, allowing more blood to flow in when you are sexually aroused. This helps you get and keep an erection suitable for sexual activity. Tadalafil does not work without sexual stimulation—it is not an aphrodisiac and will not cause an erection on its own.

Tadalafil is available in two forms: on-demand tablets (usually 10 mg or 20 mg taken at least 30 minutes before sex, with effects lasting up to 36 hours) and daily low-dose tablets (2.5 mg or 5 mg taken once a day) [4]. The long duration of action is why tadalafil is sometimes called the 'weekend pill'. Because tadalafil lowers blood pressure slightly as part of how it works, it can interact dangerously with other substances that also affect blood pressure, including poppers.

What are poppers and why are they used?

Poppers is the common name for a group of chemicals called alkyl nitrites, including amyl nitrite, butyl nitrite, and isobutyl nitrite. They are volatile liquids that produce vapour when the container is opened, and users inhale the fumes to experience a brief 'rush' or 'high' that lasts a few minutes. Poppers cause blood vessels throughout the body to relax and widen rapidly, which lowers blood pressure and increases heart rate. Some people use poppers recreationally during sex because they can produce a feeling of euphoria, warmth, and muscle relaxation.

Although poppers are sometimes sold in shops or online as 'room odourisers' or 'leather cleaners', they are not safe to inhale and are not approved medicines in the UK. Possession of alkyl nitrites for personal use is not illegal, but supply for human consumption is restricted under the Psychoactive Substances Act 2016. Importantly, poppers belong to the same chemical family as medical nitrates (such as GTN spray used for angina), and they have the same dangerous interaction with tadalafil and all other PDE5 inhibitors.

Why tadalafil and poppers must never be taken together

Do not take tadalafil and poppers together. This combination is absolutely contraindicated, meaning it is never safe under any circumstances [4]. Both substances lower blood pressure by relaxing blood vessels, but they do so through different mechanisms that amplify each other. Tadalafil works by inhibiting an enzyme called PDE5, which leads to increased levels of a molecule (cGMP) that relaxes smooth muscle in blood vessels. Poppers (alkyl nitrites) release nitric oxide in the body, which also increases cGMP levels through a different pathway.

When you combine tadalafil with poppers, the effect on cGMP is dramatically increased, causing blood vessels to relax far more than they would with either substance alone. This can lead to a severe and sudden drop in blood pressure (hypotension), which may cause fainting, dizziness, heart attack, stroke, or death [3][4]. The risk applies even if you take poppers hours after tadalafil, because tadalafil stays in your system for up to 36 hours. There is no safe time gap between the two substances during this period, and no safe dose of either that makes the combination acceptable.

How the interaction affects your body

When blood pressure drops suddenly and severely, your heart and brain may not receive enough oxygen-rich blood. You may feel dizzy, lightheaded, or faint. Your heart may try to compensate by beating faster, which can trigger chest pain (angina) or even a heart attack, especially if you have underlying heart disease. In extreme cases, the drop in blood pressure can lead to shock, loss of consciousness, stroke, or cardiac arrest. Because the interaction is so dangerous and unpredictable, emergency medical treatment may be needed, and the outcome can be life-threatening even in otherwise healthy individuals.

What you need to know

• Tadalafil and poppers must never be taken together—the combination can cause life-threatening low blood pressure.
• Tadalafil stays active for up to 36 hours, so avoid poppers for at least two days after taking a dose.
• Always declare poppers or recreational drug use during your consultation—it is confidential and essential for your safety.
• If you take both by mistake, call 999 immediately and tell medical staff what you have taken.
• Non-drug ED treatments like vacuum devices or Eroxon gel do not carry the same interaction risk.

What your prescriber checks before prescribing tadalafil

Before tadalafil can be prescribed, a UK-registered prescriber must review your medical history and current medicines to ensure it is safe for you [2][4]. You will be asked about any heart or blood vessel problems, recent heart attack or stroke, blood pressure (both high and low), and whether you take any nitrate medicines for angina (such as GTN spray, isosorbide mononitrate, or nicorandil). You must also declare if you use poppers or any other recreational substances, as this will affect whether tadalafil can be prescribed safely.

The prescriber will check for other contraindications, including severe liver or kidney disease, certain eye conditions (such as previous sudden vision loss or inherited retinal disorders), and whether sexual activity is advisable for you given your overall health [4]. If you take other medicines—such as alpha-blockers for prostate problems, blood pressure tablets, or medicines that interact with tadalafil metabolism (like some antibiotics or antifungals)—the prescriber will assess whether tadalafil is suitable and, if so, which dose is safest. Honesty during this consultation is essential: withholding information about poppers or other drug use can put your life at risk.

Why you must be honest about poppers use

Some men feel embarrassed to mention recreational drug use during a medical consultation, but it is vital that you do. Prescribers are not there to judge you—they need accurate information to prescribe safely and protect your health. If you use poppers and do not declare it, you may be prescribed tadalafil and then suffer a life-threatening reaction if you use poppers while the medicine is still in your system. All information you provide during an online consultation at Cured Pharmacy is confidential and handled in line with UK data protection laws. Your safety is the priority, and no treatment will be supplied if the combination poses a serious risk.

Practical advice if you are prescribed tadalafil

If you have been prescribed tadalafil, do not use poppers at any time while the medicine is in your system. Because tadalafil can remain active for up to 36 hours after you take an on-demand dose, you must avoid poppers for at least two full days after taking a tablet [4]. If you are on daily tadalafil, you must not use poppers at all while you are taking the treatment. There is no safe way to combine the two, and even a small amount of poppers can trigger a dangerous drop in blood pressure.

If you have used poppers and are considering starting tadalafil, you should wait until the poppers have completely left your system (usually within a few hours of inhalation) and discuss the timing with your prescriber. However, if you find it difficult to avoid poppers, tadalafil and other PDE5 inhibitors may not be suitable for you, and you should speak to your doctor or pharmacist about alternative treatments for ED, such as vacuum devices, topical treatments like Eroxon gel (a non-prescription medical device), or other options that do not carry the same interaction risk [1][2].

When to get urgent help

• Severe dizziness, fainting, or feeling like you might faint after taking tadalafil and poppers together—call 999 immediately.
• Chest pain, fast or irregular heartbeat, or difficulty breathing during or after sex—go to A&E or call 999.
• Sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing—seek emergency medical help.
• An erection lasting longer than four hours (priapism)—go to A&E immediately to prevent permanent damage.
• Confusion, loss of consciousness, or signs of shock after combining tadalafil with any nitrate substance—call 999.

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

Warning signs and when to get urgent help

If you have taken tadalafil and poppers together—even by mistake—and you feel unwell, seek emergency medical help immediately by calling 999 or going to A&E. Tell the paramedics or doctors exactly what you have taken and when, as this information is critical for treatment. Warning signs of a dangerous drop in blood pressure include severe dizziness, fainting or feeling like you might faint, a fast or irregular heartbeat, chest pain, difficulty breathing, confusion, or loss of consciousness. Do not wait to see if symptoms improve—this is a medical emergency.

Even if you have not combined tadalafil with poppers, you should seek urgent help if you experience chest pain during or after sex, sudden loss of vision in one or both eyes, sudden decrease or loss of hearing (sometimes with ringing in the ears), or an erection that lasts longer than four hours (priapism) [3][4]. These are rare but serious side effects of tadalafil that require immediate medical attention. Always carry a list of your current medicines (including tadalafil) and be honest with healthcare professionals about any recreational substances you have used, as this helps them provide the safest and most effective treatment.

Other medicines and substances to avoid with tadalafil

In addition to poppers, tadalafil must never be taken with any nitrate medicines (such as GTN spray, isosorbide mononitrate, or isosorbide dinitrate), nicorandil (used for angina), or riociguat (used for pulmonary hypertension), as these all cause the same dangerous interaction [4]. You should also not take tadalafil at the same time as another PDE5 inhibitor (such as sildenafil or vardenafil). Other medicines may require dose adjustments or extra caution—for example, alpha-blockers for prostate problems, some blood pressure tablets, and certain antibiotics or antifungals. Your prescriber will review all your current medicines during the consultation, but you should never stop or change a prescribed medicine without professional advice.