Tadalafil and Ramipril: Can You Take Them Together?

Tadalafil and Ramipril: Understanding the Interaction

Published: 25 October 2026

Tadalafil and ramipril can usually be taken together safely, but because both medicines lower blood pressure, your prescriber will check carefully before approving the combination. Ramipril is an ACE inhibitor used to treat high blood pressure and heart conditions, while tadalafil is a PDE5 inhibitor that helps with erectile dysfunction (ED) by improving blood flow to the penis [1][4]. This page explains how the two medicines interact, what checks are needed, and practical steps to use them safely.

What Is Tadalafil and How Does It Work?

Tadalafil is a prescription medicine used to treat erectile dysfunction in men. 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 [4]. Tadalafil does not cause an erection on its own—sexual stimulation is still needed.

Tadalafil is available in two main 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) for men who prefer to be ready at any time [4]. Common brand names include Cialis, and generic versions are widely available at lower cost.

Because tadalafil relaxes blood vessels throughout the body, it can cause a small drop in blood pressure. This effect is usually mild, but it becomes more important when tadalafil is combined with other medicines that also lower blood pressure, such as ramipril [4].

What Is Ramipril and Why Is It Prescribed?

Ramipril is a medicine called an ACE inhibitor (angiotensin-converting enzyme inhibitor), commonly prescribed to treat high blood pressure, heart failure, and to protect the kidneys in people with diabetes. It works by blocking an enzyme that narrows blood vessels, allowing vessels to relax and widen, which lowers blood pressure and reduces the workload on the heart.

Ramipril is usually taken once a day, and it may take several weeks to show its full effect on blood pressure. Common side effects include a dry cough, dizziness (especially when standing up), and tiredness. Because ramipril lowers blood pressure, adding another medicine that also has this effect—such as tadalafil—can increase the risk of dizziness or feeling faint.

Many men with high blood pressure or heart conditions also experience erectile dysfunction, so it is not uncommon to need both ramipril and an ED treatment. The good news is that the combination is usually manageable with the right precautions and medical oversight.

How Do Tadalafil and Ramipril Interact?

Tadalafil and ramipril can both lower blood pressure, so when taken together, there is a potential for an additive effect—meaning your blood pressure may drop more than it would with either medicine alone [4]. This can lead to symptoms such as dizziness, light-headedness, or fainting, particularly when you stand up quickly or after taking the first dose of tadalafil.

However, this interaction is not a contraindication. Unlike nitrates, nicorandil, or riociguat—which must never be taken with tadalafil because they can cause a dangerous drop in blood pressure—ramipril and tadalafil can be used together if your prescriber judges it safe to do so [4]. The key is careful assessment and sometimes starting with a lower dose of tadalafil.

Your prescriber will review your current blood pressure control, any symptoms of low blood pressure, and your overall heart health. If your blood pressure is well controlled on ramipril and you have no history of dizziness or fainting, tadalafil is usually considered safe. The prescriber may recommend starting with the lowest effective dose (for example, 10 mg on-demand or 2.5 mg daily) and monitoring how you feel [4].

The Mechanism in Plain English

Both ramipril and tadalafil cause blood vessels to relax, but they do so in different ways. Ramipril blocks a hormone system that tightens blood vessels, while tadalafil increases a chemical (cyclic GMP) that relaxes smooth muscle in blood vessel walls. When both effects happen at once, blood vessels relax more, and blood pressure can fall further than with one medicine alone. This is usually well tolerated, but it is why your prescriber checks your blood pressure and asks about symptoms before approving the combination.

What Your Prescriber Will Check Before Approving Tadalafil and Ramipril Together

Before prescribing tadalafil to someone taking ramipril, a UK prescriber will ask several important questions. They will want to know your current blood pressure readings, whether you have experienced dizziness or fainting, and whether your blood pressure is stable on your current dose of ramipril. They will also ask about other medicines you take, as some combinations (such as alpha-blockers or potent CYP3A4 inhibitors) require extra caution [4].

The prescriber will review your heart health, including any history of heart attack, stroke, angina, or heart failure. Tadalafil is not suitable if sexual activity itself is inadvisable due to severe heart disease [4]. They will also check for contraindications such as recent stroke, very low blood pressure, or use of nitrates or nicorandil.

If everything is suitable, the prescriber may start you on a lower dose of tadalafil and advise you to monitor for symptoms such as dizziness, especially in the first few doses. You should never adjust the dose of ramipril or tadalafil yourself—always follow the prescriber's instructions and report any concerns.

Declaring All Your Medicines

It is essential to list every medicine you take during your online consultation, including over-the-counter products, herbal remedies, and any medicines prescribed by different doctors. This includes other blood pressure medicines, alpha-blockers (such as tamsulosin for prostate symptoms), and medicines that can interact with tadalafil, such as ritonavir or ketoconazole. The prescriber uses this information to check for interactions and choose the safest dose for you.

Practical Advice for Taking Tadalafil and Ramipril Safely

If you are prescribed tadalafil while taking ramipril, take both medicines exactly as directed. Do not take more tadalafil than prescribed, and do not take it more often than once a day (for on-demand doses) [4]. If you are using daily tadalafil, take it at the same time each day, and do not double up if you miss a dose.

Be cautious when standing up, especially in the first few hours after taking tadalafil, as this is when blood pressure is most likely to drop. Sit on the edge of the bed for a moment before standing, and avoid sudden movements. If you feel dizzy or light-headed, sit or lie down until the feeling passes. Avoid heavy alcohol, as it can worsen low blood pressure and make erectile dysfunction worse.

Keep your GP or prescriber informed if you notice new symptoms such as persistent dizziness, fainting, unusual tiredness, or if your blood pressure readings change. Do not stop taking ramipril without medical advice, as this can cause your blood pressure to rise suddenly. If you have any concerns about the combination, contact your prescriber or pharmacist for advice.

Warning Signs and When to Seek Help

Most men tolerate tadalafil and ramipril together without problems, but you should know the warning signs that need urgent attention. If you experience chest pain during or after sex, stop activity and seek immediate medical help—do not take more tadalafil or any nitrate medicine (such as GTN spray), as this combination is dangerous [4].

If you have an erection lasting more than four hours (priapism), go to A&E immediately, as this can cause permanent damage if not treated quickly [4]. Sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing (sometimes with ringing in the ears or dizziness), also requires urgent medical attention.

Severe dizziness, fainting, or a very fast or irregular heartbeat after taking tadalafil should be reported to a doctor the same day. If you are unsure whether a symptom is serious, contact NHS 111 for advice, or call 999 if you feel very unwell.

What About Other Blood Pressure Medicines?

If you take other blood pressure medicines in addition to ramipril—such as amlodipine, bisoprolol, or bendroflumethiazide—the same principles apply: tadalafil can add to the blood-pressure-lowering effect, so your prescriber will check the combination carefully. Alpha-blockers (such as doxazosin or tamsulosin) require particular caution, and you should be stable on the alpha-blocker before starting tadalafil, usually at the lowest dose. Always declare every medicine during your consultation.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 25 October 2026]
2. National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 25 October 2026]
3. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 25 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.