Tadalafil and Rilpivirine: Can They Be Taken Together?
Understand the interaction, what your prescriber checks, and how to use ED treatment safely with HIV medication.
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Tadalafil and Rilpivirine: Understanding the Interaction
Published: 25 October 2026
If you're taking rilpivirine for HIV and considering tadalafil for erectile dysfunction, you may be wondering whether tadalafil and rilpivirine can be used together safely. The good news is that rilpivirine is not known to cause a major interaction with tadalafil, but your prescriber will still need to review your full medication list and adjust your dose if necessary. This page explains how these medicines work, what checks are carried out, and the practical steps to ensure safe and effective treatment.
At a glance
What is tadalafil and rilpivirine?
Tadalafil is a prescription medicine used 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 increased blood flow when you're 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). It requires sexual stimulation to work and will not cause an erection on its own.
Rilpivirine is an antiretroviral medicine used to treat HIV-1 infection. It is a non-nucleoside reverse transcriptase inhibitor (NNRTI) that stops the virus from multiplying in your body. Rilpivirine is usually taken once daily as part of combination therapy and is found in branded products such as Edurant, Eviplera, Odefsey, and Juluca. Like all HIV medicines, it must be taken exactly as prescribed to keep the virus under control and protect your immune system.
How do tadalafil and rilpivirine interact?
Rilpivirine does not significantly affect the way tadalafil is broken down in the body. Unlike some other antiretroviral medicines (such as ritonavir or cobicistat, which are potent enzyme inhibitors), rilpivirine is not expected to raise tadalafil levels to a clinically important degree [4][12]. This means that the standard doses of tadalafil are generally considered appropriate for people taking rilpivirine.
However, it is important to remember that rilpivirine is often prescribed in combination with other antiretroviral drugs. Some of these combination tablets contain boosting agents (such as cobicistat) or protease inhibitors that do interact with tadalafil by slowing its breakdown, leading to higher levels in the blood. If your HIV treatment includes a booster or a protease inhibitor, your prescriber will need to adjust your tadalafil dose accordingly—usually starting with a lower dose and not exceeding a maximum daily amount [4]. Always tell your prescriber about every medicine you take, including the exact brand name of your HIV treatment, so they can check for interactions with all components.
Why the prescriber checks your full medication list
During your online consultation at Cured Pharmacy, the prescriber will ask you to list all your current medicines, including those for HIV. This is because some antiretroviral combinations can affect tadalafil levels, and some other medicines you take for other conditions (such as alpha-blockers for prostate symptoms or blood-pressure tablets) can also interact with tadalafil [3][4]. The prescriber will review the specific components of your HIV regimen and any other treatments to ensure the dose of tadalafil is safe and effective for you. Never assume a medicine is safe to add without a clinical check, even if you have taken it before.
What your prescriber will check before prescribing tadalafil and rilpivirine together
Your prescriber will review your medical history and current medicines to ensure tadalafil is suitable. Key checks include confirming that you are not taking any medicines that must never be combined with tadalafil—such as nitrates (GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, or recreational drugs known as 'poppers' (amyl or alkyl nitrites). Taking tadalafil with any of these can cause a dangerous drop in blood pressure [3][4].
The prescriber will also check whether your HIV treatment contains any boosting agents or protease inhibitors that might raise tadalafil levels. If so, they may recommend a lower starting dose (for example, 10mg instead of 20mg for on-demand use, or a reduced maximum dose if you prefer daily tadalafil). They will ask about your cardiovascular health, including any history of heart attack, stroke, angina, or very low blood pressure, because tadalafil is not suitable when sexual activity itself is inadvisable [2][4]. If you take alpha-blockers (such as tamsulosin or doxazosin) for prostate symptoms, the prescriber will ensure you are stable on that treatment and start you on the lowest dose of tadalafil to minimise the risk of dizziness or fainting.
Finally, the prescriber will check for any history of sudden vision loss (a rare condition called NAION) or inherited retinal disorders, as tadalafil is not recommended in these cases [4]. If you have any concerns or questions, the consultation is your opportunity to discuss them with a qualified UK healthcare professional.
What you need to know
- Rilpivirine does not significantly interact with tadalafil; standard doses are usually suitable
- If your HIV treatment includes a booster or protease inhibitor, your tadalafil dose may need adjusting
- Always tell your prescriber every medicine you take, including the exact brand of your HIV treatment
- Never take tadalafil with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor
- Seek urgent help for erections lasting over four hours or sudden vision or hearing loss
Practical advice for taking tadalafil with rilpivirine
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, but you should not take more than one dose in any 24-hour period [4]. For daily tadalafil (2.5mg or 5mg), take one tablet at the same time each day, whether or not you plan to have sex. Sexual stimulation is still needed for the medicine to work.
Continue taking your rilpivirine (and any other HIV medicines) exactly as prescribed by your HIV specialist. Do not stop or change your antiretroviral treatment without advice, as this could lead to the virus becoming resistant. Tadalafil does not affect how well rilpivirine controls HIV, and rilpivirine does not reduce the effectiveness of tadalafil when used as directed.
Avoid drinking large amounts of alcohol, as heavy drinking can worsen erectile dysfunction and add to the blood-pressure-lowering effect of tadalafil, increasing the risk of dizziness [3][4]. Grapefruit juice can raise the level of tadalafil in your blood, so it is best to avoid it or limit your intake. If you experience side effects such as headache, indigestion, back pain, or flushing, these are usually mild and temporary. However, if you develop chest pain during sex, an erection lasting more than four hours, or sudden loss of vision or hearing, seek urgent medical help.
When to contact your doctor or pharmacist
Contact your GP, HIV specialist, or pharmacist if you start any new medicine (prescription or over-the-counter) while taking tadalafil, as some drugs can interact. If your HIV treatment changes—for example, if a boosting agent is added or removed—let your ED prescriber know, as your tadalafil dose may need adjusting. If tadalafil does not seem to be working, do not simply increase the dose yourself; speak to your prescriber, who can review your treatment and explore other options. Remember, erectile dysfunction can sometimes be an early sign of other health conditions, so if ED is new or worsening, see your GP for a full assessment [1][2].
Other ED treatments and rilpivirine interactions
Tadalafil is not the only option for treating erectile dysfunction. Other PDE5 inhibitors include sildenafil (the active ingredient in Viagra), vardenafil (Levitra), and avanafil (Spedra). All of these medicines work in a similar way and share the same important contraindications—never take them with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor [3][5][6].
Rilpivirine itself does not significantly interact with sildenafil, vardenafil, or avanafil. However, if your HIV treatment includes a potent CYP3A4 inhibitor (such as ritonavir or cobicistat), the prescriber will need to adjust the dose or avoid certain PDE5 inhibitors altogether. For example, vardenafil and avanafil are contraindicated or not recommended with potent inhibitors, whereas sildenafil and tadalafil can be used at reduced doses [3][4][5][6]. Your prescriber will choose the most suitable option based on your full medication list.
If oral tablets are not suitable or effective, other prescription treatments are available, such as Vitaros (alprostadil cream applied to the tip of the penis) or Caverject (alprostadil injection). These work by a different mechanism and are not affected by the same drug interactions as PDE5 inhibitors, though they require careful instruction and are usually considered after oral treatments have been tried [7]. Your GP or a specialist can discuss these options with you if needed.
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 – seek urgent medical attention
- Sudden decrease or loss of hearing – contact a doctor straight away
- Chest pain during or after sex – call 999; do not take more tadalafil or any nitrate medicine
- Severe dizziness or fainting, especially when standing – sit or lie down and contact your doctor
Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.
How to access tadalafil safely through Cured Pharmacy
Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering a convenient, confidential service for erectile dysfunction treatment. All prescription medicines, including tadalafil, are only supplied after an online consultation that is reviewed by a UK-registered prescriber. During the consultation, you will be asked about your medical history, current medicines (including your HIV treatment), and any other health conditions. This ensures that tadalafil is safe and appropriate for you.
We offer a range of tadalafil products, including generic tadalafil tablets and branded Cialis, as well as other ED treatments such as sildenafil, vardenafil, and avanafil. Once your consultation is approved, your medicine is dispensed by our qualified pharmacists and delivered discreetly to your door. If you have any questions about your treatment or how to take it, our pharmacy team is here to help.
Remember, while online services offer convenience, it is important to see your GP if you have new or worsening erectile dysfunction, as ED can be an early warning sign of cardiovascular disease or diabetes [1][2]. Your GP can arrange tests and address any underlying causes. If you are already under the care of an HIV specialist and your general health is stable, an online consultation for ED treatment can be a safe and effective option, provided you give complete and accurate information about all your medicines.
Why choose Cured Pharmacy for your ED treatment
Cured Pharmacy combines clinical expertise with a straightforward, supportive service. Our prescribers and pharmacists are experienced in managing ED and understand the importance of checking for drug interactions, especially in people taking complex medication regimens such as antiretroviral therapy. We respect your privacy and provide clear, honest information to help you make informed decisions about your treatment. All our medicines are sourced from licensed UK suppliers and meet rigorous quality standards. If you have any concerns or need advice at any stage, our team is just a message away.
Always declare your HIV treatment
During your consultation, list the exact brand name of your HIV medicine (not just 'rilpivirine'), as combination tablets may contain boosting agents that require a lower tadalafil dose. Complete information ensures safe, effective treatment.
Scientific References
- NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 25 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 25 October 2026]
- Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 25 October 2026]
- Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 25 October 2026]
- Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 25 October 2026]
- Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 25 October 2026]
- Joint Formulary Committee. (n.d.). Alprostadil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/alprostadil/ [accessed 25 October 2026]
- Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [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.
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Common Questions
Can I take tadalafil if I'm on rilpivirine for HIV?
Yes, rilpivirine does not significantly interact with tadalafil, so standard doses are usually suitable. However, your prescriber will review your full HIV treatment (including any boosting agents) and other medicines to ensure safety.
Will tadalafil affect how well my HIV medication works?
No, tadalafil does not interfere with rilpivirine or other antiretroviral medicines. Continue taking your HIV treatment exactly as prescribed by your specialist.
Do I need a lower dose of tadalafil if I take rilpivirine?
Rilpivirine alone does not usually require a dose reduction. However, if your HIV regimen includes a boosting agent (ritonavir or cobicistat) or a protease inhibitor, your prescriber will adjust the tadalafil dose accordingly.
What should I tell my prescriber during the consultation?
List all your current medicines, including the exact brand name of your HIV treatment, any other prescriptions, over-the-counter medicines, and supplements. This allows the prescriber to check for interactions and choose the safest dose.
Can I take tadalafil with other antiretroviral drugs?
Many antiretroviral medicines can be taken with tadalafil, but some (especially those containing ritonavir or cobicistat) require dose adjustments. Your prescriber will review your specific regimen and advise you.
Are there any HIV medicines I must not take with tadalafil?
Tadalafil can be used with most HIV medicines, though doses may need adjusting. The main concern is potent enzyme inhibitors (boosters), which require lower tadalafil doses. Your prescriber will check the SmPC for your specific combination.
What are the warning signs I should watch for?
Seek urgent help if you have an erection lasting more than four hours, sudden loss of vision or hearing, or chest pain during sex. Contact your doctor if you feel dizzy or faint, especially when standing up.
Can I switch from tadalafil to another ED treatment if needed?
Yes, other PDE5 inhibitors (sildenafil, vardenafil, avanafil) are available, though the same interaction principles apply. Your prescriber can discuss alternatives if tadalafil is not suitable or effective for you.
Medically reviewed by
Tarun Kumar, Superintendent Pharmacist (GPhC 2233073)