Tadalafil and Roflumilast: Can You Take Them Together?

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Tadalafil and Roflumilast: Understanding the Interaction

Published: 25 October 2026

If you're prescribed roflumilast for chronic obstructive pulmonary disease (COPD) and considering tadalafil for erectile dysfunction, you may wonder whether tadalafil and roflumilast can be taken together safely. The good news is that no major interaction between these two medicines is commonly reported in clinical practice. However, because both medicines can affect your body in different ways, your prescriber will carefully review your full medication list and health history during your consultation to ensure the combination is appropriate for you.

What is tadalafil and roflumilast used for?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction (ED) in adult men [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 option (2.5mg or 5mg taken once a day) [4]. It requires sexual stimulation to work and does not increase desire on its own.

Roflumilast is a phosphodiesterase type 4 (PDE4) inhibitor prescribed for severe COPD in adults with chronic bronchitis and a history of frequent flare-ups [12]. It works by reducing inflammation in the airways, helping to prevent COPD exacerbations. Roflumilast is taken as a 500 microgram tablet once daily and is used alongside bronchodilator therapy, not as a first-line treatment. Because tadalafil and roflumilast target different enzymes (PDE5 versus PDE4), they do not directly interfere with each other's mechanism of action.

Both medicines are prescription-only in the UK. If you are considering tadalafil for ED while taking roflumilast, you will need an online or face-to-face consultation with a prescriber who will review your current medications, COPD severity, cardiovascular health, and any other conditions to ensure tadalafil is safe and suitable for you.

Is there an interaction between tadalafil and roflumilast?

No major drug interaction between tadalafil and roflumilast is commonly reported in standard reference sources or clinical practice [3][4][12]. The two medicines work on different enzyme systems: tadalafil inhibits PDE5 (found mainly in blood vessels of the penis, lungs, and other tissues), while roflumilast inhibits PDE4 (involved in inflammatory cells in the airways). This means they do not compete for the same biochemical pathways or significantly alter each other's breakdown or effectiveness.

However, both medicines can have effects on the cardiovascular system. Tadalafil can cause a small drop in blood pressure, which is usually mild and well tolerated [4]. Roflumilast is not known to significantly affect blood pressure, but COPD itself and other medicines you may be taking for lung or heart conditions can influence cardiovascular stability. Your prescriber will assess your overall health picture, including lung function, heart health, and any other medications (such as beta-blockers, diuretics, or corticosteroids), to ensure the combination is safe for you.

It is important never to stop or change the dose of roflumilast or any prescribed medicine without consulting your doctor or pharmacist. If you experience new or worsening symptoms after starting tadalafil, contact your healthcare team promptly for advice.

What your prescriber will check

During your consultation, the prescriber will ask about your current dose of roflumilast, how well your COPD is controlled, and whether you have any cardiovascular conditions such as angina, heart failure, or a recent heart attack or stroke [2][4]. They will also check for medicines that are known to interact dangerously with tadalafil, including nitrates (GTN spray, isosorbide mononitrate), nicorandil, riociguat, and alpha-blockers (e.g. doxazosin, tamsulosin) [3][4]. If you are on an alpha-blocker, you must be stable on that treatment and start tadalafil at the lowest dose to minimise the risk of dizziness or fainting. The prescriber will also review any other medicines that affect liver enzymes, as these can alter tadalafil levels in your blood.

How tadalafil and roflumilast are processed in the body

Tadalafil is broken down mainly by an enzyme in the liver called CYP3A4 [4]. Medicines that strongly inhibit this enzyme (such as ritonavir, cobicistat, ketoconazole, itraconazole, or clarithromycin) can increase tadalafil levels, raising the risk of side effects like headache, flushing, or low blood pressure. Conversely, medicines that induce CYP3A4 (such as rifampicin, carbamazepine, phenytoin, or St John's wort) can reduce tadalafil levels and make it less effective [3][4].

Roflumilast is also metabolised by liver enzymes, including CYP3A4 and CYP1A2 [12]. Strong CYP3A4 inhibitors can increase roflumilast levels, and strong inducers (like rifampicin) can reduce them. However, because tadalafil itself is a substrate (not an inhibitor or inducer) of CYP3A4, it does not significantly alter roflumilast metabolism, and roflumilast does not significantly affect tadalafil breakdown.

If you are taking any other medicines alongside tadalafil and roflumilast, always declare them during your consultation. Your prescriber or pharmacist will check for any potential interactions and adjust doses or timing if needed. Do not start new medicines, including over-the-counter products or herbal supplements, without seeking advice first.

Practical advice for taking tadalafil and roflumilast together

If your prescriber confirms that tadalafil is suitable for you while taking roflumilast, follow the dosing instructions carefully. Take roflumilast once daily at the same time each day, with or without food, as directed by your doctor [12]. For on-demand tadalafil, take one tablet (usually 10mg, adjusted to 20mg or reduced to 5mg as needed) at least 30 minutes before sexual activity; do not take more than one dose in 24 hours [4]. If you are prescribed daily tadalafil (2.5mg or 5mg), take it at the same time each day, regardless of when you plan to have sex.

Be aware of common side effects of tadalafil, which include headache, indigestion, back pain, muscle aches, flushing, and nasal congestion [4]. These are usually mild and temporary. Roflumilast can cause nausea, diarrhoea, weight loss, headache, and mood changes [12]. If you experience dizziness or light-headedness after taking tadalafil, avoid driving or operating machinery until you feel steady. Limit alcohol intake, as heavy drinking can worsen erectile dysfunction and add to the blood-pressure-lowering effect of tadalafil [1][4].

Avoid grapefruit juice while taking tadalafil, as it can increase the medicine's levels in your blood [4]. Continue to attend regular reviews with your GP or respiratory specialist to monitor your COPD and overall health. If you develop chest pain during sex, stop immediately and seek urgent medical help; do not take nitrate medicines (GTN spray) if you have used tadalafil in the past 48 hours, as this combination can cause a dangerous drop in blood pressure [3][4].

When tadalafil is not suitable

Tadalafil must never be taken if you are using nitrates (GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, or recreational drugs called 'poppers' (amyl or alkyl nitrites) [3][4]. Do not take tadalafil alongside another PDE5 inhibitor (sildenafil, vardenafil, or avanafil). It is also not suitable if you have had a heart attack or stroke in the past three months, have unstable angina, severe heart failure, very low blood pressure, or a history of sudden vision loss (non-arteritic anterior ischaemic optic neuropathy, or NAION) [2][4]. Your prescriber will assess whether sexual activity is safe for you based on your cardiovascular and respiratory health.

Warning signs and when to seek help with tadalafil and roflumilast

Most men taking tadalafil and roflumilast together do not experience serious problems, but you should know the warning signs that require urgent medical attention. If you develop an erection that lasts longer than four hours (priapism), go to A&E immediately, as this can cause permanent damage to the penis [3][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), are rare but serious side effects; stop tadalafil and seek medical help straight away [4].

If you experience chest pain, severe dizziness, or fainting during or after sex, call 999 or go to A&E [2][4]. Tell the paramedics or emergency doctor that you have taken tadalafil and when, as this will affect which treatments they can safely give you. Do not take nitrate medicines (such as GTN spray) yourself if you have used tadalafil in the past 48 hours.

For less urgent concerns—such as persistent headache, worsening breathlessness, unexplained weight loss, or mood changes that may be related to roflumilast—contact your GP or pharmacist for advice [12]. If you are unsure whether a symptom is related to your medicines or your underlying conditions, it is always safer to ask. Never stop taking roflumilast or any prescribed medicine without consulting your doctor, as this could lead to a flare-up of your COPD.

Getting tadalafil safely with roflumilast from Cured Pharmacy

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering a range of erectile dysfunction treatments, including tadalafil, after a confidential online consultation reviewed by a UK-registered prescriber [4]. When you complete the health questionnaire, you will be asked to list all your current medicines, including roflumilast, and to provide details of your COPD, cardiovascular health, and any other conditions. The prescriber will review this information to ensure tadalafil is safe and appropriate for you.

If approved, your medicine is dispensed by UK pharmacists and delivered discreetly to your door. You can choose from generic tadalafil (from £7.95, or £6.36 for your first order with code Ednew), branded Cialis (from £12.00, or £9.60 with code Ednew), or other PDE5 inhibitors such as sildenafil, vardenafil, or avanafil if tadalafil is not suitable [3][4][5][6]. All treatments require a valid prescription following the online consultation.

If you have any questions about taking tadalafil and roflumilast together, or if your health changes after starting treatment, you can contact the pharmacy team for advice. Remember that erectile dysfunction can be an early sign of heart disease or diabetes, so if you are experiencing ED for the first time, it is important to see your GP for a full health check [1][2]. Online consultations are a convenient option for ongoing treatment, but they complement—not replace—regular face-to-face care with your doctor.

Other ED treatment options

If tadalafil is not suitable or you prefer a different option, other PDE5 inhibitors are available. Sildenafil (generic Viagra) is taken about one hour before sex and lasts around four to six hours [3]. Vardenafil (generic Levitra) is taken 25 to 60 minutes before sex [5], and avanafil (Spedra) works in as little as 15 to 30 minutes [6]. All require sexual stimulation to work and have similar precautions regarding nitrates, alpha-blockers, and other interactions. Your prescriber will help you choose the most suitable treatment based on your health, preferences, and how you respond to the medicine.

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.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 25 October 2026]
4. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 25 October 2026]
5. Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 25 October 2026]
6. Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 25 October 2026]
7. 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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