Tadalafil and Telmisartan: Can You Take Them Together?

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What is tadalafil and telmisartan?

Tadalafil is a prescription medicine licensed in the UK to treat erectile dysfunction [4]. 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 are sexually aroused. Tadalafil is the active ingredient in branded Cialis and is also available as a lower-cost generic. It can be taken on-demand (10mg or 20mg at least 30 minutes before sex, with effects lasting up to 36 hours) or as a daily tablet (2.5mg or 5mg) [4].

Telmisartan is a prescription medicine used to treat high blood pressure (hypertension). It belongs to a class of medicines called angiotensin II receptor blockers (ARBs), which work by blocking the action of a hormone that narrows blood vessels, thereby lowering blood pressure and reducing the strain on your heart. Telmisartan is often prescribed as a long-term treatment to reduce the risk of heart attacks, strokes, and kidney problems in people with high blood pressure.

Both medicines affect blood pressure, which is why understanding their interaction is important for safe and effective treatment.

How do tadalafil and telmisartan interact?

Tadalafil and telmisartan 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 is not the same as a dangerous interaction like the one between tadalafil and nitrates (which you must never take together), but it does mean the combination needs to be managed carefully.

In plain English, telmisartan lowers your blood pressure by relaxing your blood vessels throughout your body. Tadalafil also causes blood vessels to relax, particularly in the penis, but it has a mild blood-pressure-lowering effect elsewhere too. When you take both medicines, the combined relaxation of blood vessels can sometimes cause dizziness, light-headedness, or fainting, especially when you stand up quickly.

For most men whose blood pressure is well controlled on telmisartan, tadalafil can be used safely, but your prescriber will need to check your current blood pressure, your dose of telmisartan, and whether you have any other conditions or take other medicines that might increase the risk of low blood pressure. This is why a clinical consultation is required before tadalafil is prescribed.

Is the interaction dangerous?

The interaction between tadalafil and telmisartan is usually manageable and not considered dangerous for most men, provided your blood pressure is stable and you are under medical supervision [4]. However, if your blood pressure drops too low, you may feel dizzy, faint, or unwell, and in rare cases this can lead to falls or other complications. This is why it is essential to be honest during your consultation about all the medicines you take, including over-the-counter products and supplements, and to report any symptoms of low blood pressure to your prescriber or pharmacist.

When to get urgent help

• Chest pain or discomfort during or after sex (call 999 immediately)
• Erection lasting more than four hours (priapism – go to A&E)
• Sudden loss of vision or hearing (stop tadalafil and seek urgent medical help)
• Severe dizziness, fainting, or feeling very unwell (contact GP same day or call 111)
• Swelling of face, lips, or throat, or difficulty breathing (call 999 – possible allergic reaction)

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

What will my prescriber check before prescribing tadalafil and telmisartan together?

When you request tadalafil through Cured Pharmacy, a UK-registered prescriber will review your online consultation to ensure it is safe for you. If you are taking telmisartan or any other blood pressure medicine, the prescriber will check several important factors [2].

First, they will ask about your current blood pressure readings and whether your blood pressure is well controlled on telmisartan. If your blood pressure is too low (hypotension) or poorly controlled, tadalafil may not be suitable, or adjustments may be needed. Second, they will review your full list of medicines to check for other interactions, particularly with nitrates, nicorandil, riociguat, alpha-blockers, or other medicines that affect blood pressure. Third, they will assess your overall cardiovascular health, including any history of heart attack, stroke, angina, or heart failure, because sexual activity itself can put strain on the heart [2].

The prescriber may recommend starting on a lower dose of tadalafil (such as 10mg on-demand or 2.5mg daily) to minimise the risk of low blood pressure. They will also advise you on warning signs to watch for and when to seek medical help. This careful assessment is a legal requirement and ensures your safety.

Practical advice for taking tadalafil with telmisartan

If your prescriber approves tadalafil while you are taking telmisartan, there are several practical steps you can take to use both medicines safely. Take telmisartan exactly as prescribed by your GP, at the same time each day, and do not stop or change the dose without medical advice. If you are using on-demand tadalafil, take it at least 30 minutes before sexual activity (effects can last up to 36 hours), and remember that sexual stimulation is needed for it to work [4].

Be cautious when standing up from sitting or lying down, especially in the first few hours after taking tadalafil, as this is when the blood-pressure-lowering effect is most noticeable. If you feel dizzy or light-headed, sit or lie down until the feeling passes. Avoid drinking large amounts of alcohol, as this can make low blood pressure worse and reduce the effectiveness of tadalafil. Grapefruit juice can raise tadalafil levels in your blood and should be avoided [4].

Monitor your blood pressure at home if your GP or prescriber has recommended it, and report any unusual symptoms such as persistent dizziness, fainting, or feeling unwell. If you experience chest pain during sex, stop immediately and seek urgent medical help. Do not take tadalafil more than once a day, and never take it with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor, as these combinations can cause a dangerous drop in blood pressure.

What if I take other blood pressure medicines?

If you take other blood pressure medicines in addition to telmisartan—such as amlodipine (a calcium-channel blocker), bisoprolol (a beta-blocker), or a diuretic (water tablet)—the same principles apply. The prescriber will assess the combined effect on your blood pressure and may adjust the dose of tadalafil or advise extra caution. Alpha-blockers (such as doxazosin or tamsulosin, often used for prostate symptoms) require particular care, as they can interact more significantly with tadalafil; you should be stable on the alpha-blocker and start on the lowest dose of tadalafil [3][4]. Always declare every medicine you take during your consultation.

At a glance

Warning signs and when to seek help with tadalafil and telmisartan

Most men tolerate tadalafil and telmisartan together without problems, but it is important to know the warning signs that need medical attention. Seek urgent help (call 999 or go to A&E) if you experience chest pain or discomfort during or after sex, as this could indicate a heart problem. Also seek emergency help if you have an erection lasting more than four hours (priapism), as this can cause permanent damage if not treated quickly, or if you have sudden loss of vision or hearing [4].

Contact your GP or prescriber the same day if you feel persistently dizzy, faint, or unwell after taking tadalafil, or if your blood pressure readings are unusually low. Stop taking tadalafil and seek advice if you develop severe headache, palpitations, or swelling of the face, lips, or throat (signs of an allergic reaction). If you are unsure whether a symptom is serious, contact NHS 111 for advice or speak to a pharmacist.

Remember that tadalafil is not suitable for everyone. If sexual activity is inadvisable due to severe heart disease, very low blood pressure, recent heart attack or stroke, or certain eye conditions, your prescriber will discuss alternative treatments for ED [2][4].

Getting tadalafil safely at Cured Pharmacy

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering convenient access to ED treatments, including tadalafil, after a clinical consultation reviewed by a UK-registered prescriber. If you are taking telmisartan or any other blood pressure medicine, you will be asked to provide details during the online consultation, and the prescriber will assess whether tadalafil is safe and appropriate for you.

We stock a range of tadalafil options to suit different needs and budgets, including generic tadalafil from £7.95 (£6.36 with first-order code Ednew), branded Cialis from £12.00 (£9.60 with code Ednew), and other PDE5 inhibitors such as sildenafil (generic Viagra) from £0.45 (£0.36 with code Ednew) and Spedra (avanafil) from £20.95 (£16.76 with code Ednew). All prices include the prescriber consultation and discreet delivery.

If you have new or worsening erectile dysfunction, we encourage you to see your GP first, as ED can be an early warning sign of heart disease, diabetes, or other health conditions that need investigation [1][2]. Once any underlying causes have been addressed, our prescribers can help you find the right ED treatment to use safely alongside your blood pressure medicine.

What if tadalafil is not suitable for me?

If tadalafil is not suitable due to your blood pressure or other health conditions, there are alternative treatments for ED. Other PDE5 inhibitors such as sildenafil, vardenafil, or avanafil work in a similar way and may be options, though they have similar interactions with blood pressure medicines [3][5][6]. Non-tablet treatments include Eroxon gel (a medical device available without prescription), Vitaros cream (alprostadil, prescription-only), or Caverject injections (alprostadil, prescription-only) [7]. Your GP or a specialist can also discuss vacuum devices, lifestyle changes, or psychological support. Our prescribers will guide you to the most appropriate option based on your individual circumstances.

In summary

• Tadalafil and telmisartan can usually be taken together, but both lower blood pressure so prescriber assessment is essential.
• Your prescriber will check your blood pressure control, other medicines, and heart health before approving tadalafil.
• Watch for dizziness when standing up, avoid heavy alcohol, and never take tadalafil with nitrates or nicorandil.
• Seek urgent help for chest pain during sex, erections lasting over four hours, or sudden vision or hearing loss.
• Cured Pharmacy offers tadalafil from £7.95 after a clinical consultation reviewed by a UK-registered prescriber.

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