Tadalafil and Tofacitinib: Can You Take Them Together?

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What is tadalafil and how does it work?

Tadalafil is the generic name for Cialis, one of the most widely used treatments for erectile dysfunction in the UK [4]. It belongs to a class of medicines called PDE5 inhibitors, which work by relaxing blood vessels in the penis, allowing increased blood flow when you're sexually aroused. Unlike some other ED treatments, tadalafil has a long duration of action—its effects can last up to 36 hours, which is why it's sometimes called the 'weekend pill' [4].

Tadalafil is available in two forms: on-demand tablets (usually 10mg or 20mg taken at least 30 minutes before sexual activity) and daily low-dose tablets (2.5mg or 5mg taken once a day) [4]. The daily option can be helpful if you prefer spontaneity and don't want to plan ahead. Whichever option you choose, tadalafil only works when you're sexually stimulated—it won't cause an automatic erection.

At Cured Pharmacy, tadalafil is available after an online consultation with a UK-registered prescriber. Common side effects include headache, indigestion, back pain, and flushing, though most men tolerate it well [4]. It's important to tell your prescriber about all your current medicines and health conditions, as tadalafil isn't suitable for everyone.

What is tofacitinib and what is it used for?

Tofacitinib (brand name Xeljanz) is a prescription medicine used to treat inflammatory conditions including moderate to severe rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis [12]. It belongs to a class of medicines called JAK (Janus kinase) inhibitors, which work by blocking certain enzymes in your immune system that contribute to inflammation and joint damage.

Unlike older arthritis medicines such as methotrexate or biologics, tofacitinib is taken as a tablet, usually twice daily. It helps reduce joint pain, swelling, and stiffness, and can slow the progression of joint damage in rheumatoid arthritis [12]. Because tofacitinib affects your immune system, it can increase your risk of infections, and your doctor will monitor you carefully with regular blood tests.

Tofacitinib is not a medicine that directly affects erectile function or blood pressure in the same way that tadalafil does. However, living with a chronic inflammatory condition like rheumatoid arthritis can sometimes contribute to erectile dysfunction—through pain, fatigue, reduced mobility, or the psychological impact of a long-term illness [1]. Treating the underlying condition effectively may help improve overall quality of life, including sexual health.

Does tofacitinib cause erectile dysfunction?

Erectile dysfunction is not listed as a common side effect of tofacitinib in the official prescribing information [12]. However, chronic inflammatory diseases themselves—and the stress, pain, and fatigue they cause—can contribute to ED [1]. If you've noticed changes in your erectile function since starting tofacitinib or any other medicine, it's worth discussing with your GP or rheumatologist. They can help identify whether the medicine, the underlying condition, or other factors might be playing a role.

When to get urgent help

• Erection lasting more than 4 hours (priapism) — go to A&E immediately
• Sudden loss of vision or hearing — stop tadalafil and seek urgent medical help
• Chest pain during sexual activity — stop and seek urgent medical help
• Signs of serious infection while on tofacitinib (fever, persistent sore throat, unusual tiredness) — contact your GP or rheumatologist promptly

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

Can you take tadalafil and tofacitinib together?

No major direct interaction between tadalafil and tofacitinib is commonly reported in the medical literature or standard drug interaction databases [2][12]. Tadalafil works on blood vessels in the penis, while tofacitinib works on the immune system, so they act on different systems in the body. This means that, in most cases, the two medicines can be used together without one directly affecting how the other works.

However, 'no major interaction' does not mean the combination is automatically suitable for everyone. Your prescriber will still need to review your full medical history, including your rheumatoid arthritis or other inflammatory condition, any heart or blood pressure problems, and all your current medicines [2]. Some people with rheumatoid arthritis may have other health conditions—such as cardiovascular disease—that could affect whether tadalafil is safe for you.

During your online consultation at Cured Pharmacy, you'll be asked about all your current medicines, including tofacitinib. Our UK-registered prescribers will check for any potential issues and ensure that tadalafil is a safe and appropriate choice for you. Never stop or change a prescribed medicine like tofacitinib without advice from the doctor who prescribed it.

What does your prescriber check before approving tadalafil?

When you request tadalafil through Cured Pharmacy, a UK-registered prescriber reviews your consultation answers to make sure the treatment is safe for you [2]. They'll check for conditions that make PDE5 inhibitors unsuitable, such as recent heart attack or stroke, unstable angina, severe heart failure, very low blood pressure, or previous sudden vision loss (NAION) [4]. They'll also ask about any medicines you're taking that could interact with tadalafil.

Certain medicines must never be taken with tadalafil because they can cause a dangerous drop in blood pressure. These include nitrates (such as GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, and recreational drugs called 'poppers' (amyl or alkyl nitrites) [4]. You must also never take tadalafil with another PDE5 inhibitor (such as sildenafil or vardenafil) at the same time.

Other medicines require caution but aren't absolute contraindications. Alpha-blockers (used for prostate symptoms or high blood pressure, such as tamsulosin or doxazosin) can add to the blood-pressure-lowering effect of tadalafil, so you'll usually start on a lower dose [4]. Potent CYP3A4 inhibitors—such as ritonavir, ketoconazole, itraconazole, or clarithromycin—can raise tadalafil levels in your blood, and your prescriber may need to adjust the dose [4]. Your prescriber will also consider other blood pressure medicines, as these can add to the effect of tadalafil.

Declaring all your medicines during the consultation

It's essential to list every medicine you're taking during your consultation, including prescription medicines (like tofacitinib), over-the-counter products, herbal remedies (such as St John's wort), and any recreational drugs. Even if you think a medicine is unrelated to erectile dysfunction, it's important to declare it—your prescriber needs the full picture to make a safe decision. If you're unsure about a medicine name, check the label or your repeat prescription list from your GP.

At a glance

Practical advice for taking tadalafil with tofacitinib

If your prescriber approves tadalafil and you're already taking tofacitinib, there are a few practical tips to help you use both medicines safely. First, take each medicine exactly as prescribed—don't change the dose or timing without advice. Tofacitinib is usually taken twice daily with or without food, while on-demand tadalafil is taken at least 30 minutes before sexual activity (or once daily if you're using the low-dose option) [4][12].

Be aware of side effects from both medicines. Tadalafil can cause headache, indigestion, back pain, flushing, or dizziness [4]. Tofacitinib can cause infections, headache, diarrhoea, and changes in blood counts [12]. If you notice any new or worsening symptoms after starting tadalafil, contact your prescriber or GP. It's also important to avoid heavy alcohol when using tadalafil, as alcohol can make erectile dysfunction worse and add to the blood-pressure-lowering effect [4].

Keep all your healthcare professionals informed. Let your rheumatologist or GP know that you're using tadalafil, and let your ED prescriber know about your tofacitinib and any changes to your arthritis treatment. This joined-up approach helps ensure your care is safe and effective. If you're due for surgery or a procedure, tell the healthcare team about all your medicines, including tadalafil and tofacitinib.

When to seek medical advice about tadalafil and tofacitinib

Seek urgent medical help if you experience an erection lasting more than four hours (priapism), sudden loss of vision or hearing, or chest pain during sexual activity [4]. Priapism is a medical emergency that requires immediate treatment to prevent permanent damage. Sudden vision or hearing loss is rare but serious—stop taking tadalafil and contact a doctor straight away.

Contact your GP or rheumatologist promptly if you develop signs of infection while taking tofacitinib, such as fever, persistent sore throat, or unusual tiredness, as tofacitinib can increase infection risk [12]. Also speak to your doctor if you notice new or worsening symptoms that might be related to either medicine, or if your erectile dysfunction doesn't improve with tadalafil—there may be other treatment options or underlying causes to explore [1][2].

If you're thinking about starting tadalafil and you haven't discussed your erectile dysfunction with a doctor before, it's a good idea to see your GP. ED can be an early warning sign of cardiovascular disease or diabetes, so it's important to check your overall health [1]. Your GP can arrange blood tests (such as glucose, cholesterol, and testosterone) and review your cardiovascular risk. At Cured Pharmacy, our prescribers work alongside your GP to provide safe, convenient access to ED treatment after a thorough online consultation.

Other medicines and lifestyle factors

Many people with rheumatoid arthritis take other medicines alongside tofacitinib, such as methotrexate, NSAIDs (like ibuprofen or naproxen), or corticosteroids. None of these are known to have major direct interactions with tadalafil, but your prescriber will still review your full medicine list during the consultation [2][12]. Lifestyle factors also matter: stopping smoking, maintaining a healthy weight, exercising regularly, and managing stress can all help improve erectile function and overall health [1].

In summary

• No major direct interaction between tadalafil and tofacitinib is commonly reported in medical literature
• Your prescriber reviews your full medical history and all medicines during the consultation
• Declare every medicine you take, including tofacitinib, during your online consultation
• Chronic inflammatory conditions can contribute to erectile dysfunction through pain and fatigue
• Keep all your healthcare professionals informed about the medicines you're taking

Frequently Asked Questions