Tadalafil and Trandolapril: Can You Take Them Together?

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Key takeaways

• Tadalafil and trandolapril can usually be taken together safely if your blood pressure is stable and well controlled.
• Both medicines can lower blood pressure, so your prescriber will check your BP readings and may start tadalafil at a lower dose.
• Never take tadalafil with nitrate medicines, nicorandil, or poppers—this combination is dangerous.
• Always declare all your current medicines during your online consultation, including trandolapril and any other blood pressure treatments.
• If you experience persistent dizziness or fainting after starting tadalafil, contact your GP or prescriber for advice.

What is tadalafil and trandolapril?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction [4]. It works by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Tadalafil is available as the branded medicine Cialis and as generic tadalafil. It can be taken on-demand (10 mg or 20 mg at least 30 minutes before sexual activity, with effects lasting up to 36 hours) or as a daily low dose (2.5 mg or 5 mg) [4].

Trandolapril belongs to a group of medicines called angiotensin-converting enzyme (ACE) inhibitors. It is prescribed to treat high blood pressure (hypertension), to reduce the risk of heart attack and stroke, and to help the heart work more efficiently after a heart attack or in heart failure. Trandolapril works by relaxing and widening blood vessels, which lowers blood pressure and reduces the workload on the heart.

Both medicines affect blood vessels and blood pressure, which is why it is important to understand how they work together and what precautions your prescriber will take before you start treatment.

How do tadalafil and trandolapril interact?

Tadalafil and trandolapril do not interact through the liver enzyme system that breaks down many medicines, so there is no major chemical clash between them [3][4]. The main consideration is that both medicines can lower blood pressure. Tadalafil causes mild blood vessel relaxation throughout the body (not just in the penis), and trandolapril is specifically designed to lower blood pressure.

When taken together, the blood-pressure-lowering effects can add up. For most men whose blood pressure is well controlled on trandolapril, this additive effect is usually mild and manageable. You might notice slight dizziness or light-headedness, especially when standing up quickly. However, if your blood pressure is already on the low side, or if you are taking several blood-pressure medicines at once, the combination requires closer monitoring.

This is not the same as the dangerous interaction that occurs when tadalafil is combined with nitrate medicines (such as GTN spray or isosorbide mononitrate) or nicorandil, which can cause a severe and potentially life-threatening drop in blood pressure. Trandolapril does not carry this risk, but your prescriber will still check your blood pressure readings, current dose of trandolapril, and any other medicines you take before approving tadalafil [2][4].

Why the interaction is usually manageable

Most men taking trandolapril for high blood pressure or heart protection can safely use tadalafil for erectile dysfunction, provided their condition is stable and their blood pressure is well controlled [2]. The prescriber will review your recent blood pressure readings, ask about symptoms such as dizziness, and may recommend starting on a lower dose of tadalafil (such as 10 mg on-demand or 2.5 mg daily) to minimise the risk of a noticeable blood pressure drop. If you tolerate the lower dose well, the dose can be adjusted if needed.

At a glance

What your prescriber checks before approving tadalafil and trandolapril together

When you request tadalafil through an online consultation at Cured Pharmacy, the UK-registered prescriber will ask detailed questions about your current health and medicines. If you are taking trandolapril, the prescriber will want to know your usual blood pressure readings, how long you have been on trandolapril, whether your dose is stable, and whether you have experienced any dizziness or fainting [2][4].

The prescriber will also check for other medicines that affect blood pressure. Many men with high blood pressure or heart conditions take more than one medicine—for example, trandolapril plus a diuretic (water tablet), a beta-blocker, or a calcium-channel blocker. The prescriber needs to see the full picture to assess whether adding tadalafil is safe. If you are also taking an alpha-blocker (such as doxazosin or tamsulosin, often prescribed for prostate symptoms), extra caution is needed because alpha-blockers can cause a more significant drop in blood pressure when combined with PDE5 inhibitors [3][4].

The prescriber will also ask about your heart health. Tadalafil is not suitable if sexual activity itself is inadvisable—for example, if you have had a recent heart attack or stroke, unstable angina, or severe heart failure [4]. If your heart condition is stable and well managed, and your blood pressure is controlled, tadalafil is usually considered safe. Always answer the consultation questions honestly and include every medicine you take, including over-the-counter products and supplements.

Practical advice for taking tadalafil with trandolapril

If your prescriber approves tadalafil, take it exactly as directed. For on-demand tadalafil, take one tablet (usually 10 mg or 20 mg) at least 30 minutes before you plan to have sex; the effect can last up to 36 hours, so you do not need to rush [4]. For daily tadalafil, take one low-dose tablet (2.5 mg or 5 mg) at the same time each day, whether or not you plan to have sex. Tadalafil requires sexual stimulation to work—it will not cause an erection on its own.

Continue taking your trandolapril as prescribed by your GP or cardiologist. Do not stop or change the dose of trandolapril without medical advice, even if you experience mild side effects from tadalafil. If you feel dizzy or light-headed after taking tadalafil, sit or lie down until the feeling passes, and avoid driving or operating machinery. Standing up slowly from sitting or lying can help prevent dizziness.

Avoid drinking large amounts of alcohol when using tadalafil, as alcohol can worsen erectile dysfunction and add to the blood-pressure-lowering effect, increasing the risk of dizziness [4]. Grapefruit juice can raise tadalafil levels in the blood, so it is best to avoid it or drink only small amounts. If you develop a headache, indigestion, or a blocked nose (common mild side effects of tadalafil), these usually settle on their own. If side effects are troublesome or persistent, speak to your prescriber or pharmacist.

When to contact your doctor

Contact your GP or prescriber if you experience persistent dizziness, fainting, or a noticeable drop in your usual blood pressure readings after starting tadalafil. Also get in touch if you develop new chest pain, shortness of breath, or swelling in your ankles, as these may indicate that your heart condition needs review. Do not simply stop tadalafil without advice—your prescriber can adjust the dose or timing, or suggest an alternative approach.

Medicines that must not be taken with tadalafil

While tadalafil and trandolapril can usually be taken together, there are some medicines that must never be combined with tadalafil because they cause a dangerous drop in blood pressure. Do not take tadalafil if you are using any nitrate medicine, such as glyceryl trinitrate (GTN) spray or tablets, isosorbide mononitrate, or isosorbide dinitrate, which are prescribed for angina (chest pain) [3][4]. Do not take tadalafil with nicorandil, another angina medicine, or with riociguat, a medicine for pulmonary hypertension.

Do not use tadalafil alongside recreational drugs known as 'poppers' (amyl nitrite or alkyl nitrites), as these also cause a severe blood pressure drop [4]. Never take tadalafil at the same time as another PDE5 inhibitor (such as sildenafil, vardenafil, or avanafil)—you should only use one ED medicine at a time.

If you are prescribed a new medicine by your GP or hospital doctor while you are taking tadalafil, always tell them you are using tadalafil for erectile dysfunction. Some medicines, such as certain antifungals (ketoconazole, itraconazole) or HIV medicines (ritonavir, cobicistat), can raise tadalafil levels and require dose adjustments [4]. Your Cured Pharmacy prescriber will check for these interactions during your consultation, but it is your responsibility to keep your medicine list up to date.

Why erectile dysfunction matters and when to see your GP

Erectile dysfunction is very common, affecting about half of men aged 40–70 to some degree [10]. It is not just a natural part of ageing—ED can be an early warning sign of underlying health problems, particularly cardiovascular disease and diabetes [1][2]. The blood vessels in the penis are smaller than those in the heart, so damage to blood vessels often shows up as ED before it causes a heart attack or stroke.

If you are experiencing ED for the first time, it is important to see your GP for a health check, even if you are already being treated for high blood pressure or heart disease. Your GP can check your blood pressure, blood sugar, cholesterol, and hormone levels, and review your current medicines to see if any might be contributing to ED [2]. Some blood pressure medicines (especially older beta-blockers and diuretics) can worsen erectile function, and your GP may be able to switch you to an alternative.

Treating ED with tadalafil or another PDE5 inhibitor can be very effective, but it works best as part of a broader approach to your health [1][2]. Lifestyle changes—such as losing weight if needed, exercising regularly, stopping smoking, cutting down on alcohol, and managing stress—can all improve erectile function and reduce your risk of heart disease. If you have diabetes, keeping your blood sugar well controlled is also important. Your GP or practice nurse can support you with all of these steps.

How Cured Pharmacy can help

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering discreet access to ED treatments after a clinical consultation reviewed by a UK-registered prescriber. If you are taking trandolapril and would like to try tadalafil, complete the online questionnaire honestly, listing all your current medicines and health conditions. The prescriber will review your answers and, if appropriate, approve a prescription. Your medicine is then dispensed by our pharmacy team and delivered discreetly to your door. You can contact our pharmacists at any time if you have questions about your treatment.

When to get urgent help

• Erection lasting more than 4 hours (priapism)—go to A&E immediately to prevent permanent damage
• Sudden loss of vision in one or both eyes—stop tadalafil and seek urgent medical help
• Chest pain during or after sex—stop activity, sit down, and call 999 if pain does not settle quickly
• Severe dizziness, fainting, or collapse after taking tadalafil—call 999 or go to A&E
• Sudden loss of hearing or ringing in the ears—stop tadalafil and contact your GP or NHS 111 the same day

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

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