Tadalafil and Upadacitinib: Can They Be Taken Together?
Learn about this interaction and how UK prescribers ensure your ED treatment is safe.
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Tadalafil and Upadacitinib: Understanding the Interaction
Published: 26 October 2026
Many men wonder whether tadalafil and upadacitinib can be taken together safely. Tadalafil is a medicine used to treat erectile dysfunction (ED), while upadacitinib is prescribed for rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, and ulcerative colitis. No major direct interaction is commonly reported between these two medicines, but your prescriber will still review your full medical history and all current medicines during your consultation to ensure tadalafil is suitable for you.
Always Declare All Your Medicines
Even when no major interaction is expected, your prescriber needs to know every medicine you take—including upadacitinib—to ensure tadalafil is safe for you. Never stop or change a prescribed medicine without professional advice.
What Is Tadalafil and How Does It Work?
Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction [3][4]. It works by relaxing the blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Unlike some ED treatments, tadalafil does not cause an erection on its own—sexual stimulation is still needed.
Tadalafil is available in two forms: on-demand tablets (usually 10 mg or 20 mg taken at least 30 minutes before sexual activity, with effects lasting up to 36 hours) and daily low-dose tablets (2.5 mg or 5 mg taken once a day) [4]. The longer duration of action has earned tadalafil the nickname 'the weekend pill'. Common brand names include Cialis, and generic versions are widely available at lower cost.
Because tadalafil affects blood vessels, it can interact with other medicines that lower blood pressure or are broken down by the same liver enzymes. This is why a full medication review is essential before starting treatment, even when no major interaction is expected with a specific medicine like upadacitinib.
What Is Upadacitinib and What Is It Used For?
Upadacitinib is a Janus kinase (JAK) inhibitor, a type of medicine that works by blocking certain enzymes involved in inflammation [12]. It is prescribed for moderate to severe rheumatoid arthritis, active psoriatic arthritis, axial spondyloarthritis, atopic dermatitis (eczema), and ulcerative colitis in adults. Upadacitinib helps reduce joint pain, swelling, and skin inflammation by dampening the immune system's overactive response.
The medicine is taken as a once-daily tablet, usually at a dose of 15 mg or 30 mg depending on the condition being treated. Because upadacitinib affects the immune system, it can increase the risk of infections and requires regular monitoring by your rheumatologist or specialist. It is not known to have a direct effect on erectile function or blood pressure in the same way that tadalafil does.
Upadacitinib is broken down in the liver by an enzyme called CYP3A4, the same enzyme involved in metabolising tadalafil and many other medicines. However, upadacitinib is not a strong inhibitor or inducer of this enzyme, so it is not expected to significantly alter tadalafil levels in the body.
When to get urgent help
- Erection lasting more than 4 hours (priapism)—call 999 or go to A&E immediately
- Sudden loss of vision in one or both eyes—seek urgent medical help
- Chest pain during or after sexual activity—stop and call 999
- Sudden decrease or loss of hearing, sometimes with ringing or dizziness—contact a doctor urgently
- Severe dizziness, fainting, or signs of very low blood pressure—seek same-day medical advice
Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.
Can Tadalafil and Upadacitinib Be Taken Together?
No major interaction between tadalafil and upadacitinib is commonly reported in UK prescribing resources [3][4][12]. Both medicines are processed partly by the liver enzyme CYP3A4, but upadacitinib does not strongly inhibit or speed up this enzyme, so it is unlikely to cause a clinically significant change in tadalafil levels. This means that, in most cases, the two medicines can be prescribed together if both are clinically appropriate for you.
However, 'no major interaction' does not mean the combination is automatically safe for everyone. Your prescriber will still need to check your full medical history, including your heart health, blood pressure, kidney and liver function, and any other medicines you take. Tadalafil is not suitable for everyone—for example, it must not be used if you take nitrates, nicorandil, riociguat, or recreational drugs called 'poppers', as these combinations can cause a dangerous drop in blood pressure [3][4].
If you are already taking upadacitinib and are considering treatment for erectile dysfunction, you should declare this during your online consultation. The prescriber will review whether tadalafil (or another ED medicine) is suitable, taking into account your rheumatoid arthritis or other condition, any cardiovascular risk factors, and the full list of your current medicines. Never start, stop, or change the dose of any prescribed medicine without professional advice.
What Your Prescriber Will Check
During your consultation, the prescriber will ask about your heart health (including any history of heart attack, stroke, angina, or heart failure), blood pressure, and whether you take any medicines that could interact with tadalafil [2][3]. They will also check for conditions that make PDE5 inhibitors unsuitable, such as severe liver or kidney disease, recent stroke, very low blood pressure, or a history of sudden vision loss (non-arteritic anterior ischaemic optic neuropathy, or NAION).
If you are taking upadacitinib, the prescriber will note this but will focus more on other medicines that are known to interact significantly with tadalafil—such as alpha-blockers (e.g. tamsulosin, doxazosin), potent CYP3A4 inhibitors (e.g. ritonavir, ketoconazole, clarithromycin), or any nitrate medicines. They will also consider whether your underlying condition (such as rheumatoid arthritis) or its treatment affects your overall cardiovascular health, as this can influence whether sexual activity and ED treatment are safe for you.
Other Medicines That Interact with Tadalafil
While tadalafil and upadacitinib do not have a major interaction, there are several other medicines that do interact significantly with tadalafil and must be carefully managed or avoided [3][4]. The most important are nitrates (such as glyceryl trinitrate spray, isosorbide mononitrate, or isosorbide dinitrate), nicorandil, and riociguat. Do not take tadalafil with any of these medicines, as the combination can cause a severe and potentially life-threatening drop in blood pressure.
Alpha-blockers, used for an enlarged prostate or high blood pressure (e.g. tamsulosin, doxazosin, alfuzosin), can also lower blood pressure when combined with tadalafil, leading to dizziness or fainting [3][4]. If you take an alpha-blocker, you should be stable on it before starting tadalafil, and your prescriber will usually recommend the lowest dose of the ED medicine. Potent CYP3A4 inhibitors—such as the HIV medicines ritonavir and cobicistat, the antifungals ketoconazole and itraconazole, and the antibiotic clarithromycin—can raise tadalafil levels, requiring dose adjustments or avoidance [4].
Other blood-pressure medicines (such as ACE inhibitors, angiotensin receptor blockers, calcium-channel blockers, or diuretics) can add to the blood-pressure-lowering effect of tadalafil, but this is usually manageable and does not mean you cannot use ED treatment. Grapefruit juice can also raise tadalafil levels and should be avoided. Always declare every medicine, supplement, and herbal remedy you take during your consultation, even if you think it is unrelated to ED.
At a glance
Practical Advice for Taking Tadalafil with Upadacitinib
If your prescriber approves tadalafil while you are taking upadacitinib, follow the dosing instructions carefully. For on-demand tadalafil (10 mg or 20 mg), take one tablet at least 30 minutes before you plan to have sex; the effect can last up to 36 hours, and you should not take more than one dose in 24 hours [4]. For daily tadalafil (2.5 mg or 5 mg), take one tablet at the same time each day, with or without food. Sexual stimulation is still required for the medicine to work.
Continue taking upadacitinib exactly as prescribed by your rheumatologist or specialist. Do not stop or change the dose without their advice, even if you start a new medicine for ED. If you experience dizziness, light-headedness, or fainting after taking tadalafil, sit or lie down and avoid driving or operating machinery. These symptoms can sometimes occur when starting ED treatment, especially if you also take other medicines that lower blood pressure.
Avoid heavy alcohol while using tadalafil, as alcohol can worsen erectile dysfunction and increase the risk of dizziness and low blood pressure [3][4]. If you develop any new symptoms—such as chest pain during sex, an erection lasting more than four hours (priapism), sudden loss of vision or hearing, or severe dizziness—stop taking tadalafil and seek urgent medical help. Report any side effects or concerns to your prescriber or pharmacist.
When to Seek Medical Advice
Seek urgent medical help (call 999 or go to A&E) if you experience an erection lasting more than four hours, sudden loss of vision in one or both eyes, sudden decrease or loss of hearing (sometimes with ringing in the ears or dizziness), or chest pain during sexual activity [3][4]. These are rare but serious side effects that require immediate attention.
Contact your GP or prescriber if you develop new or worsening symptoms while taking tadalafil, such as persistent dizziness, fainting, shortness of breath, or swelling of the ankles. If you are prescribed a new medicine by another doctor (including your rheumatologist), always mention that you are taking tadalafil for erectile dysfunction, and check with your pharmacist or prescriber whether the combination is safe.
Erectile Dysfunction Treatment Options at Cured Pharmacy
Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering a range of licensed ED treatments after a confidential online consultation reviewed by a UK-registered prescriber [1][2]. All PDE5 inhibitors—including tadalafil, sildenafil, vardenafil, and avanafil—require a prescription, and your consultation will include a full medication review to check for interactions and ensure the treatment is safe and suitable for you.
Tadalafil is available in several forms, including generic tadalafil and branded Cialis, in both on-demand and daily doses. Other options include sildenafil (generic Viagra), which works for about four to six hours, vardenafil (generic Levitra), and avanafil (Spedra), which has a faster onset of action [3][5][6]. Your prescriber will recommend the most appropriate treatment based on your health, preferences, and any other medicines you take, including upadacitinib.
If you have erectile dysfunction and are taking upadacitinib or any other medicine for a long-term condition, it is important to have a full assessment before starting ED treatment. Our online consultation is designed to be straightforward and discreet, and our pharmacists and prescribers are here to answer any questions you may have about drug interactions, side effects, or how to use your medicine safely.
How to Get Started
To request ED treatment from Cured Pharmacy, complete our online consultation form, which asks about your medical history, current medicines (including upadacitinib), and any symptoms or conditions that might affect your suitability for treatment. A UK-registered prescriber will review your answers, and if approved, your medicine will be dispensed by our pharmacy and delivered discreetly to your door.
If you have not seen a GP about your erectile dysfunction before, we encourage you to do so, as ED can be an early warning sign of heart disease, diabetes, or other health conditions [1][2]. Treating the underlying cause—alongside using ED medication if appropriate—can improve both your sexual health and your overall wellbeing. Our service is here to support you, but it does not replace regular check-ups with your GP or specialist.
In summary
- No major interaction is commonly reported between tadalafil and upadacitinib.
- Your prescriber will review all your medicines and health conditions during consultation.
- Never take tadalafil with nitrates, nicorandil, riociguat, or poppers—this is dangerous.
- Declare upadacitinib and all other medicines when requesting ED treatment online.
- Seek urgent help if you have chest pain, an erection over 4 hours, or sudden vision loss.
Scientific References
- NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 26 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 26 October 2026]
- Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 26 October 2026]
- Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 26 October 2026]
- Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 26 October 2026]
- Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 26 October 2026]
- Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [accessed 26 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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Medically reviewed by
Tarun Kumar, Superintendent Pharmacist (GPhC 2233073)