Tadalafil and Verapamil: Can You Take Them Together?
Learn how these medicines interact and what your prescriber checks during a UK pharmacist-led consultation.
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Tadalafil and Verapamil: Understanding the Interaction
Published: 27 October 2026
Many men wonder whether tadalafil and verapamil can be taken together safely. The good news is that this combination is not absolutely contraindicated, but it does require careful prescriber assessment because both medicines can lower blood pressure. Understanding how they interact and what precautions to take will help you use tadalafil safely and effectively.
Key takeaways
- Tadalafil and verapamil can be taken together after prescriber assessment; the combination is not contraindicated.
- Both medicines can lower blood pressure, so your prescriber may start you on a lower tadalafil dose.
- Watch for dizziness or light-headedness and avoid large amounts of alcohol.
- Never take tadalafil with nitrates, nicorandil, riociguat, or poppers—this combination is dangerous.
- Declare all medicines during your consultation so your prescriber can check for interactions.
What is tadalafil and what is verapamil?
Tadalafil is a prescription medicine used to treat erectile dysfunction (ED). 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 [4]. Tadalafil is available as the branded medicine Cialis or as a generic version, and it can be taken either on-demand (10mg or 20mg at least 30 minutes before sex, with effects lasting up to 36 hours) or as a daily low dose (2.5mg or 5mg) [4].
Verapamil is a calcium channel blocker, a type of medicine commonly prescribed to treat high blood pressure (hypertension), angina (chest pain), and certain abnormal heart rhythms [12]. It works by relaxing and widening blood vessels, which lowers blood pressure and reduces the workload on the heart. Verapamil is available in immediate-release and modified-release (slow-release) formulations, and it is taken regularly as prescribed by your doctor.
Both medicines affect blood vessels and blood pressure, which is why their interaction needs to be understood and managed by your prescriber.
How do tadalafil and verapamil interact?
The main concern when taking tadalafil and verapamil together is the potential for an additive blood-pressure-lowering effect. Tadalafil relaxes blood vessels in the penis but also has a mild effect on blood pressure throughout the body [4]. Verapamil also lowers blood pressure by relaxing blood vessels. When taken together, these effects can add up, potentially causing dizziness, light-headedness, or fainting, especially when standing up quickly.
This interaction is generally manageable and does not mean the combination is unsafe for everyone. However, it does require your prescriber to assess your individual circumstances, including how well controlled your blood pressure is on verapamil, whether you experience any symptoms of low blood pressure, and your overall cardiovascular health [2].
It is important to note that tadalafil and verapamil is not in the same category as absolutely contraindicated combinations. Tadalafil must never be taken with nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or poppers, because these combinations can cause a dangerous and potentially life-threatening drop in blood pressure [4]. Verapamil does not fall into this category, but caution and prescriber oversight are still essential.
At a glance
What does your prescriber check before prescribing tadalafil with verapamil?
When you request tadalafil and you are already taking verapamil, your prescriber will carry out a thorough assessment during your online consultation. They will ask about your current dose of verapamil, how long you have been taking it, and whether your blood pressure is well controlled. They will also ask about any symptoms you may have experienced, such as dizziness, fainting, or light-headedness, which could indicate low blood pressure.
Your prescriber will review your full medical history, including any heart conditions, recent heart attacks or strokes, and other medicines you are taking. They will check whether sexual activity is safe for you, as this is an important consideration for anyone with cardiovascular conditions [2]. If you have unstable angina, severe heart failure, or very low blood pressure, tadalafil may not be suitable.
If the prescriber decides that tadalafil is appropriate for you, they may recommend starting with a lower dose to minimise the risk of side effects. For on-demand tadalafil, this might mean starting with 10mg rather than 20mg. They will also provide advice on how to take the medicine safely and what warning signs to watch for.
Why starting doses matter
Starting with the lowest effective dose is a key safety principle when combining tadalafil with blood-pressure medicines like verapamil. A lower dose reduces the risk of an excessive drop in blood pressure while still allowing you to assess how well the medicine works for you. If the lower dose is effective and well tolerated, there may be no need to increase it. If a higher dose is needed, your prescriber can adjust the dose after reviewing your response and any side effects.
Practical advice for taking tadalafil and verapamil together
If your prescriber approves tadalafil while you are taking verapamil, there are several practical steps you can take to use the combination safely. First, take tadalafil exactly as prescribed. Do not take more than the recommended dose, and do not take it more frequently than once a day (for on-demand use) or once a day at the same time (for daily use) [4].
Be aware of the signs of low blood pressure, which include dizziness, light-headedness, feeling faint, blurred vision, or weakness. These symptoms are more likely when you first start tadalafil, when the dose is increased, or if you stand up quickly. If you experience these symptoms, sit or lie down until they pass, and let your prescriber know.
Avoid drinking large amounts of alcohol when taking tadalafil, as alcohol can lower blood pressure further and make erectile dysfunction worse [1]. Grapefruit juice can increase the levels of tadalafil in your blood, so it is best to avoid it. Continue taking verapamil exactly as your doctor has prescribed—do not stop or change the dose without medical advice, as this could affect your blood pressure or heart condition.
If you develop chest pain during sexual activity, stop and seek urgent medical help. Do not take nitrate medicines (such as GTN spray) if you have used tadalafil within the last 48 hours, as this combination is dangerous [4].
Start low, go slow
If you take verapamil, your prescriber may recommend starting tadalafil at a lower dose to reduce the risk of dizziness or low blood pressure. This approach allows you to assess how well the medicine works while minimising side effects.
Are there other blood pressure medicines that interact with tadalafil?
Yes, tadalafil can interact with several types of blood pressure medicines, though the level of concern varies. Alpha-blockers (such as doxazosin, tamsulosin, alfuzosin, and terazosin) carry a higher risk of low blood pressure and dizziness when combined with tadalafil. 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 tadalafil [4].
Other blood pressure medicines, including ACE inhibitors (such as ramipril or lisinopril), angiotensin receptor blockers (such as losartan or candesartan), beta-blockers (such as bisoprolol or atenolol), and diuretics (such as bendroflumethiazide or furosemide), can also add to the blood-pressure-lowering effect of tadalafil. These combinations are generally manageable, but they must be declared during your consultation so your prescriber can assess the overall risk [2].
It is essential to tell your prescriber about every medicine you take, including over-the-counter medicines, herbal remedies, and supplements. Some medicines, such as potent CYP3A4 inhibitors (including ritonavir, ketoconazole, and clarithromycin), can increase tadalafil levels in your blood, requiring dose adjustments [4]. Never assume a combination is safe without checking.
What about other calcium channel blockers?
Verapamil is one of several calcium channel blockers. Others include amlodipine, diltiazem, nifedipine, and felodipine. The interaction between tadalafil and these medicines is similar to that with verapamil: there is a potential for additive blood-pressure-lowering effects, which requires prescriber assessment. If you take any calcium channel blocker, declare it during your consultation so your prescriber can tailor advice and dosing to your situation.
When should you seek urgent help?
While most men tolerate tadalafil well, even when taking verapamil, there are some warning signs that require urgent medical attention. If you experience an erection lasting longer than four hours (priapism), seek emergency help immediately, as this can cause permanent damage if not treated promptly [4]. Go to A&E or call 999.
Sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing (which may be accompanied by ringing in the ears or dizziness), are rare but serious side effects that require urgent medical assessment [4]. Stop taking tadalafil and seek help straight away.
If you develop chest pain during or after sexual activity, stop and seek urgent medical help. Do not take nitrate medicines if you have used tadalafil in the last 48 hours. If you experience severe dizziness, fainting, or symptoms of a severe allergic reaction (such as swelling of the face, lips, or throat, or difficulty breathing), call 999 immediately.
For less urgent concerns—such as persistent mild dizziness, headaches, or other side effects—contact your prescriber or GP for advice. Never stop taking verapamil suddenly without medical guidance, as this could worsen your heart condition or blood pressure.
Reporting side effects
If you experience any side effects while taking tadalafil, whether or not they are listed in the patient information leaflet, you can report them via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard or by searching for 'Yellow Card' in the Google Play or Apple App Store. Reporting side effects helps improve the safety information available for all patients.
When to get urgent help
- Erection lasting longer than 4 hours—go to A&E or call 999 immediately
- Sudden loss of vision or hearing—stop tadalafil and seek urgent medical help
- Chest pain during or after sex—stop activity and seek urgent help; do not take nitrates if you have used tadalafil in the last 48 hours
- Severe dizziness, fainting, or signs of allergic reaction (swelling, difficulty breathing)—call 999
- Persistent or severe side effects—contact your prescriber or GP for advice
Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.
Scientific References
- NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 27 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 27 October 2026]
- Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 27 October 2026]
- Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [accessed 27 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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Common Questions
Can't find your answer? Our UK pharmacists review every consultation and can help.
Can I take tadalafil if I'm on verapamil?
Yes, tadalafil and verapamil can be taken together, but only after a prescriber has assessed your blood pressure, cardiovascular health, and overall suitability. The combination is not contraindicated, but it requires careful monitoring.
Will tadalafil make my blood pressure too low if I take verapamil?
Tadalafil can add to the blood-pressure-lowering effect of verapamil, which may cause dizziness or light-headedness in some people. Your prescriber will assess this risk and may start you on a lower dose to minimise side effects.
Do I need to stop verapamil before taking tadalafil?
No, do not stop verapamil without medical advice. Your prescriber will review both medicines and advise on safe use. Stopping verapamil suddenly can worsen your blood pressure or heart condition.
What should I do if I feel dizzy after taking tadalafil with verapamil?
Sit or lie down until the dizziness passes. Avoid standing up quickly. If dizziness is severe, persistent, or accompanied by fainting, contact your prescriber or seek medical advice.
Can I drink alcohol while taking tadalafil and verapamil?
Drinking large amounts of alcohol can lower blood pressure further and worsen erectile dysfunction. It is best to limit alcohol intake when taking tadalafil, especially if you are also on verapamil.
Are there any blood pressure medicines I absolutely cannot take with tadalafil?
Yes, tadalafil must never be taken with nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or poppers, as these combinations can cause a dangerous drop in blood pressure.
How do I get tadalafil if I'm taking verapamil?
You can request tadalafil through an online consultation at Cured Pharmacy. Declare that you are taking verapamil and any other medicines. A UK prescriber will review your request and, if appropriate, issue a prescription.
What if I'm taking other medicines as well as verapamil?
You must declare all medicines, including over-the-counter products and herbal remedies, during your consultation. Your prescriber will check for interactions and advise on safe use of tadalafil.
Medically reviewed by
Tarun Kumar, Superintendent Pharmacist (GPhC 2233073)