When used alone, Cialis may cause small reductions in blood pressure, but if used with nitrates or guanylate cyclase stimulators like riociguat (brand name: Adempas) your blood pressure may dangerously drop. Do not use these drugs with Cialis. You could get dizzy, faint, or have a heart attack or stroke.

• Blood pressure may drop to dangerous levels if Cialis is combined with nitrates, which includes medicines like nitroglycerin used for chest pain (angina) or recreational drugs called “poppers” (amyl nitrite and butyl nitrite).
• A serious drop in blood pressure can also occur if Cialis is used with a guanylate cyclase stimulator medicine (for example: riociguat / Adempas), used for high blood pressure in the lungs.
• Do not use these drugs if you are also taking Cialis. Ask your doctor or pharmacist if you are not sure if you take any of these medicines.
• Tell your doctor and pharmacist about all prescription, over-the-counter, herbal, vitamin or recreational drugs you use before starting treatment with Cialis. Certain combinations may be unsafe.

Cialis may also lead to low blood pressure if used with some alpha-blockers, antihypertensives (blood pressure-lowering medicines) or substantial amounts of alcohol (for example, 5 glasses of wine or 5 shots of whiskey).

Do not use Cialis with other PDE5 inhibitors for erectile dysfunction like Viagra (sildenafil), Stendra (avanafil) or vardenafil.

Cialis may cause small reductions in blood pressure (7 to 10 mm Hg) when it’s used alone or combined with certain medicines to lower blood pressure (antihypertensives).

Cialis is an oral prescription medicine approved for the treatment of:

• erectile dysfunction (ED)
• symptoms of benign prostatic hyperplasia (BPH)
• both ED and BPH

Low blood pressure with these medicines may occur if you are taking Cialis either as needed for erectile dysfunction (ED) OR once a day for Benign Prostatic Hyperplasia (BPH) and / or ED.

Ask your healthcare provider if it is safe for you to have sexual activity. You should not take Cialis if your healthcare provider has told you not to have sexual activity because of any health problems.

If you develop chest pain, contact your healthcare provider, go to the nearest emergency room, or call 911 right away. Tell all of your healthcare providers that you take Cialis.

Which drugs can cause low blood pressure with Cialis?

Nitrates

Nitrates like nitroglycerin are commonly used to treat angina, a symptom of heart disease. Angina symptoms include pain in your chest, jaw, or down your arm. They are commonly found in medicines like tablets, sprays, ointments, pastes, or patches. Do not use Cialis with any nitrate.

Common brand names of nitroglycerin include:

• Nitro-Dur
• Nitrolingual Pump Spray
• NitroMist
• Nitrostat
• Rectiv

Nitrates can also be found in other medicines such as isosorbide dinitrate or isosorbide mononitrate. Some recreational drugs called “poppers” also contain nitrates, such as amyl nitrite and butyl nitrite.

If you have taken Cialis, but your doctor decides a nitrate is medically necessary, you must wait at least 48 hours since your last dose of Cialis before nitrate administration can be given by your healthcare provider. Your doctor should monitor your blood pressure under close medical supervision when you receive the nitrate.

Guanylate cyclase stimulators

Guanylate cyclase stimulators include a medicine called riociguat (Adempas), used to treat conditions that cause high blood pressures in the lungs (pulmonary arterial hypertension and chronic-thromboembolic pulmonary hypertension). Do not use Cialis with any guanylate cyclase stimulator.

Vasodilators: Alpha Blockers and PDE5 inhibitors

Caution is advised when PDE5 inhibitors are co-administered with alpha-blockers.

Certain alpha-blockers, like doxazosin (Cardura), terazosin (Hytrin) or alfuzosin (Uroxatral), used to treat symptoms of benign prostatic hyperplasia (BPH), should be used cautiously with Cialis.

These medicines, if used with Cialis, can dilate (widen) your blood vessels which may cause low blood pressure. When they are used together, they may cause an additive effect on blood pressure and you may experience very low blood pressure, dizziness or fainting.

Tamsulosin (Flomax), another alpha blocker, has not been shown to cause significant effects on blood pressure when used with Cialis.

Tell your doctor if you take any medicines to lower your blood pressure or to treat BPH, or if you currently use any other PDE5 inhibitor, like Viagra (sildenafil), Stendra (avanafil) or vardenafil.

If you experience any dizziness, low blood pressure, or fainting while taking these medicines, contact your doctor right away.

Alcohol

Alcohol is also a mild vasodilator and can cause low blood pressure.

You should also avoid drinking too much alcohol when taking Cialis (for example, 5 glasses of wine or 5 shots of whiskey). Drinking excessive alcohol can increase your risk of getting a headache, a fast heart rate, low blood pressure, dizziness, or fainting.

The amount of alcohol that might cause these side effects could vary between people, so use caution if you combine Cialis with any alcoholic beverages. Ask your doctor if it is safe for you to drink alcohol while taking Cialis.

Antihypertensives (blood pressure medicines)

Using Cialis with blood pressure medicines like amlodipine, angiotensin II receptor blockers (ARBs), bendrofluazide, enalapril, and metoprolol may cause small reductions in your blood pressure, based on studies done by the manufacturer.

For example, one study looked at the interaction of angiotensin II receptor blockers (ARBs), used alone or with other blood pressure medicines, and Cialis 20 mg.

• Angiotensin II receptor blockers include agents like Benicar (olmesartan), Diovan (valsartan), and Cozaar (losartan).
• After dosing, blood pressure measurements revealed differences between Cialis and placebo (inactive pill) of 8 / 4 mm Hg in systolic / diastolic blood pressure.

Another study looked at the interaction between 5 mg of amlodipine (Norvasc), a calcium channel blocker, and Cialis 10 mg.

• After Cialis dosing, blood pressure measurements when lying down were reduced by 3 / 2 mm Hg for systolic / diastolic blood pressure when compared to placebo.
• However, a similarly conducted study using Cialis 20 mg did not find significant differences in blood pressure.

Small reductions in blood pressure were also seen when studies looked at enalapril, metoprolol and bendrofluazide.

Ask your doctor if it safe for you to take your blood pressure or heart medicine with Cialis.

How much does Cialis lower blood pressure if used alone?

When used alone, Cialis can dilate blood vessels which may cause small, temporary decreases in blood pressure, but in general this should not be a problem for most healthy people. Modest decreases of up to a 7 mm reduction in systolic and 5 mm in diastolic lasting up to 12 hours may occur.

• Tell your doctor if you have low blood pressure or high blood pressure that is not controlled before you start treatment with Cialis.
• Also tell them about any heart problems you might have, such as angina (chest pain), heart failure, irregular heartbeats, pulmonary (lung) hypertension, or a previous heart attack.

Low blood pressure is not listed as a common side effect with Cialis when used alone.

The most common side effects with Cialis, which are usually temporary and clear up within a few hours, include:

• Headache
• Indigestion
• Flushing (redness)
• Stuffy or runny nose

Back pain or muscle aches are also common side effects, but usually occur 12 to 24 hours after a dose of Cialis and goes away within 2 days.

Tell your healthcare provider and pharmacist about all the medications you take. Use with other medicines may cause dangerous drops in blood pressure.

Call your healthcare provider if you get any side effect that bothers you or one that does not go away.

Does Cialis raise blood pressure?

High blood pressure (hypertension) has been noted as a possible, but infrequent, side effect in a 24-week long study. It is not a common side effect with Cialis and was not seen in all studies.

In general, hypertension is considered a blood pressure reading of 130 / 80 millimeters of mercury (mm Hg) or higher.

In the study, participants received either Cialis 2.5 mg, Cialis 5 mg or a placebo (inactive treatment), given once daily for erectile dysfunction (ED).

Hypertension (high blood pressure) was reported in:

• 3% of people taking the 5 mg dose
• 1% of people taking the 2.5 mg dose
• 0% of people taking a placebo

Before you start treatment with Cialis, tell your doctor if you have high blood pressure that is not controlled. Cialis is not recommended for use if you have uncontrolled blood pressure, a recent heart attack or stroke, chest pain (angina), heart failure, irregular heart beats, severe liver disease or retinal eye problems (for example: macular degeneration or diabetic retinopathy).

This is not all the information you need to know about Cialis (tadalafil) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.