Is tadalafil (Cialis) safe to take with amlodipine (10mg)/benazepril (40mg)?

From the Guidelines

It is not recommended to take tadalafil with Lodipine 10mg/benazepril 40mg without medical supervision due to potential interactions that may lead to excessive hypotension, dizziness, fainting, or serious cardiovascular events. Tadalafil is a PDE5 inhibitor used for erectile dysfunction or benign prostatic hyperplasia, while Lodipine (amlodipine) is a calcium channel blocker and benazepril is an ACE inhibitor, both used to treat high blood pressure.

• The combination of these medications can cause a significant drop in blood pressure, which may be harmful, especially in patients with pre-existing cardiovascular conditions 1.
• According to the 2014 AHA/ACC guideline, nitrates should not be administered to patients with NSTE-ACS who recently received a phosphodiesterase inhibitor, especially within 24 hours of sildenafil or vardenafil, or within 48 hours of tadalafil 1.
• The 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction also highlights the potential risks of combining calcium channel blockers with other medications that lower blood pressure 1.
• If you need to take these medications together, consult your healthcare provider first, as they may need to adjust your dosages, monitor your blood pressure closely, or recommend taking the medications at different times of day to minimize interaction risks.
• Never start, stop, or adjust these medications on your own, as improper management could lead to serious health complications.
• It is essential to prioritize medical supervision to ensure safe and effective management of your condition, considering the potential risks and benefits of combining these medications 1.

From the FDA Drug Label

Effects on Blood Pressure When Administered with Antihypertensives Angiotensin II receptor blockers (with and without other antihypertensives) — A study was conducted to assess the interaction of angiotensin II receptor blockers and tadalafil 20 mg. Enalapril — A study was conducted to assess the interaction of enalapril (10 mg to 20 mg daily) and tadalafil 10 mg Following dosing, the mean reduction in supine systolic/diastolic blood pressure due to tadalafil 10 mg in subjects taking enalapril was 4/1 mm Hg, compared to placebo.

Tadalafil and Benazepril Interaction:

• The FDA drug label does mention the interaction between tadalafil and angiotensin-converting enzyme (ACE) inhibitors like enalapril, but not specifically benazepril.
• However, since benazepril is also an ACE inhibitor, similar to enalapril, caution should be exercised when taking tadalafil with benazepril.
• The interaction between tadalafil and amlodipine (a calcium channel blocker) is also mentioned, but the question is about the combination of lodipine (likely amlodipine) and benazepril.
• Key Points:
  • Tadalafil can cause a decrease in blood pressure.
  • The combination of tadalafil with antihypertensive medications like ACE inhibitors or calcium channel blockers may increase the risk of hypotension.
  • Monitor blood pressure closely when taking tadalafil with lodipine (amlodipine) and benazepril. 2

From the Research

Tadalafil and Antihypertensive Medications

• The use of tadalafil with antihypertensive medications, such as Lodipine (likely amlodipine) and benazepril, has been studied in several clinical trials 3, 4, 5.
• A pooled safety analysis of 72 Phase II-IV studies found that tadalafil was not associated with an increased risk of hypotension-related treatment-emergent adverse events (TEAEs) or major adverse cardiovascular events (MACEs) in patients receiving concomitant antihypertensive medications 3.
• Another study found that tadalafil resulted in small changes in blood pressure, which are not believed to be clinically relevant, in healthy subjects and patients with mild erectile dysfunction 4.
• A study on the influence of a single dose of 20 mg tadalafil on ambulatory blood pressure in subjects with hypertension found that tadalafil reduced mean ambulatory blood pressure by 4.8 mmHg and 2.9 mmHg, respectively, compared with placebo 5.

Benazepril and Amlodipine

• Benazepril and amlodipine are often used in combination to treat hypertension, and their effects on blood pressure have been studied in several clinical trials 6, 7.
• A study on the fixed-dose combination of amlodipine and benazepril found that it has substantial blood pressure-lowering capabilities and is well-tolerated by patients 6.
• The ACCOMPLISH Trial investigated the effects of intensive antihypertensive combination treatment with benazepril + amlodipine or benazepril + hydrochlorothiazide on cardiovascular outcomes in patients with systolic hypertension, and found that the benazepril + amlodipine combination was effective in reducing blood pressure 7.

Interaction between Tadalafil and Lodipine/Benazepril

• While there is no direct evidence on the interaction between tadalafil and Lodipine (amlodipine) and benazepril, the available studies suggest that tadalafil can be safely used with antihypertensive medications, including calcium channel blockers like amlodipine and ACE inhibitors like benazepril 3, 4, 5.
• However, it is essential to monitor blood pressure and adjust the dosage of antihypertensive medications as needed when using tadalafil concomitantly 5.