From the FDA Drug Label
Tadalafil tablets and other medicines may affect each other. Always check with your healthcare provider before starting or stopping any medicines. Especially tell your healthcare provider if you take any of the following*: • some types of oral antifungals such as ketoconazole (Nizoral®), itraconazole (Sporanox®)
The use of Itraconazole with Tadalafil may require caution and monitoring by a healthcare provider due to potential interactions. It is recommended to inform your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements, before starting or stopping any medicines, including Itraconazole and Tadalafil 1.
From the Research
No, itraconazole should not be used with tadalafil due to a significant drug interaction. Itraconazole is a strong inhibitor of the CYP3A4 enzyme, which is responsible for metabolizing tadalafil in the body 2. When these medications are taken together, itraconazole can substantially increase tadalafil blood levels, potentially leading to dangerous side effects including severe hypotension (low blood pressure), priapism (prolonged erection), and cardiovascular complications.
Some key points to consider:
- Itraconazole has a broad-spectrum of activity and is available in both an intravenous and oral form making long-term use in chronic mycoses practical 3.
- The use of nitrates remains the only contraindication for all PDE5 inhibitors, but precaution is also suggested in the presence of potent CYP3A inhibitors, such as azole antifungals like itraconazole 2.
- If you are taking itraconazole for a fungal infection and require treatment for erectile dysfunction, you should consult your healthcare provider about alternative medications that don't interact with itraconazole, such as sildenafil at reduced doses with careful monitoring, or non-PDE5 inhibitor treatments.
- A recent study in 2022 discussed the pharmacokinetic interaction between tadalafil and another medication, canagliflozin, which is also a CYP3A4 inhibitor, and found significant interaction between them when administered simultaneously 4.
Given the potential risks, it is recommended to avoid concomitant use of itraconazole and tadalafil and instead explore alternative treatment options for erectile dysfunction that do not interact with itraconazole. If you're already taking both medications, contact your healthcare provider immediately for guidance rather than stopping either medication abruptly.