From the Guidelines
Certain individuals should not take Cialis (tadalafil) due to potential severe adverse effects, including those with known allergies to tadalafil, those taking nitrates, and men with severe heart or liver problems. People with known allergies to tadalafil or any ingredients in the medication should avoid it. Those taking nitrates (like nitroglycerin, isosorbide) for chest pain or heart problems must not use Cialis as this combination can cause a dangerous drop in blood pressure, as stated in the guidelines for the management of patients with ST-elevation myocardial infarction 1. Men with severe heart or liver problems, uncontrolled high or low blood pressure, recent stroke or heart attack (within the last 6 months), or certain eye conditions like non-arteritic anterior ischemic optic neuropathy (NAION) should not take this medication. Patients with severe kidney disease should use Cialis cautiously, often with dose adjustments. Additionally, those taking certain medications like some antibiotics (erythromycin, clarithromycin), antifungals (ketoconazole, itraconazole), HIV protease inhibitors, or other erectile dysfunction medications should consult their doctor before using Cialis due to potential drug interactions. The American College of Physicians recommends that clinicians initiate therapy with a PDE-5 inhibitor in men who seek treatment for erectile dysfunction and who do not have a contraindication to PDE-5 inhibitor use, as stated in their clinical practice guideline 1.
Some key points to consider when determining who should not take Cialis include:
- Contraindications such as nitrate therapy, as it can cause a dangerous drop in blood pressure 1
- Severe heart or liver problems, which can be exacerbated by the increased blood flow caused by Cialis
- Uncontrolled high or low blood pressure, recent stroke or heart attack, or certain eye conditions, which can increase the risk of adverse effects
- Potential drug interactions with certain medications, such as antibiotics, antifungals, or HIV protease inhibitors, which can affect the metabolism or increase the risk of adverse effects of Cialis.
From the FDA Drug Label
Do not take Tadalafil Tablets if you: take any medicines called “nitrates”. use recreational drugs called “poppers” like amyl nitrite and butyl nitrite. take any medicines called guanylate cyclase stimulators, such as riociguat. are allergic to Tadalafil Tablets or ADCIRCA®, or any of its ingredients.
The following individuals should not take Cialis (tadalafil):
- Those taking nitrates or guanylate cyclase stimulators, such as riociguat
- Those using recreational drugs called “poppers”
- Those allergic to tadalafil or any of its ingredients
- Additionally, individuals with certain medical conditions, such as heart problems, pulmonary hypertension, low blood pressure, or uncontrolled high blood pressure, should exercise caution and consult their healthcare provider before taking tadalafil tablets 2 2.
From the Research
Contraindications for Cialis (Tadalafil)
The following individuals should not take Cialis (tadalafil) or should use it with caution:
- Patients taking any nitric oxide donor, as this combination can lead to life-threatening hypotension 3, 4
- Patients taking alpha-blocking agents, such as doxazosin, unless they are hemodynamically stable and using the lowest dose of tadalafil with close blood pressure monitoring 3
- Patients with recent serious cardiovascular events, hypotension, or uncontrolled hypertension 5
- Patients with retinitis pigmentosa, as safety has not been established in this population 5
Special Considerations
- Patients with cardiovascular disease should have a complete diagnostic workup and potentially optimized cardiovascular treatment before taking tadalafil 3
- Patients taking tadalafil should be aware of the potential for hypotensive effects, especially when combined with other medications or in certain medical conditions 3, 4
- Tadalafil may be beneficial for patients with certain cardiovascular diseases, such as pulmonary arterial hypertension or coronary artery disease, but further studies are needed to confirm its efficacy 6