Is it safe to take Clomid (clomiphene citrate) with tadalafil (Cialis)?

Safety of Taking Clomid with Tadalafil

Clomid (clomiphene citrate) can be safely taken with tadalafil (Cialis) as there is no known significant drug interaction between these medications that would affect morbidity or mortality.

Mechanism and Safety Profile

Tadalafil is a phosphodiesterase-5 (PDE5) inhibitor primarily used for erectile dysfunction and pulmonary arterial hypertension. Clomiphene citrate is a selective estrogen receptor modulator used for ovulation induction. These medications work through different mechanisms:

• Tadalafil inhibits PDE5, increasing cGMP levels, leading to smooth muscle relaxation and vasodilation 1
• Clomiphene blocks estrogen receptors in the hypothalamus, increasing gonadotropin release

Important Considerations

Known Contraindications with Tadalafil

While tadalafil can be taken with clomiphene, it's crucial to be aware of medications that are absolutely contraindicated with tadalafil:

• Nitrates: The combination of tadalafil with nitrates (like nitroglycerin) is absolutely contraindicated due to the risk of severe, potentially fatal hypotension 2
• Tadalafil should not be taken within 48 hours of using any nitrate medication 2

Cardiovascular Considerations

• There is a rare but documented risk of myocardial infarction associated with clomiphene citrate use 3
• Patients with pre-existing cardiovascular risk factors should be monitored more closely when taking either medication

Dosing and Administration

• Standard dosing of tadalafil (5-20mg) can be maintained when used concurrently with clomiphene
• No dose adjustments are typically required for either medication when used together

Evidence for Combined Use

There is actually evidence suggesting potential benefits of combined use in certain clinical scenarios:

• A pilot study demonstrated that tadalafil (5mg daily for 7 days) improved endometrial growth in patients undergoing clomiphene ovarian stimulation for intrauterine insemination 4
• The study showed better endometrial growth in the tadalafil + clomiphene group compared to clomiphene alone (8.9 ± 1.8 mm vs 6.3 ± 1.8 mm, P < 0.0002) 4

Long-term Safety

Tadalafil has demonstrated good long-term safety and tolerability:

• A 24-month extension trial involving 1,173 men showed tadalafil was well-tolerated even in patients with comorbidities 5
• The rate of discontinuation due to adverse events was only 6.3% over this extended period 5

Clinical Approach

When prescribing these medications together:

1. Review the patient's complete medication list to ensure no contraindicated drugs (especially nitrates)
2. Assess cardiovascular risk factors
3. Monitor for common side effects of tadalafil (headache, dyspepsia, back pain)
4. Consider the potential beneficial effect of tadalafil on endometrial thickness if the patient is undergoing fertility treatment

In conclusion, there is no significant contraindication to using clomiphene citrate and tadalafil concurrently, and in some fertility treatment contexts, the combination may even offer benefits for endometrial development.