Can Cialis (Tadalafil) Be Taken With Losartan?
Yes, Cialis (tadalafil) can generally be taken safely with losartan, as there are no significant drug interactions between these medications that would affect mortality or morbidity. 1
Pharmacological Considerations
Tadalafil is a phosphodiesterase-5 (PDE5) inhibitor used for erectile dysfunction, while losartan is an angiotensin II receptor blocker (ARB) used primarily for hypertension. When considering their combined use:
- Losartan does not appear on lists of medications contraindicated with PDE5 inhibitors 2
- Unlike nitrates, which are absolutely contraindicated with PDE5 inhibitors due to potentially life-threatening hypotension, ARBs like losartan do not pose this severe risk 2
- The blood pressure-lowering effects of tadalafil in healthy individuals are minimal and generally don't cause severe hypotension when combined with most antihypertensive medications 2
Important Precautions
While generally safe to use together, there are some precautions to consider:
- Both medications can lower blood pressure, so there is potential for additive hypotensive effects
- Monitor blood pressure when starting this combination, especially during initial dosing
- Start with the lowest effective dose of tadalafil when using with losartan
- If symptoms of hypotension occur (dizziness, lightheadedness), adjust timing of medications or dosages
Special Populations
Patients with Heart Failure
- In patients with heart failure, ARBs like losartan are often recommended as part of standard therapy 3
- For these patients, careful monitoring is advised when adding tadalafil
Patients with Renal Impairment
- No dosage adjustment of losartan is typically required in mild to moderate renal dysfunction 4
- However, the combination should be used with caution in severe renal impairment
What to Avoid
- Absolute contraindication: Never combine tadalafil with nitrates (must wait at least 48 hours after the last dose of tadalafil before taking any nitrate) 2
- Use caution when combining tadalafil with alpha-blockers (like doxazosin) - this combination requires careful blood pressure monitoring and hemodynamic stability 2
- Avoid grapefruit juice as it may increase tadalafil levels
Potential Benefits
Interestingly, both medications may have positive effects on erectile function:
- Losartan is one of the few antihypertensive medications that may actually have a positive effect on erectile function 5
- This makes the combination potentially beneficial for patients with both hypertension and erectile dysfunction
Conclusion
The combination of tadalafil and losartan is generally safe for most patients, with no major drug interactions that would significantly impact mortality or morbidity. However, monitoring for additive blood pressure-lowering effects is recommended, especially when initiating therapy.