From the Guidelines
Patients with high blood pressure should consult their doctor before taking Cialis (tadalafil), as it may cause a dangerous drop in blood pressure when combined with certain blood pressure medications, especially nitrates like nitroglycerin 1.
Important Considerations
- Never take Cialis with nitrates under any circumstances, as this can lead to a life-threatening drop in blood pressure.
- For patients with well-controlled hypertension who are not on nitrates, doctors may prescribe Cialis starting at a lower dose (5-10mg) to assess tolerance.
- Cialis works by relaxing blood vessels, which is why it affects blood pressure.
- Before taking Cialis, patients should ensure their blood pressure is adequately controlled, inform their doctor about all medications they're taking, and report any symptoms like dizziness or fainting that might occur after taking the medication.
Key Points to Discuss with Your Doctor
- Your current blood pressure readings and any medications you're taking to control your blood pressure.
- Any history of cardiovascular disease, including heart attacks, strokes, or high blood pressure.
- Any other medical conditions you have, such as diabetes, kidney disease, or liver disease.
- Any symptoms you're experiencing, such as dizziness, fainting, or chest pain.
Monitoring and Follow-up
- Regular blood pressure monitoring is important while using Cialis.
- Your doctor may need to adjust your dosage or medication regimen based on your response to treatment and any side effects you experience.
- It's essential to follow up with your doctor regularly to ensure that your blood pressure is well-controlled and that you're not experiencing any adverse effects from taking Cialis.
From the FDA Drug Label
As with other PDE5 inhibitors, tadalafil has mild systemic vasodilatory properties that may result in transient decreases in blood pressure In a clinical pharmacology study, tadalafil 20 mg resulted in a mean maximal decrease in supine blood pressure, relative to placebo, of 1.6/0.8 mm Hg in healthy subjects [see Clinical Pharmacology (12. 2)]. While this effect should not be of consequence in most patients, prior to prescribing tadalafil tablets, physicians should carefully consider whether their patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects Patients with severely impaired autonomic control of blood pressure may be particularly sensitive to the actions of vasodilators, including PDE5 inhibitors. The following groups of patients with cardiovascular disease were not included in clinical safety and efficacy trials for tadalafil, and therefore until further information is available, tadalafil is not recommended for the following groups of patients: ... uncontrolled hypertension
High blood pressure patients can take Cialis, but with caution.
- Patients with uncontrolled hypertension should not take tadalafil.
- The drug has mild systemic vasodilatory properties, which may result in transient decreases in blood pressure.
- Physicians should carefully consider the potential effects of tadalafil on patients with underlying cardiovascular disease.
- Patients with severely impaired autonomic control of blood pressure may be particularly sensitive to the actions of vasodilators, including PDE5 inhibitors 2.
From the Research
Patient Considerations
- Patients with high blood pressure (BP) can take Cialis (tadalafil), but caution is advised when combining it with certain medications, such as nitrates or alpha-blockers, as it may cause severe hypotension and syncope 3, 4.
- The blood pressure-lowering effects of tadalafil in healthy volunteers are minimal, but greater declines in blood pressure may be observed in treated and untreated hypertensive patients 5.
- Tadalafil can be used with most antihypertensive agents, but dose adjustment may be necessary when co-administered with cytochrome P (CYP) 3A inhibitors or inducers 3.
Medication Interactions
- Combination of tadalafil with nitrates is absolutely contraindicated due to the risk of life-threatening hypotension 4.
- Combination with alpha-blocking agents, such as doxazosin, may be considered when patients are hemodynamically stable, using the lowest dose of tadalafil, and with close blood pressure monitoring 4.
- Tadalafil plasma concentrations may be influenced by CYP3A inhibitors, which can affect the severity and timing of drug interactions 3.
Cardiovascular Safety
- Severe adverse cardiovascular events were rare in tadalafil users and similar in frequency compared to placebo in placebo-controlled trials 4.
- Patients with erectile dysfunction often have underlying cardiovascular disease, and a complete diagnostic workup and potentially optimized cardiovascular treatment may be necessary before prescribing tadalafil 4.
- Phosphodiesterase-5 inhibitors, including tadalafil, have shown promise in preclinical studies for cardioprotection, but further research is needed to fully understand their effects 6.