From the Guidelines
Tadalafil is not contraindicated with lopressor (metoprolol), and these medications can generally be used together safely, though patients should be monitored for potential additive blood pressure-lowering effects. According to the Princeton III Consensus Recommendations 1, the safety and appropriate use of phosphodiesterase-5 (PDE5) inhibitors, such as tadalafil, were reviewed, and no new concerns regarding cardiovascular events were found. In fact, PDE5 inhibition may have a potential role in the management of hypertension and endothelial dysfunction in patients at risk for cardiovascular disease.
When combining tadalafil with beta-blockers like metoprolol, the main concern is the possibility of enhanced hypotensive effects, as both can lower blood pressure. Patients should be advised to report symptoms like dizziness, lightheadedness, or fainting. This combination requires particular caution in elderly patients or those with pre-existing cardiovascular conditions. If a patient experiences significant hypotension when taking both medications, dosage adjustments may be necessary.
It's essential to note that the interaction between tadalafil and beta-blockers like metoprolol is manageable with appropriate monitoring, unlike the absolute contraindication with nitrates due to dangerous blood pressure drops. The ACC/AHA guideline update for the management of ST-segment elevation myocardial infarction 2 also emphasizes the importance of careful consideration when using nitrates in patients with right-sided ischemia and phosphodiesterase inhibitor use for erectile dysfunction within the past 24 hours (48 hours for tadalafil). However, this guideline does not explicitly address the interaction between tadalafil and beta-blockers like metoprolol.
In clinical practice, the key is to balance the benefits of treating erectile dysfunction with the potential risks of combining medications, particularly in patients with cardiovascular disease. By monitoring patients closely and adjusting dosages as needed, healthcare providers can minimize the risks associated with combining tadalafil and metoprolol.
From the FDA Drug Label
7. 1 Potential for Pharmacodynamic Interactions with Tadalafil ... Antihypertensives — PDE5 inhibitors, including tadalafil, are mild systemic vasodilators. Clinical pharmacology studies were conducted to assess the effect of tadalafil on the potentiation of the blood-pressure-lowering effects of selected antihypertensive medications (amlodipine, angiotensin II receptor blockers, bendrofluazide, enalapril, and metoprolol)
Lopressor, also known as metoprolol, is listed as one of the antihypertensive medications studied. The use of tadalafil with Lopressor (metoprolol) is not contraindicated, but caution is advised as tadalafil can potentiate the blood-pressure-lowering effects of metoprolol 3.
From the Research
Tadalafil Contraindications
- Tadalafil is contraindicated with nitrates due to the risk of severe hypotension and potential life-threatening consequences 4, 5, 6, 7.
- Caution is advised when combining tadalafil with alpha-blocking agents, such as doxazosin, as it may lead to orthostatic hypotension 4, 5, 6.
- There is no direct evidence to suggest that tadalafil is contraindicated with Lopressor (metoprolol), a beta-blocker, but patients with cardiovascular disease should be carefully evaluated before prescribing tadalafil 5, 8.
Safety of Tadalafil with Antihypertensive Medications
- Studies have shown that tadalafil can be safely used with most antihypertensive agents, including beta-blockers like metoprolol, without a significant increase in the risk of hypotension-related adverse events or major adverse cardiovascular events 5, 8.
- However, it is essential to monitor blood pressure and adjust the dose of tadalafil or antihypertensive medications as needed to minimize the risk of hypotension 4, 5, 8.