Possible food and drug interactions when taking Tadalafil

Consumer Information (PDR)

Be sure to check with your doctor about the medications that should never be taken with Cialis, including:

Alpha-blocking drugs prescribed for high blood pressure or prostate problems, including doxazosin (Cardura), terazosin (Hytrin), prazosin (Minipress), and alfuzosin (Uroxatral)
Nitrate-based drugs prescribed for chest pain, such as nitroglycerin patches (Nitro-Dur, Transderm-Nitro), nitroglycerin ointment (Nitro-Bid, Nitrol), nitroglycerin pills (Nitro-Bid, Nitrostat), and isosorbide pills (Dilatrate-SR, Isordil, Sorbitrate)
Street drugs known as "poppers," including amyl nitrate and butyl nitrate

Cialis could intensify the effects of certain drugs used to lower blood pressure. Be sure to tell your doctor if you take any of the following:

Angiotensin II receptor blockers, such as candesartan (Atacand), eprosartan (Tevetan) and irbesartan (Avapro)
Bendrofluazide
Enalapril (Vasotec)
Metoprol (Lopressor)

If Cialis is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Cialis with the following:

Other impotence drugs including alprostadil (Caverject), sildenafil (Viagra), and vardenafil (Levitra)
Erythromycin (E-Mycin, Ery-Tab, PCE)
Grapefruit juice
Indinavir (Crixivan)
Itraconazole (Sporanox)
Ketoconazole (Nizoral)
Rifampin (Rifadin, Rimactane)
Ritonavir (Norvir)

It's best not to drink too much alcohol while you're taking Cialis. Combining the two could lower your blood pressure and cause dizziness, especially upon standing. Drinking five or more servings of alcohol could intensify this effect and also cause headache and rapid heartbeat.

Consumer Information (Cerner Multum)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For tadalafil, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to tadalafil. Also tell your doctor and pharmacist if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Tadalafil is for use in men only. Tadalafil has not been studied in pregnant women. Tadalafil has not been shown to cause birth defects or other problems in animals.

Breast-feeding—Tadalafil is for use in men only. It is not known whether tadalafil passes into human breast milk.

Children—Tadalafil is not for use in children.

Older adults—This medicine has been tested in a limited number of patients 65 years of age or older and has not been shown to cause different side effects or problems in older people than it does in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking tadalafil, it is especially important that your doctor and pharmacist know if you are taking any of the following:

• Erectile dysfunction medicines—These medicines should not be used at the same time as tadalafil because the safety of using these medicines in combination has not been proven.

• Nitrates (medicine used to treat chest pain [e.g., nitroglycerin])—These medicines should not be used at the same time as tadalafil because they can cause very low blood pressure and serious side effects.

• Alcoholic beverages—Drinking alcohol can cause an increased chance of some side effects.

• Alpha blockers, other than tamsulosin 0.4 mg taken once a day (medicine for high blood pressure)—These medicines should be used with caution when taken at the same time as tadalafil because they can cause very low blood pressure and serious side effects.

• Erythromycin (e.g., Apo-erythro) or
• Itraconazole (e.g., Sporanox) or
• Ketoconazole (e.g., Nizoral) or
• Grapefruit juice or
• Ritonavir (e.g., Norvir) or
• Saquinavir (e.g., Fortovase, Invirase)—These medicines or food may increase your chance of getting side effects.

Other medical problems—The presence of other medical problems may affect the use of tadalafil. Make sure you tell your doctor if you have any other medical problems, especially:

• Age greater than 50 years or
• Coronary artery disease or
• Diabetes or
• Hyperlipidemia (excess of lipids in the blood) or
• Hypertension (high blood pressure) or
• Low cup to disc ratio (“crowded disc”) or
• Smoking—These conditions may increase risk for a serious eye problem called NAION.

• Angina (reoccurring chest pain) or
• Arrhythmia (irregular heartbeat) or
• Hypotension (low blood pressure) or
• Hypertension (high blood pressure) or
• Stroke (recent history of) or
• Heart attack (within the last 3 months) or
• Heart failure (within the last 6 months) or
• Retinal disorders (rare hereditary eye problem)—Tadalafil has not been studied in patients with these medical conditions and should not be used.

• Kidney disease (severe)—Tadalafil should be used with caution in these patients and a lower dose may be needed.

• Liver disease—Tadalafil should not be used in patients with serious liver disease; in patients with less serious liver disease, tadalafil should be used with caution and a lower dose may be needed.

• Abnormal penis, including curved penis and birth defects of the penis—Chance of problems occurring may be increased and this medicine should be used with caution in these patients

• Bleeding disorders or
• Stomach ulcers—Chance of problems occurring may be increased; it is not known if the medicine is safe for use in these patients.

• Heart disease, underlying—Chance of low blood pressure occurring is greater; tadalafil should be used carefully in these patients.

• Heart blood flow problems—These conditions may cause you to be more sensitive to tadalafil.

• Sickle-cell anemia (blood disorder) or
• Bone marrow cancer or
• Leukemia (blood related cancer)—Tadalafil should be used with caution in these patients as problems with prolonged erection of the penis may occur.

• NAION (serious eye condition) in one or both eyes, previously—May increase your chance of getting NAION again.