Is tadalafil bad for your heart? For most healthy men, the answer is no. When used correctly, tadalafil (Cialis) is not considered harmful to the heart, and in some men it may even be a marker of better vascular health. But there are important exceptions, and one dangerous drug combination you must know about. Here’s what men should understand about tadalafil, heart health, and blood pressure.
The Short Answer
Tadalafil is a phosphodiesterase-5 (PDE5) inhibitor used to treat erectile dysfunction (ED) and benign prostatic hyperplasia (BPH). Large safety reviews have not shown that tadalafil increases the risk of heart attack, stroke, or other serious cardiovascular events in the general population of men who use it (Terentes-Printzios et al., Nature Reviews Cardiology, 2022). In fact, research suggests PDE5 inhibitors may have beneficial effects on blood vessels.
The catch: tadalafil is a mild vasodilator, so it slightly lowers blood pressure. That’s usually harmless, but it becomes dangerous when combined with nitrates, and it requires caution in men with certain heart conditions.
At Maze Men’s Health, our providers review your full cardiovascular history before prescribing ED treatment, so you get an answer tailored to your heart, not a one-size-fits-all pill.
How Tadalafil Affects Your Blood Vessels and Blood Pressure
Tadalafil works by relaxing the smooth muscle lining blood vessels, improving blood flow, including to the penis, which is how it treats ED. Because this vasodilating effect isn’t limited to one area, tadalafil causes a small, generally harmless drop in blood pressure throughout the body.
How small? In healthy men, tadalafil 20 mg lowered blood pressure by an average of only about 1.6/0.8 mm Hg compared with placebo, a change most people never notice (FDA Tadalafil Label). Daily tadalafil over 26 weeks produced blood pressure changes similar to placebo.
Reassuringly, a large pooled analysis of over 22,000 patients found that taking tadalafil alongside blood pressure medications did not increase the risk of hypotension-related side effects or major cardiovascular events compared with those medications alone (Kloner et al., Journal of Clinical Hypertension, 2022).
Who Can Generally Use Tadalafil Safely?
Most men with stable cardiovascular health can use tadalafil safely, including many men with well-controlled high blood pressure. Because sexual activity itself places some demand on the heart, the key question is whether your heart can safely handle sex. For most men who are active without chest pain or severe symptoms, the answer is yes.
Who Needs Extra Caution, or Should Avoid Tadalafil
Tadalafil is not recommended, or requires careful medical evaluation, in men with certain conditions. According to the FDA tadalafil label, tadalafil should be avoided or used only with caution in men with:
- Nitrate use, This is an absolute contraindication. Combining tadalafil with any nitrate (such as nitroglycerin or isosorbide) can cause a sudden, dangerous drop in blood pressure. Never combine them.
- Recent heart attack (within the last 90 days)
- Unstable angina or chest pain during sex
- Heart failure (NYHA Class 2 or greater in the last 6 months)
- Uncontrolled arrhythmias, low blood pressure, or uncontrolled high blood pressure
- Recent stroke (within the last 6 months)
- Alpha-blocker use or heavy alcohol intake, which can add to the blood pressure lowering effect
Men also taking guanylate cyclase stimulators (such as riociguat) should not use tadalafil. If you develop chest pain after taking tadalafil, seek immediate medical attention and tell the provider you have taken it.
Why Getting Evaluated Matters
ED can be an early warning sign of underlying cardiovascular disease. That’s why treating ED is about more than a prescription, it’s an opportunity to assess your heart health. The medical team at Maze Men’s Health evaluates your blood pressure, medications, and cardiac risk factors to determine whether tadalafil is right for you and at what dose.
Come to Maze Men’s Health
Wondering whether tadalafil is safe for your heart? Don’t guess, get a personalized answer from the experts. Maze Men’s Health offers discreet, physician-led evaluation and treatment for erectile dysfunction, with careful attention to your cardiovascular safety. Contact Maze Men’s Health today to schedule a confidential consultation.
Sources
- FDA Tadalafil Prescribing Information (Warnings, Contraindications, and Blood Pressure Effects)
- Terentes-Printzios D, et al. Interactions between erectile dysfunction, cardiovascular disease and cardiovascular drugs. Nature Reviews Cardiology, 2022.
- Kloner RA, et al. Analysis of integrated clinical safety data of tadalafil in patients receiving concomitant antihypertensive medications. Journal of Clinical Hypertension, 2022