Can Cialis lower blood pressure?
Cialis (tadalafil) is used to treat erectile dysfunction (ED) and benign prostatic hyperplasia (BPH). By relaxing smooth muscle in blood vessel walls, it widens vessels and increases blood flow. This mechanism can also reduce systemic blood pressure. For most men, this mild drop is not problematic, but combining Cialis with certain medications or substances may cause dangerously low blood pressure.
When can Cialis cause hypotension?
- With nitrates (nitroglycerin, isosorbide dinitrate, isosorbide mononitrate or poppers): risk of severe blood pressure drop.
- With riociguat (Adempas): additive vasodilation in pulmonary hypertension.
- With alpha‑blockers or other antihypertensives.
- With heavy alcohol use.
- Do not combine with other PDE‑5 inhibitors (Viagra, Levitra, Stendra).
Always inform your healthcare provider of all prescription drugs, over‑the‑counter medicines, supplements, and recreational substances you use before starting Cialis.
How much does Cialis lower blood pressure?
In clinical studies:
- Average systolic decrease: 4.8 mmHg; diastolic decrease: 2.9 mmHg versus placebo.
- In patients on multiple antihypertensives: systolic decrease 7.5 mmHg; diastolic decrease 4.3 mmHg versus placebo.
What is Cialis approved for?
Cialis is approved for adult men to treat:
- Erectile dysfunction
- Benign prostatic hyperplasia
- Both ED and BPH concurrently
How does Cialis work?
Tadalafil inhibits the enzyme phosphodiesterase type 5 (PDE‑5), preventing breakdown of cyclic GMP. Nitric oxide‑mediated cGMP accumulation causes smooth muscle relaxation in blood vessels, improving penile erection and alleviating urinary symptoms of BPH.
Common side effects
- Headache
- Nasal congestion
- Indigestion
- Stomach upset
- Back pain
- Muscle aches
- Dizziness
Serious side effects (seek immediate help)
- Vision loss or retinitis pigmentosa
- Sudden hearing loss
- Priapism (erection > 4 hours)
- Heart attack, stroke, chest pain
- Allergic reactions: facial or throat swelling, hives, difficulty breathing
- Severe hypotension
Precautions before taking Cialis
Discuss with your provider if you have:
- Heart conditions: heart failure, chest pain, arrhythmias, recent heart attack or stroke
- Bleeding disorders or blood cancers
- Liver or kidney impairment
- Vision disorders (NAION, retinitis pigmentosa)
- Stomach ulcers
- Peyronie’s disease
- If you already take tadalafil (Adcirca)
Does Cialis ever raise blood pressure?
No. It is not known to increase blood pressure. Its main cardiovascular effect is a mild reduction in blood pressure, which may become significant when combined with nitrates, riociguat, alpha‑blockers, alcohol, or other antihypertensive drugs.
Sources
- Cialis (tadalafil) tablets prescribing information. Eli Lilly and Company. Last Updated 4/23.
- Patterson D, McInnes GT, et al. Influence of a single dose of 20 mg tadalafil on ambulatory blood pressure in hypertension. Br J Clin Pharmacol. 2006;62(3):280–287.