Drug interactions
Ramipril + Tadalafil
Severity: Moderate
Ramipril and Tadalafil: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Tadalafil is a vasodilator and can add to the blood pressure lowering of ACE inhibitors such as ramipril. Symptomatic hypotension, dizziness or syncope may occur, particularly after the first doses or in volume-depleted patients.
What this interaction means in plain words
Ramipril and Tadalafil can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Ramipril belongs to Cardiovascular; Tadalafil belongs to Genitourinary.
Why it happens
Additive vasodilation through PDE5 inhibition (nitric oxide/cGMP pathway) combined with ACE inhibition.
What to do
Monitor blood pressure and counsel the patient about orthostatic symptoms when starting tadalafil. Reduce the dose or review antihypertensive therapy if symptomatic hypotension develops.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Ramipril and Tadalafil, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 14 days on the web. No card needed.
Other interactions of Tadalafil
- Amyl nitrite + Tadalafil Contraindicated
- Isosorbide dinitrate + Tadalafil Contraindicated
- Isosorbide mononitrate + Tadalafil Contraindicated
- Nitroglycerin po + Tadalafil Contraindicated
- Nitroglycerin rectal + Tadalafil Contraindicated
- Nitroglycerin sublingual + Tadalafil Contraindicated
Other interactions of Ramipril
- Aliskiren + Ramipril Contraindicated
- Protein a column + Ramipril Contraindicated
- Ramipril + Sacubitril / valsartan Contraindicated
- Ramipril + Sacubitril-valsartan Contraindicated
- Amifostine + Ramipril Major
- Amiloride + Ramipril Major
Frequently asked questions
Can I take Ramipril with Tadalafil?
MediHelp rates the interaction as moderate. Ramipril and Tadalafil can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Tadalafil is a vasodilator and can add to the blood pressure lowering of ACE inhibitors such as ramipril. Symptomatic hypotension, dizziness or syncope may occur, particularly after the first doses or in volume-depleted patients.
How serious is the interaction between Ramipril and Tadalafil?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood pressure and counsel the patient about orthostatic symptoms when starting tadalafil. Reduce the dose or review antihypertensive therapy if symptomatic hypotension develops.
What other medicines interact with Tadalafil?
MediHelp also lists interactions of Tadalafil with, for example, Amyl nitrite, Isosorbide dinitrate, Isosorbide mononitrate. The full list is on the Tadalafil page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
