Tadalafil
An increase in drug-drug interactions were deemed unlikely for tadalafil with nitrates due to their low and decreasing usage in Germany (0.8); in 2024, there were 53 million defined daily doses (DDD) of long-acting nitrates prescribed (reduced from 233 million DDDs in 2024), 52 million DDDs of molsidomine and 31 million DDDs of glyceryl Given the ubiquitous use of nitrates and the potential for patients with PAH to demonstrate chest pain, it is important to counsel all patients taking sildenafil, tadalafil, or riociguat to warn providers in emergency medical services to avoid nitrates. tadalafil and nitrates Should a patient develop chest pain while taking sildenafil or vardenafil, nitrate may be administered under supervision at 24 hours (and possibly earlier); should a patient take tadalafil and develop chest pain, nitrate may not be given until at least 48 hours after the tadalafil dose and then again, only under close monitoring. -Blockers Organic nitrates are drugs that widen arteries by increasing their supply of nitric oxide; that’s how they open the partially blocked coronary arteries in patients with angina. But because nitrates and ED pills both act on nitric oxide, the drugs don’t mix; healthy volunteers given Viagra followed an hour later by nitroglycerin see their blood
Despite the modest additive effect of tadalafil on nitrate-induced decreases in mean blood pressure, the frequency of potentially significant blood pressure effects indicates that, as with sildenafil, tadalafil should not be used in combination with nitrates.
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