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Can I Take Cialis Along With Isosorbide?

Posted on Mon, 26 May 2014

Question: I am currently taking isosorbide mononitrate 30 mg once a day. I understand that I am not to take cialis while I am taking this drug because it may lead to severe low blood pressure. May I stop taking the nitrate 4 or 5 days before I start a 5 day period for using cialis, and then return to the nitrate two days thereafter without ill effect?

Answered by Dr. Raju A.T (8 hours later)

Brief Answer:
No, Avoid Cialis

Detailed Answer:
Hi,

Thanks for your query.

Avoid taking Cialis even without Isosorbide. If the indication for Isosorbide is cardiac ischemia then taking Cialis alone could cause serious problems.

Cialis can cause tachycardia which could be dangerous for a heart with risk of ischemia.

Hope, I answered your query.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Raju A.T (2 hours later)

I don't follow your logic, Dr. If both isosorbide momonitrate and tadalafil dilate arteries so as to increase blood flow, why doesn't, one substitute for the other. My formerly blocked artery was the circumflex artery. One larger coronary artery is only 40 percent blocked.

Answered by Dr. Raju A.T (22 hours later)

Brief Answer:
the action is different

Detailed Answer:
Hi,

Thanks for writing back.

Both do dilate the arteries but not the same arteries.

Tadalafil inhibits an enzyme called PDE5 (phosphodiesterase type 5) and cause increased penile blood flow resulting from the relaxation of penile arteries and the smooth muscle of the corpus cavernosum.

Whereas the Isosorbide Mononitrate targets at the cardiac coronary circulation.

Lowering the blood pressure by tadalafil alone is higher than Isosorbide. Tadalafil results in pooling of around 500ml of blood into the penile circulation leading to hypovolemia in the central circulation. This results in increased heart rate and can cause trouble in heart with history of ischemia.

Hope, I answered your query.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Raju A.T (1 hour later)

If they target different blood vessels why can't both be taken?

Answered by Dr. Raju A.T (14 hours later)

Brief Answer:
Both have a similar side effect

Detailed Answer:
Hi again,

Since they dilate blood vessels (different sites) they cause pooling of the blood into those areas respectively. The other areas get less blood and the blood pressure drops. The drop in the blood pressure by both gets added up and there can be severe hypotension if taken together. Also, Tadalafil causes increased heart rate which is dangerous for people with existing heart disease.

Please ask if any doubts.

regards,

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar