Is Cialis Good for Your Heart? Safe for Most Men, But Not a Treatment

No. Cialis (tadalafil) is not a heart treatment, and you should not take it to protect your heart. For most men without a nitrate medicine or a serious heart condition, it is considered safe. Safe is not the same as good for you.

Why some headlines say it lowers heart risk#

A 2024 study in Clinical Cardiology (Kloner and colleagues) looked at US insurance records. It compared men with erectile dysfunction (ED) who had a tadalafil claim with men who had no claim for any PDE5 inhibitor. That is the drug class that includes Cialis and Viagra.

The study reported lower rates of major heart events, and of death from any cause, in the tadalafil group.

These findings show a link, not a cause. The researchers looked back at records. Nobody was picked at random to take tadalafil.

Men who fill repeat prescriptions may be healthier, or may look after themselves more. That could explain some or all of the difference. Only a proper trial could settle it.

Is it safe for most men?#

A 2003 review of tadalafil clinical trial data (Kloner, 2003) found small blood pressure changes in healthy men. The author concluded that tadalafil was generally well tolerated in the men studied, including some with heart disease, as long as they did not take nitrates.

That review is dated, and it is not blanket reassurance for anyone with heart disease. Current UK prescribing information (the SmPC) lists heart conditions where tadalafil should not be used. These are covered in "Who should not take it" below.

Those trials were short and used selected men. They cannot rule out rare risks. Sex is also physical effort, a bit like climbing a couple of flights of stairs. A heart that is not stable may struggle with that.

Nitrates are the one hard rule#

Nitrates are angina medicines such as GTN spray or tablets and isosorbide mononitrate. Poppers (alkyl nitrites) work the same way. Taken with tadalafil, they can drop your blood pressure to a dangerous level.

Tadalafil stays in your body for a long time. Leave at least 48 hours after your last dose before any nitrate. This applies at every dose, including daily 2.5mg and 5mg tablets.

If you need a nitrate regularly, tadalafil is not for you. In an emergency, tell the paramedics you have taken tadalafil.

Who should not take it#

Do not take tadalafil if you:

• take nitrates or use poppers
• take riociguat (a medicine for lung blood pressure)
• had a heart attack in the last 90 days
• had a stroke in the last 6 months
• had heart failure of NYHA class 2 or worse in the last 6 months (breathless with ordinary activity)
• have unstable angina, or chest pain during sex
• have an uncontrolled irregular heartbeat, very low blood pressure or uncontrolled high blood pressure
• have lost sight in one eye from optic nerve damage (NAION)

Other medicines matter too. Doxazosin is not recommended with tadalafil. Tamsulosin and blood pressure tablets can add to a drop in blood pressure, so a prescriber may change your plan.

Strong CYP3A4 blockers raise tadalafil levels. Examples are ritonavir, ketoconazole and clarithromycin. Always show your full medicine list to a pharmacist.

Tadalafil is also licensed for pulmonary arterial hypertension (high blood pressure in the lungs). That use needs a different dose under specialist care. It does not make Cialis a heart drug.

ED can be an early heart warning#

The blood vessels in the penis are small, so they can show damage before the arteries around the heart do. ED can appear years before a heart problem. If you have ED, get your blood pressure, cholesterol and HbA1c (a blood sugar test) checked.

The NHS Health Check is free for ages 40 to 74. Many community pharmacies also check blood pressure. Tadalafil does not replace statins or blood pressure tablets.

If something feels wrong#

Stop and call 999 for chest pain that does not ease, or for fainting. Dizziness or a racing heartbeat during sex is a reason to stop and get advice from NHS 111 or your pharmacist. An erection lasting over 4 hours needs urgent care. So does sudden loss of vision or hearing.

You can report side effects through the Yellow Card scheme. If you are unsure about your heart, speak to your GP or pharmacist before you start. You can also read our guide on whether Viagra can cause a heart attack, which covers the same drug class.