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Does Cialis Lower Blood Pressure?

Kelly Brown MD, MBA

Reviewed by Kelly Brown, MD

Written by Geoffrey Whittaker

Published 02/22/2021

Updated 03/12/2024

There are many common side effects associated with Cialis® use — as well as generic Cialis (known as tadalafil).

While this erectile dysfunction (ED) medication is known for its benefits as an ED treatment, the fact is that the active ingredient tadalafil can cause some problems of its own. This includes vision impairment, dizziness, back pain, indigestion and flu-like symptoms, among others.

Before this medication was an ED treatment, it was a treatment for an enlarged prostate (also known as benign prostatic hyperplasia or BPH). And before that, uses of tadalafil included cardiovascular treatment to manage high blood pressure (hypertension).

In other words, the very reason we have Cialis is that some scientists once thought it could be harnessed to lower blood pressure.

Does Cialis actually lower someone’s blood pressure when they take it?

Below, we’ll explain how this medication works, what it does to your blood pressure and why that’s vital information for safe use of this ED drug. We’ll also give you some reminders about how to protect yourself from a bad day taking tadalafil.

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Tadalafil is an FDA-approved phosphodiesterase type 5 inhibitor (or PDE5 inhibitor for short).

PDE is an enzyme that prevents smooth muscles — like the ones that let your penis become erect — from relaxing. When you use a PDE-5 inhibitor, your blood vessels can dilate to accommodate blood flow, making erections easier to achieve and maintain.

ED can be caused by a number of issues relating to physical or mental health. But at the center of many sexual function problems is a blood flow issue.

Tadalafil is just one of several PDE5 inhibitors, including Viagra® (sold as generic sildenafil) and Levitra® (or generic vardenafil). But unlike those taken as needed, you can also take tadalafil daily at a low dose — in part because it can stay in your system and be effective for up to 36 hours.

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Since tadalafil has vasodilating effects, it can lower blood pressure. And depending on how healthy your blood pressure is, this can either be a benefit or one of the side effects of Cialis.

Most research says these drops are generally safe at the dosages used for ED.

A clinical study found that healthy men taking 20 mg (milligrams) of Cialis® versus a placebo experienced an average decrease of up to 1.6 mm Hg (millimeters of mercury) in systolic blood pressure and 0.8 mm Hg in diastolic blood pressure when lying down. They had a decrease of 0.2 Hg in systolic blood pressure and 4.6 mm Hg in diastolic blood pressure when standing.

For context, people may begin to feel negative effects after a sudden blood pressure drop of 20 mm Hg.

Tadalafil can have a greater effect on lowering pulmonary blood pressure (the one that tells you how well blood is moving through your lungs). That’s why this medication is sometimes used to treat pulmonary hypertension under the brand name Adcirca®.

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On its own, tadalafil isn’t likely to cause a dangerous drop in blood pressure in healthy men. But certain medical conditions and drugs can potentially heighten its hypotensive effects.

For instance, tadalafil is currently not recommended for people who have had:

  • Recent heart failure

  • Recent heart attack

  • Recent stroke

  • Severe, uncontrolled arrhythmia (irregular heartbeat)

  • Angina (chest pain)

  • Uncontrolled hypertension

  • Hypotension (low blood pressure)

Tadalafil may likewise not be perfectly safe for:

  • People with left ventricle obstructions, such as idiopathic hypertrophic subaortic stenosis or aortic stenosis

  • Those in too poor of health for sexual activity

  • People with bleeding problems or disorders, like multiple myeloma or leukemia, sickle cell anemia or severely impaired autonomic control of blood pressure

  • Individuals with liver problems or kidney problems (including those on dialysis)

  • Folks with vision loss, non-arteritic anterior ischemic optic neuropathy (NAION) or retinitis pigmentosa

  • People with stomach ulcers

Additionally, Cialis may not be safe for men suffering from penile deformations or Peyronie’s disease. It could also be a risk for those predisposed to or with a history of priapism (prolonged erection lasting more than four hours).

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Certain disorders can make Cialis dangerous for some users. On top of that, you also need to worry about potential tadalafil interactions.

Some medications can increase the drug’s hypotensive effects to a dangerous level, including:

  • Guanylate cyclase stimulators

  • Alpha-blockers

  • Prescription and over-the-counter nitrates, including poppers, nitric oxide and nitroglycerin

  • Substantial amounts of alcohol

  • Antihypertensives

  • Other medicines that treat erectile dysfunction

Be sure to let your provider know if you take any of these medications.

Things are about to get a little technical here. But chances are, if you’re worried about your blood pressure, you’ve already got some background on the numbers.

Healthcare professionals generally define low blood pressure as any reading below 90/60 mm Hg. If blood pressure goes too low, it can lead to heart attacks, strokes or shock.

If you experience symptoms like chest pain, nausea, vomiting or anything unusual during sex, seek medical attention right away.

Other signs of low blood pressure in the danger zone include:

  • Poor concentration

  • Fainting

  • Difficulty breathing

  • Fatigue

  • Dehydration or unusual thirst

  • Blurry vision

  • Cold, clammy or pale skin

  • Rapid heart rate

Check in with your healthcare provider if you experience any of these after taking tadalafil.

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The effects of tadalafil on your penis are well known. Like other FDA-approved treatment options for ED, it can be safe and effective when used properly.

But here’s the disclaimer: Some people aren’t in a position to use it safely — ever.

If you’re unsure whether you’re one of them, seek medical advice before using tadalafil.

In the meantime, here’s the big picture on tadalafil and your blood pressure:

  • While tadalafil does have the potential to lower blood pressure, this effect is typically not cause for concern in healthy men.

  • In some cases, however, certain medical conditions or prescription drugs can increase tadalafil’s hypotensive effects — sometimes to a dangerous level.

  • That’s why it’s crucial to discuss your medical history and current medications with your healthcare provider before starting this drug.

With a robust understanding of your health, your healthcare provider can work with you to find the best erectile dysfunction solution.

Want to learn more?

We also offer various other erectile dysfunction treatments  — sildenafil (generic for Viagra), Stendra (avanafil) and our chewable ED hard mints — along with therapy and mental health support.

6 Sources

  1. U.S. Department of Health and Human Services. (n.d.). Low blood pressure. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health/low-blood-pressure.
  2. HIGHLIGHTS OF PRESCRIBING INFORMATION : CIALIS (tadalafil) tablets, for oral use. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021368s030lbl.pdf.
  3. HIGHLIGHTS OF PRESCRIBING INFORMATION: ADCIRCA (tadalafil) tablets for oral administration . (n.d.-c). https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022332lbl.pdf.
  4. U.S. Department of Health and Human Services. (n.d.-a). Definition & Facts for erectile dysfunction - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts
  5. Dhaliwal A, Gupta M. PDE5 Inhibitors. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549843/.
  6. Penn Medicine. (2021). Low Blood Pressure. University of Pennsylvania. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/low-blood-pressure
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kelly Brown MD, MBA
Kelly Brown, MD

Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown is a founding member of Posterity Health where she is Medical Director and leads strategy and design of their Digital Health Platform, an innovative education and telehealth model for delivering expert male fertility care.

She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.

Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.

Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.

Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.

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