Can You Take Viagra and Cialis Together?

While you shouldn’t take high doses of Viagra® and Cialis® together, you can take lower doses of their active ingredients together if and only if prescribed by a medical provider. 

What’s the Difference Between Viagra and Cialis?  

When it comes to erectile dysfunction treatments, Cialis® and Viagra® are often thought of as being on different, opposing ends of the spectrum. Cialis® (tadalafil) is long-lasting and can be taken daily or up to many hours before sexual activity. 

Its long duration of action creates a big therapeutic window when the drug is active and supporting erectile function. That creates a more flexible schedule that helps guys be “ready to go” whenever they need to be. 

Viagra® (sildenafil)—on the other hand—is a drug that works best when sex is going to happen at a predictable time. It is taken as needed and known for delivering fast-acting, reliable results when taken 1-4 hours before sex.

Now, if I were to ask you to choose just one ED treatment based on those two descriptions, which would you choose? In my clinical experience, many men say, “both.” 

And while you shouldn’t combine full doses of Viagra® and Cialis®, there are some circumstances in which a provider might deem it appropriate for you to take a compounded drug that combines the active ingredients in both of those medications at lower levels.

Read on for a more detailed explanation. 

How Do Viagra® and Cialis® Work?

Erections start with sexual stimulation, which triggers sexual arousal in your brain. Your brain generates nerve impulses that travel through your spinal cord and pelvic nerves to your penis, where they ultimately trigger a complex series of biological events that cause an erection. 

Lots of different body systems, especially your blood vessels, need to be healthy in order for everything to go right and for you to achieve a fully hard erection.

Common medical conditions or health conditions that impact men’s health, like hypertension (high blood pressure) or diabetes, can affect the function of this system and cause erectile dysfunction. 

Cialis® and Viagra®, as well as their generic equivalents, are both FDA-approved ED medications that belong to a class of treatment options called PDE5 inhibitors. PDE5 (which is short for phosphodiesterase type 5) is an enzyme that works to enhance blood flow to the penis. 

These ED drugs help you get hard by keeping the blood vessels and smooth muscle in your penis relaxed so that blood can keep flowing quickly.

By inhibiting the actions of PDE5, medications like Cialis and Viagra increase the total amount of blood that can flow to your penis when you’re sexually aroused.

This increase in blood flow can make it easier for you to get an erection when you feel ready to have sex and maintain it during sexual intercourse.

Can you take Cialis® in the morning and Viagra® at night? 

Because Cialis® lasts for a long time and Viagra® works quickly, many men affected by ED have wondered if they can take Cialis in the morning and Viagra at night to make these medications even more effective at treating erectile dysfunction.

But it isn't a good idea to DIY it. These are medications after all. You shouldn't be mixing Viagra® and Cialis® without a prescription and the oversight of a healthcare provider.

So, why shouldn’t you take Viagra® and Cialis® together?

These drugs are not meant to be taken together at their full, commercially available doses. In fact, the patient information packets that come with Viagra® and Cialis® warn specifically against combining them together. Those warnings are there for a reason. 

First, there’s no firm evidence that taking high, commercially-available doses of Viagra® and Cialis® together results in better erections. 

Second, taking both medications can increase the chances of certain side effects like low blood pressure, fainting, or even priapism (an emergency condition that can cause permanent ED in which an erection won’t go away). 

Can you ever take Viagra® and Cialis® together?

The answer is yes, BUT… you’ll need a prescription from a healthcare provider who can judge whether a combination treatment is safe for you.

Some sexual medicine experts, including me, do prescribe name brand or generic Cialis® and name brand or generic Viagra® at the same time for certain men who we think can benefit from combining the unique characteristics of both drugs.

In fact, a published clinical trial reported that combination treatment with sildenafil citrate (the active ingredient in Viagra®) and tadalafil (the active ingredient in Cialis®) resulted in similar rates of side effects and better effectiveness when compared with treatment using only one drug. 

My personal experience prescribing sildenafil and tadalafil together for my own patients has been similarly positive.

It’s important to note, once again, that these combination treatments need to be prescribed by a healthcare provider who deems them safe and appropriate for the individual seeking care. The combination of Viagra® and Cialis® together is considered an “off-label” use.

Can I take one medicine that contains the active ingredients in Viagra® and Cialis® together?

Yes, and the answer lies in “compounding.” This is a process wherein pharmacists create personalized medications for patients by combining a customized mix of active ingredients at individualized doses. 

This allows providers to deliver treatments in a way that may fit an individual patient’s needs and preferences better than a commercially-available medication. 

Hard Mints by Hims: a personalized, compounded treatment for ED

Hard Mints by Hims are personalized, compounded chewable tablets with clinically proven ingredients known to treat erectile dysfunction. 

ED Hard Mints are be available in 7 variations, depending on the needs of the patient, as determined by their medical provider:

• Combination Tadalafil and Sildenafil (in 2 different dosages): Tadalafil is both fast acting and long lasting. The combination Hard Mint includes the same active ingredients as Cialis® and Viagra® in an innovative formulation

• Vardenafil (in 2 different dosages): fast acting with the same active ingredients as Levitra® and Stayxn®

• Tadalafil (in 3 different dosages): long lasting, now offered as either a daily or as needed chewable with the same active ingredients as Cialis® 

The clinically active ingredient combinations available in Hard Mints can empower guys to be performance ready within 30 minutes and can keep them ready to go for up to 36 hours. Plus, a lot of folks may prefer their chewable format over traditional pills.  

The real benefit of Hard Mints is that they allow patients to get personalized ED medication. This way, affected patients can get results in a way that best fits their specific needs.

How are Hard Mints different from traditional ED medications?

Erectile dysfunction medications are typically one-size-fits-all. In other words, patients are prescribed a standard, non-custom dosage of medication in oral pill form, leaving them little wiggle room between what they are prescribed and the dose or ingestion format that might suit them best.

Hard Mints flip that paradigm by offering patients with ED the opportunity to get highly personalized medicine that contains the right mix and doses of pharmaceutical ingredients for them, at prices that won’t break the bank. 

For men with ED that want to be ready to go anytime, a Hard Mint containing tadalafil + sildenafil might be the right fit. For guys that like to plan around a special occasion, a Hard Mint containing vardenafil might be a better option.

Through the Hims platform, a licensed provider can help determine the best fit for each individual. 

The Benefits of Personalized Medicine for ED

As a urologist who’s treated thousands of patients throughout my career, I’ve seen firsthand how sexual medicine has been evolving towards more personalized, patient-centric care.

That’s why it’s so exciting to see an organization as far-reaching as Hims invest in making compounded ED medications accessible—and affordable—to guys who can benefit from them.

I’ve long thought that the future of erectile dysfunction treatment lies in personalization. With Hard Mints, Hims has taken real steps to make that future a reality for patients everywhere.

About Dr. Peter J. Stahl

Dr. Peter J. Stahl is a urologist and men’s health expert in private practice in New York. He currently serves as SVP of Sexual Health & Urology at Hims & Hers Health.

Dr. Stahl is the former Director of Male Reproductive and Sexual Medicine at New York-Presbyterian Hospital/Columbia University Irving Medical Center and a former Associate Professor of Urology at the Columbia University Vagelos College of Physicians and Surgeons.