Does Tramadol Interact With Cialis?

In our latest question and answer, the pharmacist discusses whether or not it is safe to combine tramadol and Cialis (tadalafil).

Question

I’m on tadalafil daily 5mg and my doctor prescribed tramadol. Are there any bad interactions I should be concerned about?

Asked by Brian On Nov 28, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Nov 28, 2022
Last updated Nov 28, 2022

Key points

  • There is no known drug interaction between tramadol and Cialis (tadalafil) but tramadol could potentially worsen certain symptoms that Cialis is used to treat.

Answer

While there is no known drug interaction between tramadol and tadalafil (generic for Cialis), there are some 'drug-disease' interactions to be aware of.

You don't mention what you are taking tadalafil for, but it is likely you are taking it for one of two reasons:

  • Erectile dysfunction
  • Benign prostatic hyperplasia (i.e., an enlarged prostate).

Opioids, like tramadol, can cause side effects in some individuals that could make each of the above conditions worse.

Now, if you are only taking tramadol for a short amount of time, the potential for side effects may not be as concerning to you, but I think they are important to be aware of just in case you notice some worsening symptoms.

Tramadol Side Effects Can Worsen Some Conditions

Tramadol is an opioid drug and shares all of the side effects traditionally associated with opioids, such as nausea, dizziness, drowsiness, physical dependence, constipation, etc.

Tramadol certainly is not as potent as some other opioids, but, again, can still cause opioid-related side effects.

In regard to the conditions you are potentially treating, let me touch base on both of them.

Benign Prostatic Hyperplasia (BPH)

Opioids like tramadol need to be used cautiously if you have an enlarged prostate as they can worsen symptoms that the condition causes.

Specifically, opioids can further worsen urinary retention. One study reported the following:

Opioids contribute to urinary retention by decreasing the sensation of bladder fullness through inhibition of the parasympathetic nerves that innervate the bladder.
Pediatr Crit Care Med . 2019 May;20(5):e240-e244.

Additionally, opioids can make it physically harder to urinate since they can increase the tension of the detrusor muscle in the bladder.

Erectile Dysfunction

Opioids, on the whole, are associated with erectile dysfunction. One study reported that it can occur in up to 50% of men taking them:

Men who chronically use opioids report an unexpectedly high prevalence of erectile dysfunction and at younger ages compared to the general population. Across several published reports, in males with a mean age of 28-49 years, prevalence rates of ED ranged from 21-52%.
J Addict Dis. 2010 Oct; 29(4): 455–460.

Now, opioid-induced erectile dysfunction generally occurs only when you take them for a long period of time, but could certainly affect anyone at any time while taking them.

Final Words

So, even though there is no interaction between tramadol and tadalafil (Cialis), I think it is important to know how the combination of drugs can potentially affect the conditions you are treating.

I hope you found this answer helpful and please reach back out again anytime.

References

  • Nalbuphine Reduces Opioid-Associated Urinary Retention in Pediatric Patients, PubMed
  • Drug-induced urinary retention: incidence, management and prevention, PubMed
  • Effects of opioids and benzodiazepines on bladder function of awake restrained mice, PubMed
  • Erectile Dysfunction in Opioid Users: Lack of Association with Serum Testosterone, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at Hello@HelloPharmacist.com! You can also connect with Dr. Brian Staiger on LinkedIn.

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