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Tadalafil is a medication that requires careful use due to the potential for serious risks and interactions, especially in individuals with certain medical conditions or those taking other medications. One of the most important precautions is to avoid using tadalafil with nitrates, such as nitroglycerin or isosorbide dinitrate, as well as recreational drugs known as "poppers" containing amyl or butyl nitrite. Combining tadalafil with these substances can result in a dangerous drop in blood pressure, which might cause dizziness, fainting, heart attack, or stroke. It is essential not to take nitrates within 48 hours of your last dose of tadalafil.

People who are currently taking medications for chest pain, certain heart conditions, or pulmonary hypertension (such as riociguat and vericiguat) should not use tadalafil. Additionally, using tadalafil with alpha blocker medications prescribed for high blood pressure or enlarged prostate (such as doxazosin or tamsulosin) can further increase the risk of low blood pressure, leading to symptoms like dizziness or fainting. In these cases, healthcare providers may adjust dosages to reduce risks.

Tadalafil can also interact with a variety of other drugs, including some antifungal medications (like itraconazole and ketoconazole), antibiotics (such as clarithromycin and erythromycin), HIV protease inhibitors, and some medications for hepatitis. These interactions may affect how tadalafil is removed from the body, potentially increasing side effects or reducing effectiveness.

It is important to inform your doctor and pharmacist about all medications, supplements, and herbal products you are taking. Tadalafil should not be used in combination with other treatments for erectile dysfunction or pulmonary hypertension, such as sildenafil or vardenafil, to avoid excessive effects or adverse reactions.

Tadalafil should be used with extra caution in individuals with underlying health conditions and should not be used in certain populations unless specifically directed by a healthcare provider. In the event of an overdose, seek emergency medical help immediately as symptoms may include severe dizziness, fainting, or prolonged erection. Prompt medical attention is crucial in these situations.

Common side effects:

• Headache
• Upset stomach
• Back pain
• Muscle pain
• Runny or stuffy nose
• Sore throat
• Symptoms resembling a common cold
• Flushing
• Dizziness

Serious side effects:

• Severe dizziness
• Fainting
• Chest pain
• Nausea during sexual activity
• Sudden loss of vision
• Sudden loss of hearing
• Ringing in the ears
• Painful or prolonged erection lasting more than four hours
• Severe allergic reaction (rash, itching, swelling, severe dizziness, or difficulty breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• Nitrate medications (e.g., Nitroglycerin, Isosorbide Dinitrate, Isosorbide Mononitrate, recreational 'poppers')
• Riociguat

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Certain antibiotics
• Certain antifungals
• Hepatitis C medicines
• HIV medicines
• Drugs used to treat high blood pressure
• Drugs used to treat prostate disorders
• Some seizure medicines

Interactions with low risk that usually do not require a change in therapy:

• Grapefruit and grapefruit juice
• Alcohol