Who Should Not Take Cialis?
Cialis (tadalafil) is contraindicated in patients using nitrates (e.g., nitroglycerin) or nitric oxide donors, as this combination can cause severe hypotension.[1] It is also contraindicated in those with known hypersensitivity to tadalafil or any Cialis component.[1]
Why Avoid Nitrates with Cialis?
Nitrates and Cialis both increase cyclic guanosine monophosphate (cGMP) levels, leading to excessive vasodilation and potentially life-threatening blood pressure drops. This applies to all forms of nitrates, including recreational amyl nitrite ("poppers").[1][2]
Heart Conditions That Rule Out Cialis
Do not use Cialis in patients with recent myocardial infarction (within 90 days), unstable angina, severe hypotension (<90/50 mmHg), uncontrolled hypertension (>170/100 mmHg), or New York Heart Association Class 2+ heart failure.[1] These increase risks of cardiovascular events during sexual activity.[2]
Eye and Vision Issues
Cialis is contraindicated in those with hereditary degenerative retinal disorders like retinitis pigmentosa, due to potential retinal toxicity from PDE5 inhibition.[1]
Other Key Restrictions
Avoid in patients with severe hepatic impairment (Child-Pugh Class C) or end-stage renal disease on dialysis, as tadalafil exposure rises significantly.[1] It is also not recommended during riociguat therapy for pulmonary hypertension, due to amplified hypotensive effects.[1]
Sources
[1]: Cialis Prescribing Information (FDA)
[2]: Drugs.com - Cialis Contraindications