Can you take tramadol and Viagra together?

Can you take tramadol and Viagra together? Neither the Australian leaflet for Viagra nor the one for Tramal (tramadol) names the other medicine, and the sildenafil label does not list tramadol. Not named means no interaction is known, not that one has been ruled out. What matters more is tramadol itself: it is an opioid that can make you dizzy or drowsy, can cause seizures and serotonin syndrome, and can itself cause erection problems. Taking it to delay ejaculation is off-label.

Do tramadol and Viagra interact?

No label says so. The Viagra leaflet's list of interacting medicines — nitrates, riociguat, cimetidine, some antifungals and antibiotics, HIV medicines, alpha-blockers and bosentan — does not include tramadol or any opioid (Viagra CMI), and neither does the sildenafil product information (EMA — Viagra). The Tramal leaflet's list does not name sildenafil or any erectile dysfunction medicine (Tramal consumer medicine and product information). In rabbits, though, tramadol did change sildenafil's blood levels (Dahshan et al., J Pharm Biomed Anal 2019). Tell each prescriber about the other medicine; Viagra's potential drug interactions are all in its leaflet.

What is tramadol, and what is it approved for?

Pain. Tramadol is a prescription-only opioid for the short-term relief of moderate to severe pain; it also raises serotonin and noradrenaline in the brain (healthdirect — Tramadol). Tramal "is used to relieve severe pain" and "poses risk of abuse, misuse and addiction" (Tramal consumer medicine information), and its product information reserves it for people for whom other options, non-opioid pain relievers included, are "ineffective, not tolerated or otherwise inadequate" (Tramal product information). Delaying ejaculation is not among its uses.

Will you feel dizzy or faint on the pair?

You might, because both can cause it. Tramal "may cause dizziness, light-headedness, tiredness, drowsiness in some people" (Tramal consumer medicine information), and a fall in blood pressure on standing is an uncommon side effect (Tramal product information). Dizziness and, less often, fainting are also side effects of Viagra (healthdirect — ED medicines). Alcohol is out on tramadol — "Do not drink alcohol while you are using this medicine" (Tramal consumer medicine information). If your blood pressure runs low: can you take Viagra with low blood pressure?

Can tramadol cause erection problems?

Yes. Opioids such as Tramal may affect the hormone system, with falls in testosterone observed, and "Androgen deficiency may manifest as low libido, impotence, erectile dysfunction" (Tramal product information); the leaflet lists loss of libido and "impotence (erectile dysfunction)" among its side effects (Tramal consumer medicine information). In trials for early ejaculation, erectile dysfunction was more common on tramadol than on placebo (Martyn-St James et al., BMC Urol 2015). If erections have worsened since you started tramadol, tell the doctor who prescribes it; do not stop it suddenly, as withdrawal symptoms can follow (healthdirect).

Is tramadol used for premature ejaculation?

Off-label, on limited evidence. Tramadol is sometimes prescribed off-label for premature ejaculation; in four placebo-controlled trials (721 men) it lengthened the time to ejaculation over 8 to 12 weeks, but results varied widely, the trials were of unclear quality, and addiction was not assessed (Martyn-St James et al.). An Australian review for GPs says it "should only be considered for monotherapy use in men with refractory premature ejaculation" (RACGP), and a Sydney specialist's review said it could not be recommended until large, well-designed randomised trials were published (McMahon, Sex Med Rev 2015). The options: treating premature ejaculation and erectile dysfunction together.

What did trials of tramadol with sildenafil find?

Better scores in one small trial. In a double-blind trial in Egypt, 155 men completed 10 weeks of placebo, sildenafil 50 mg, tramadol 100 mg or both; the authors judged the pair "safe and effective" and better than either alone, listing their small numbers as a limitation (Kurkar et al., Arab J Urol 2024). An earlier trial gave each medicine on its own, not together: tramadol produced the longest time to ejaculation, sildenafil the best satisfaction scores (Gameel et al., Arab J Urol 2013). Neither changes the labels: Tramal is approved for pain, Viagra for erectile dysfunction.

Can tramadol be taken with Priligy or an antidepressant?

Not with Priligy, which is approved for premature ejaculation in Australia. Its label rules it out with serotonergic medicines, tramadol among them, or within 14 days of stopping one, and they should not be started within 7 days of stopping Priligy (Priligy product information). With antidepressants, tramadol can cause serotonin syndrome, "a potentially life-threatening condition" whose signs include sweating, agitation, muscle twitching, tremor and a high temperature; it can make seizures more likely with SSRIs, SNRIs, tricyclics and antipsychotics; and it must not be taken with an MAOI or within 14 days of one (Tramal product and consumer medicine information). See can Viagra and Priligy be taken together? and Viagra with antidepressants.

The short answer

No label names tramadol with Viagra, so no interaction is known, though no label reports a study of the pair. Both can make you dizzy, alcohol is out on tramadol, tramadol can itself cause erection problems, and using it to delay ejaculation is off-label. It is never taken with Priligy. Other painkillers: ibuprofen and Viagra; every other combination is in our guide to taking Viagra or Cialis with other medicines.