Is Cialis safe for heart patients? It depends on the heart condition. Cialis must not be taken with nitrates, within 3 months of a heart attack or 6 months of a stroke, or with the conditions its Australian leaflet lists: "angina, arrhythmias (change in rhythm or rate of heart beat), heart failure". In healthy men, tadalafil, the medicine in Cialis, made no significant change to heart rate, and in its trials serious heart events were no more frequent than on placebo. A doctor first checks your heart can cope with sex.
Which heart conditions rule Cialis out?
Nitrates rule it out whatever the heart condition: tadalafil strengthens their blood-pressure-lowering effect, so it must not be used with "any form of organic nitrate" (EMA — Cialis), such as glyceryl trinitrate or isosorbide mononitrate (Cialis CMI). The other rules are worded more broadly in the Australian leaflet than in the European label:
| Condition | Australian Cialis leaflet | European product information |
|---|---|---|
| Heart or blood-vessel disease that makes sex inadvisable | Do not use | Must not be used |
| Heart attack | Not in the last 3 months | Not within the last 90 days |
| Stroke | Not in the last 6 months | Not within the last 6 months |
| Angina | Do not use | Unstable angina, or angina during sex |
| Irregular heartbeat (arrhythmia) | Do not use | Uncontrolled arrhythmia |
| Heart failure | Do not use | New York Heart Association class 2 or higher in the last 6 months |
| Blood pressure | Unusually high or low, or not effectively treated | Below 90/50 mm Hg, or uncontrolled high blood pressure |
Sources: Cialis CMI, section 2; EMA — Cialis, section 4.3.
Most of those groups "were not included in clinical trials" (EMA — Cialis). Where your condition sits — stable angina without nitrates, say, or a controlled irregular heartbeat — is your doctor's call. See also atrial fibrillation and erectile dysfunction and ED tablets after a stroke.
Does Cialis affect your heart rate?
Not noticeably in healthy men: compared with placebo there was "no significant change in heart rate", and blood pressure fell by at most 1.6/0.8 mm Hg on average lying down (EMA — Cialis). A fast heartbeat and palpitations are uncommon side effects, seen in fewer than 1 man in 100; daily Cialis caused slightly more ECG changes than placebo, mainly a slow rhythm, mostly with no side effects. The Australian leaflet lists "increased heart beat" as a serious side effect: call your doctor straight away or go to the nearest emergency department (Cialis CMI). Sildenafil: can Viagra cause palpitations?
Does Cialis raise the risk of a heart attack?
Its trials did not show that. Across 36 trials, serious cardiovascular events — heart attack, or death from heart disease or stroke — occurred at 0.40 per 100 patient-years in 12,487 men on tadalafil and 0.43 in 2,047 men on placebo; 5% had coronary artery disease (Kloner et al., 2006). The label lists heart attack, unstable angina and sudden cardiac death as rare; most men who had serious heart events already had cardiovascular risk factors, and it is "not possible to definitively determine" whether the cause was those risk factors, Cialis or sex itself (EMA — Cialis). Men in the table's groups were not studied.
How do you know if your heart can cope with sex?
Your doctor checks, "since there is a degree of cardiac risk associated with sexual activity" (EMA — Cialis); healthdirect advises against ED medicines "if sexual exertion could put you at risk of harm or death" (healthdirect — ED medicines). The Heart Foundation's rule of thumb: "if you can climb two flights of stairs without pain or shortness of breath, then you should be OK to have sex"; after a heart attack, your doctor tells you when you can start again (Heart Foundation). Erection problems are often an early sign of heart problems (healthdirect — ED).
What if you get chest pain during sex?
"Stop what you are doing, sit up and sit forward. Call an ambulance if the pain does not resolve. Do not use nitrates" (Cialis CMI). Tell the ambulance or hospital staff you take Cialis: nitrates such as glyceryl trinitrate are among the medicines used to treat a heart attack (healthdirect — heart attack), and after tadalafil at least 48 hours should pass before one is considered, then only in a life-threatening situation under close supervision (EMA — Cialis). Sildenafil: nitroglycerin and Viagra.
Can you take Cialis with other heart medicines?
Apart from nitrates, mostly: amlodipine, enalapril, metoprolol, a thiazide and angiotensin II receptor blockers showed no clinically significant interaction, and tadalafil changed neither warfarin's effect nor aspirin's bleeding time. It may lower blood pressure slightly more, so daily Cialis may mean adjusting a blood-pressure dose, and it is not recommended with doxazosin (EMA — Cialis). More on beta-blockers, warfarin and Xarelto.
The short answer
Not with nitrates, a heart attack in the last 3 months, a stroke in the last 6, or the angina, arrhythmias or heart failure its leaflet lists. Other heart patients may take it once a doctor has checked their heart can cope with sex. Viagra's leaflet sets 6 months after a heart attack instead of 3 (Viagra CMI): Viagra after a heart attack. After a stent: can heart stent patients take Viagra? Other conditions: our guide to ED and health conditions.
