Cialis affects blood vessels and blood pressure. Nexlizet targets cholesterol through the liver. At first glance, they seem unrelated. But what happens inside your body when they meet?
While no major interactions have been reported, combining these drugs still needs care. Why? Because people taking both often have heart concerns, may be on other meds like statins, or could face side effects like muscle pain or low blood pressure.
| 🔑 Key takeaways ➤ You can take Cialis and Nexlizet together, but only if your doctor says it’s safe for you. ➤ There is no known direct interaction between Cialis and Nexlizet. ➤ Both drugs can lower blood pressure, so using them together may cause dizziness or lightheadedness. ➤ Tell your doctor if you feel weak, faint, or have chest pain after taking them. ➤ Always follow your doctor’s advice when taking more than one medication. ➤ Never adjust your dose or stop a medicine without checking with your doctor first. |
Cialis
Cialis, also known by its generic name tadalafil, is a medication used to treat erectile dysfunction (ED) and the symptoms of benign prostatic hyperplasia (BPH). It belongs to a group of drugs called phosphodiesterase type 5 (PDE5) inhibitors.
But how does it actually work in your body?
Cialis works by increasing blood flow to certain areas of the body. Specifically, it blocks the enzyme PDE5, which normally breaks down a substance called cyclic guanosine monophosphate (cGMP). By preventing the breakdown of cGMP, Cialis helps relax the smooth muscle in the blood vessels of the penis, making it easier to achieve and maintain an erection when you’re sexually stimulated. This mechanism also allows better blood flow in the prostate and bladder, which is why it can help with symptoms of an enlarged prostate.
You might be wondering how fast Cialis kicks in and how long it lasts. A single dose can start working within 30 minutes, and its effects can last up to 36 hours, which is why it’s sometimes called “the weekend pill.” But it doesn’t cause automatic erections. Sexual arousal is still needed for it to work.
Cialis also helps lower the pressure in the pulmonary arteries in some cases of pulmonary hypertension, though that use is typically under different dosing and brand names. And it’s worth noting: tadalafil has a long half-life of around 17.5 hours, meaning it stays in your system longer compared to other ED drugs like sildenafil (Viagra).
Nexlizet
Nexlizet is a combination medication that includes two active ingredients:
- bempedoic acid
- ezetimibe
It’s used to help lower LDL cholesterol (the “bad” cholesterol) in adults who have certain types of high cholesterol and need more help even after taking the highest statin dose they can tolerate.
So, how does it work in your body?
Let’s start with bempedoic acid. According to Esperion Therapeutics, bempedoic acid works inside the liver. It blocks an enzyme called ATP-citrate lyase (ACL), which is involved in making cholesterol. By targeting this step, bempedoic acid slows down cholesterol production at its source, the liver, and helps reduce the amount of LDL cholesterol released into the blood. One key point? Bempedoic acid is only active in the liver and not in muscles, which is why it tends to cause fewer muscle-related side effects than statins.
The second part of Nexlizet is ezetimibe, a cholesterol absorption inhibitor. According to a study, ezetimibe blocks a protein in the small intestine called NPC1L1. This protein is responsible for absorbing cholesterol from food. By blocking this, ezetimibe cuts down how much cholesterol your body takes in from your diet. That means less cholesterol reaches the liver, and the liver responds by pulling more LDL cholesterol out of the bloodstream.
Is it safe to take Cialis and Nexlizet together?
Yes, it is generally safe to take Cialis (tadalafil) and Nexlizet (bempedoic acid/ezetimibe) at the same time. No major drug interaction has been reported between the two.
Their pathways of action in the body are different, and they do not compete or interfere with each other’s metabolism in any known significant way.
Additionally, neither bempedoic acid nor ezetimibe is known to significantly affect the blood pressure-lowering effects of tadalafil. However, Nexlizet may interact with certain statins, which are often taken by the same patients. It’s also worth noting that both medications are highly protein-bound and metabolized differently, tadalafil via CYP3A4 and bempedoic acid through liver activation, not CYP450.
Considerations
Here are some of the things to consider when both medications together:
Cardiovascular status
Since both medications are often prescribed to people with cardiovascular conditions, Cialis for benign prostatic hyperplasia or erectile dysfunction, and Nexlizet for lowering LDL cholesterol, it’s important to assess overall heart health. Cialis can cause mild blood pressure reduction due to vasodilation, which may be risky in people with unstable cardiovascular disease.
Always ensure your heart function is stable before starting or combining these medications.
Blood pressure effects
Cialis has vasodilatory effects and can lower blood pressure. While Nexlizet itself doesn’t affect blood pressure, many patients on it may also take antihypertensives. Combining Cialis with blood pressure-lowering drugs (like beta-blockers or ACE inhibitors) may increase the risk of hypotension, dizziness, fainting, or fatigue. Monitor blood pressure closely if you’re on both.
Muscle and joint symptoms
Both Cialis and bempedoic acid (in Nexlizet) can independently cause muscle pain or back discomfort. While the mechanisms differ, Cialis through smooth muscle relaxation, and bempedoic acid via metabolic effects, the overlap could make it hard to pinpoint the source of discomfort. If muscle pain or weakness occurs, especially in the legs or lower back, speak to your provider.
Gout and uric acid levels
Bempedoic acid may increase uric acid levels, raising the risk of gout in susceptible individuals. Cialis doesn’t directly impact uric acid, but dehydration (a risk with PDE5 inhibitors in rare cases) can worsen gout. If you have a history of gout or high uric acid, this combination warrants closer monitoring.
Kidney function
Cialis is partly eliminated through the kidneys. Nexlizet can also affect kidney markers slightly, especially in people with pre-existing kidney disease. Combining the two in someone with compromised renal function may increase the need for dose adjustment or monitoring of renal labs (eGFR, creatinine, uric acid).
Polypharmacy and statins
Many people taking Nexlizet are also on statins, which can interact with other drugs and cause muscle-related side effects. Although Cialis does not directly interact with statins, combining multiple medications that may stress the liver or muscles increases the complexity. Watch for symptoms like fatigue, dark urine, or severe muscle pain, and ensure liver enzymes are periodically checked.
Timing and absorption
There is no specific food or timing restriction for taking Cialis or Nexlizet together. However, both drugs may cause mild gastrointestinal symptoms (like nausea or indigestion). Taking them with food may help minimize stomach upset, even though food doesn’t impact their absorption significantly.
Final words
Mixing Cialis with Nexlizet is usually safe, but it depends on your health and your doctor’s guidance. These two medicines do not directly react with each other. Still, both can lower blood pressure, so taking them together may sometimes cause dizziness, tiredness, or feeling faint.
FAQs on cialis and nexlizet interaction
Does Cialis affect cholesterol?
Nope. Cialis treats erectile dysfunction and prostate issues. It doesn’t help or hurt your cholesterol levels.
Can both drugs cause muscle pain?
Yes. Muscle pain is a possible side effect of Nexlizet. Cialis can also cause muscle or back pain in some people.
Should I space out the timing of taking Cialis and Nexlizet?
There’s no required gap, but taking them at different times may help avoid side effects like dizziness. Ask your doctor what’s best for you.
Can I take vitamins with Cialis and Nexlizet?
Usually yes—but some supplements (like CoQ10 or high-dose vitamin D) might affect how these drugs work. Always double-check with your doctor.
Sources
- Esperion Therapeutics, Inc. (2024). NEXLIZET (bempedoic acid and ezetimibe) tablets, for oral use: Highlights of prescribing information. U.S. Food and Drug Administration. https://pi.esperion.com/nexlizet/nexlizet-pi.pdf.
- Garcia-Calvo, M., Lisnock, J., Bull, H. G., Hawes, B. E., Burnett, D. A., Braun, M. P., Crona, J. H., Davis, H. R., Jr., Dean, D. C., Detmers, P. A., Graziano, M. P., Hughes, M., Macintyre, D. E., Ogawa, A., O’Neill, K. A., Iyer, S. P., Shevell, D. E., Smith, M. M., Tang, Y. S., Makarewicz, A. M., Ujjainwalla, F., Altmann, S. W., Chapman, K. T., & Thornberry, N. A. (2005). The target of ezetimibe is Niemann-Pick C1-Like 1 (NPC1L1). Proceedings of the National Academy of Sciences of the United States of America, 102(23), 8132–8137. https://doi.org/10.1073/pnas.0500162102.