Itraconazole and Tadalafil interaction

Itraconazole and Tadalafil: both prescribing labels flag this combination with the strongest language, such as a contraindication, a boxed warning, or an instruction to avoid it.

Major

Do not combine without a prescriber's guidance. The label language below is the strongest FDA uses.

What the FDA labels say

From the Itraconazole (Tolsura) label · effective 2025-04-23

Major

Aliskiren Riociguat Sildenafil (for pulmonary hypertension) Tadalafil (for pulmonary hypertension) Not recommended during and 2 weeks after TOLSURA treatment.

Drug interactionsnames TadalafilView label on DailyMed
Moderate

Dutasteride Oxybutynin Sildenafil (for erectile dysfunction) Tadalafil (for erectile dysfunction and benign prostatic hyperplasia) Tolterodine Monitor for adverse reactions.

Drug interactionsnames TadalafilView label on DailyMed
Minor

For sildenafil and tadalafil, see also Urologic Drugs below.

Drug interactionsnames TadalafilView label on DailyMed
Minor

For sildenafil and tadalafil, see also Cardiovascular Drugs above.

Drug interactionsnames TadalafilView label on DailyMed

From the Tadalafil (Cialis) label · effective 2026-06-03

Moderate

…Physicians should be aware that CIALIS for once daily use provides continuous plasma tadalafil levels and should consider this when evaluating the potential for interactions with medications (e.g., nitrates, alpha-blockers, anti-hypertensives and potent inhibitors of CYP3A4) and with substantial consumption of alcohol [see Drug Interactions ( 7.1 , 7.2 , 7.3 )] .

Warnings and precautionsby drug classView label on DailyMed
Moderate

The dose of CIALIS for use as needed should be limited to 10 mg no more than once every 72 hours in patients taking potent inhibitors of CYP3A4 such as ritonavir, ketoconazole, and itraconazole [see Drug Interactions ( 7.2 )] .

Warnings and precautionsby drug classView label on DailyMed
Moderate

In patients taking potent inhibitors of CYP3A4 and CIALIS for once daily use, the maximum recommended dose is 2.5 mg [see Dosage and Administration ( 2.7 )] .

Warnings and precautionsby drug classView label on DailyMed
Moderate

CYP3A4 inhibitors (e.g. ketoconazole, ritonavir) increase CIALIS exposure ( 2.7 , 5.10 , 7.2 ) requiring dose adjustment: CIALIS for use as needed: no more than 10 mg every 72 hours CIALIS for once daily use: dose not to exceed 2.5 mg CYP3A4 inducers (e.g. rifampin) decrease CIALIS exposure ( 7.2 ).

Drug interactionsby drug classView label on DailyMed
Moderate

Studies have shown that drugs that inhibit CYP3A4 can increase tadalafil exposure.

Drug interactionsby drug classView label on DailyMed

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Not medical advice. Interaction Checker quotes FDA label text and NIH fact sheets. Whether an interaction matters for you depends on doses, timing, kidney and liver function, and other conditions. Confirm with a pharmacist or prescriber.