Tadalista 40 mg contains tadalafil, the 40 mg dose is particularly important to review with a doctor, because tadalafil for erectile dysfunction is usually prescribed at lower doses; 40 mg is primarily a regimen used for pulmonary arterial hypertension in specific circumstances. Medicines that need special attention Nitrates — do NOT combine. This includes nitroglycerin, isosorbide mononitrate, and isosorbide dinitrate. The combination can cause a dangerous drop in blood pressure. D DailyMed Alpha-blockers such as tamsulosin or doxazosin can further lower blood pressure; medical supervision is recommended. D DailyMed Blood-pressure medicines can have an additive blood-pressure-lowering effect. D DailyMed Strong CYP3A4 inhibitors, such as ritonavir or ketoconazole, can greatly increase tadalafil levels. For as-needed tadalafil, the recommended maximum with potent CYP3A4 inhibitors is 10 mg every 72 hours, not 40 mg. D DailyMed +1 Riociguat and other guanylate-cyclase stimulators — do NOT combine with tadalafil. D DailyMed Alcohol: heavy alcohol consumption can increase the risk of dizziness and low blood pressure. D DailyMed Also, people with significant kidney or liver impairment may need substantially lower doses. D DailyMed If you give me the names and doses of all the medicines you're currently taking, I can check them one by one against tadalafil 40 mg and tell you which combinations are safe, require caution, or should be avoided.