Blood pressure medicines and the Triple Action Blend

Two ingredients, two directions

The Triple Action Blend is a compounded preparation containing tadalafil, oxytocin and PT-141 (bremelanotide). Two of those ingredients affect blood pressure, and they pull in opposite directions. That makes the blend different from taking tadalafil alone, and it is the main reason your blood pressure history matters so much here.

Oxytocin's effect on blood pressure at the amounts used in sexual health products is not well characterized, so the discussion below focuses on the two ingredients with labeled data.

Tadalafil lowers blood pressure a little

Tadalafil relaxes smooth muscle in blood vessel walls. On its own, that causes a modest fall in blood pressure that most people do not notice. According to the Cialis prescribing information, adding it to common blood pressure medicines such as amlodipine, enalapril, metoprolol, ARBs or a thiazide-type diuretic produced only small additional reductions.

Alpha-blockers are the main exception. These drugs, such as doxazosin, terazosin and tamsulosin, are used for blood pressure or prostate symptoms. In a label study, tadalafil 20 mg with doxazosin 8 mg dropped standing systolic pressure by about 10 mm Hg more than placebo, which can cause dizziness or fainting when you stand up. For erectile dysfunction, the label advises being stable on the alpha-blocker first and starting tadalafil at the lowest dose.

The nitrate rule has no exceptions

Tadalafil must never be combined with any nitrate. That includes nitroglycerin tablets or spray, isosorbide mononitrate or dinitrate, nitrate patches and recreational amyl nitrite ("poppers"). Together they can cause a sudden, dangerous drop in blood pressure.

Because tadalafil lasts a long time, the label says that if a nitrate is needed in an emergency, at least 48 hours should pass after the last tadalafil dose, and only under close medical supervision. If you ever have chest pain after taking the blend, tell emergency staff exactly what you took and when.

PT-141 raises blood pressure for a few hours

PT-141 is bremelanotide. Its only FDA-approved form is Vyleesi, a self-injection for premenopausal women with low sexual desire; it is not approved for men. The Vyleesi label reports that blood pressure rises and heart rate falls after each dose: systolic pressure up to about 6 mm Hg and diastolic up to about 3 mm Hg, peaking 2 to 4 hours after dosing and usually back to baseline within 12 hours.

That label lists uncontrolled high blood pressure and known cardiovascular disease as reasons not to use it, and it is not recommended for people at high cardiovascular risk. The compounded blend has not been studied, so we apply those cautions to it.

Who is likely a candidate, and who is not

• Usually workable: blood pressure that is well controlled on one or two common medicines, with no heart disease.
• Case by case: several blood pressure medicines, an alpha-blocker, or readings that run borderline.
• Not suitable: any nitrate use, uncontrolled high blood pressure, known heart disease, a heart attack in the past 90 days, a stroke in the past 6 months, unstable angina or low blood pressure (below 90/50).
• Alcohol: heavy drinking (5 or more units) with tadalafil increases dizziness and blood pressure drops on standing.

Bringing useful information to your visit

A few home readings make the review faster and safer. Measure seated after five minutes of rest, at different times of day, over about a week, and note the numbers along with your pulse. If you get lightheaded when you stand, write down when it happens and what you had taken.

Also list everything you take, including prostate medicines, eye drops, supplements and anything used recreationally. Men are sometimes prescribed a nitrate spray "just in case" years ago and forget it is in a drawer; it still counts.

What your clinician checks

Before prescribing, your HealifyMD clinician reviews several blood pressure readings, your complete medication list (including anything for prostate symptoms, chest pain or recreational use) and your heart history. Bringing home cuff readings helps.

Often, the conclusion is that tadalafil alone, without PT-141, is the safer starting point. Daily tadalafil is from $99/month. If the blend is appropriate, it is from $149/month, confirmed at the eligibility review. It is compounded by a licensed U.S. pharmacy, is not FDA-approved, has not been reviewed by the FDA for safety, effectiveness or quality and is not equivalent to Cialis, Vyleesi or any branded product.

When to get help urgently

Seek emergency care for chest pain, fainting, a severe headache, sudden vision or hearing loss, or an erection lasting more than four hours. These are uncommon, but they are not things to wait out at home.