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Using tadalafil together with isosorbide dinitrate is not recommended. Combining these medications may cause blood pressure to fall excessively, which can lead to collapse. The risk of other side effects such as dizziness, lightheadedness, fainting, headache, flushing, heart palpitations, and priapism (prolonged and painful erection unrelated to sexual activity) may also increase. You should seek immediate medical attention if you experience chest pain or tightness during treatment with tadalafil. Do not use isosorbide dinitrate on your own without consulting your doctor, even if it has been a few days since you have taken a dose of tadalafil. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.