tadalafil (Cialis, Adcirca, 'weekend Viagra')
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Introduction
Tradename: Cialis. New agent from Lilly & Icos. (2003) Available early 2004[2]
Indications
- erectile dysfunction
- benign prostatic hyperplasia[7]
- pulmonary hypertension[6]
- adjunct treatment in Raynaud's phenomenon[9]
- vascular dementia?
- increases cerebral blood flow in all subcortical regions
- largest effect in white matter hyperintensities
- increase in cerebral blood flow is non-significant[10]
Contraindications
- concurrent administration of nitrates[11] (amyl nitrite)
- intermediate-high risk of coronary artery disease
- retinitis pigmentosa
- history of non-arteric ischemic optic neuropathy
Dosage
- erectile dysfunction: 20 mg at least 1/2 hour before intercourse
- BPH: start 2.5 mg QD, titrate to 5 mg QD[5]
Pharmacokinetics
- duration of action 24-36 hours
- metabolized by cyt P450 3A4[3]
Adverse effects
- see sildenafil (Viagra)
- prolonged 1/2life could prolong adverse effects
- non-arteritic ischemic optic neuropathy[4]
- drug adverse effects of phosphodiesterase-5-inhibitors
- drug adverse effects of antihypertensive agents
Drug interactions
- prolonged 1/2life could prolong risk of drug interactions see sildenafil (Viagra)
- reduce 20 mg dose with concurrent administration of potent inhibitors of cyt P450 3A4
- AVOID concurrent use of alpha blockers[3]
- Uroxatral, doxazosin, terazosin, prazosin
- increased risk of orthostatic hypotension
- use tamsulosin if alpha-blocker needed
- concurrent administration of nitrates or amyl nitrite contraindicated
- drug interaction(s) of nitrates with phosphodiesterase-5-inhibitors
- drug interaction(s) of phosphodiesterase-5-inhibitor with testosterone
- drug interaction(s) of phosphodiesterase-5-inhibitor with nitrates
- drug interaction(s) of phosphodiesterase-5-inhibitors with alpha-1-adrenergic receptor antagonists
- drug interaction(s) of NSAIDs & antihypertensives
Laboratory
Mechanism of action
- more selective than sildenafil (Viagra) for inhibition of phosphodiesterase-5
- associated with less risk of heart failure, myocardial infarction, & mortality vs sildenafil or no treatment[12]
Notes
More general terms
Additional terms
Component of
References
- ↑ Prescriber's Letter 8(10):57 2001
- ↑ 2.0 2.1 Prescriber's Letter 10(11):62 2003
- ↑ 3.0 3.1 3.2 Prescriber's Letter 10(12):71 2003
- ↑ 4.0 4.1 Prescriber's Letter 12(6): 2005 Viagra and Vision Loss Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210611&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 5.0 5.1 FDA NEWS RELEASE: Oct. 6, 2011 FDA approves Cialis to treat benign prostatic hyperplasia http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm
Prescriber's Letter 18(11): 2011 Tadalafil (Cialis) for the Treatment of BPH Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271102&pb=PRL (subscription needed) http://www.prescribersletter.com - ↑ 6.0 6.1 Deprecated Reference
- ↑ 7.0 7.1 Roehrborn CG et al. Effects of tadalafil once daily on maximum urinary flow rate in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. J Urol 2014 Apr; 191:1045 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24445278 <Internet> http://dx.doi.org/10.1016/j.juro.2013.10.074#sthash.Z5obxJcP.dpuf
- ↑ 8.0 8.1 Orciari Herman A Drug Makers Move Toward Over-the-Counter Cialis. Physician's First Watch, May 29, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Loftus P Lilly Strikes Licensing Deal With Sanofi for Over-the-Counter Cialis. A Nonprescription Version Still Needs Approval From Regulators. New York Times. May 28, 2014 http://online.wsj.com/news/articles/SB10001424052702304587704579588442314255198?mod=rss_Health&mg=reno64-wsj - ↑ 9.0 9.1 Shenoy PD, Kumar S, Jha LK et al Efficacy of tadalafil in secondary Raynaud's phenomenon resistant to vasodilator therapy: a double-blind randomized cross-over trial. Rheumatology (Oxford). 2010 Dec;49(12):2420-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20837499
- ↑ 10.0 10.1 Pauls MMH, Binnie LR, Benjamin P et al The PASTIS trial: Testing tadalafil for possible use in vascular cognitive impairment. Alzheimer's & Dementia. 2022. Feb 8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35135037 https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12559
- ↑ 11.0 11.1 Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022
- ↑ 12.0 12.1 Ha A, Wayne G, Jacobs M et al PD11-10 PHOSPHODIESTERASE-5 INHIBITOR USE AND PROGRESSION TO HEART FAILURE IN MEN WITH CORONARY ARTERY DISEASE AND ERECTILE DYSFUNCTION. J Urol. 2023. 209(4):e336 April https://www.auajournals.org/doi/10.1097/JU.0000000000003251.10