Tadalafil

💊 What is Tadalafil used for?

• •Erectile dysfunction (ED)
• •Signs and symptoms of benign prostatic hyperplasia (BPH), a condition where the prostate gland is enlarged and not cancer
• •Both ED and BPH at the same time
• •When used with finasteride to start BPH treatment, the label recommends this use for up to 26 weeks, because the extra benefit of tadalafil decreases from 4 weeks until 26 weeks and its benefit beyond 26 weeks is unknown

How it works

The label describes tadalafil as a selective inhibitor of cGMP-specific phosphodiesterase type 5 (PDE5), an enzyme. The label does not explain this process in more detail.

How it is usually taken

• •The label says do not split the tablets. The entire dose should be taken.
• •For use as needed for ED, the label says the tablet is taken before anticipated sexual activity, and it should not be taken more than once per day.
• •For once-daily use (for ED, BPH, or both), the label says the tablet is taken at approximately the same time every day.
• •For once-daily ED use, the label says it can be taken without regard to the timing of sexual activity.
• •The label says tadalafil may be taken with or without food.
• •Follow the instructions from your prescriber or pharmacist about which form and schedule applies to you.

Comes as

• •2.5 mg tablets (off white to pale yellow, almond shaped, film coated)
• •5 mg tablets (light yellow, almond shaped, film coated)
• •10 mg tablets (yellow, almond shaped, film coated)
• •20 mg tablets (yellow, almond shaped, film coated)

⚠️ Tadalafil side effects

🛑 Who should not take Tadalafil, and who should be careful

The label says not to take it if

• 🚨You use any form of organic nitrate, either regularly or as needed. The label says this combination is contraindicated.
• 🚨You use a guanylate cyclase (GC) stimulator, such as riociguat. The label says this combination should not be used.
• 🚨You have a known serious allergic reaction (hypersensitivity) to tadalafil or to ADCIRCA. The label lists reactions such as Stevens-Johnson syndrome and exfoliative dermatitis.

Tell your doctor before taking it if

• •Tell your prescriber about your heart and blood vessel health. The label says there is a degree of cardiac risk with sexual activity, and tadalafil should not be used when sexual activity is inadvisable because of your cardiovascular status.
• •The label says tadalafil is not recommended for people who have had a heart attack within the last 90 days, unstable angina or angina during sexual intercourse, New York Heart Association Class 2 or greater heart failure in the last 6 months, uncontrolled irregular heartbeat, low blood pressure (less than 90/50 mm Hg), uncontrolled high blood pressure, or a stroke within the last 6 months.
• •Tell your prescriber if you have had NAION (a sudden vision loss condition) in one eye, or a 'crowded' optic disc. The label says these may increase the risk of NAION.
• •Tell your prescriber if you have a condition that makes you prone to priapism (prolonged erection), or left ventricular outflow obstruction such as aortic stenosis. The label says caution is advised.
• •Tell your prescriber if you take alpha-blockers or other blood pressure medicines. The label says tadalafil can add to their blood pressure lowering effects.
• •The label says that for BPH, other urological conditions with similar symptoms should be considered first.
• •The label says tadalafil offers no protection against sexually transmitted diseases, including HIV.

🔀 Tadalafil with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Nitrates: The label says tadalafil is contraindicated with any organic nitrate. If nitrates are medically necessary in a life-threatening situation, the label says at least 48 hours should pass after the last tadalafil dose, and nitrates should only be given under close medical supervision.
• •Alpha-blockers (such as doxazosin, tamsulosin, or alfuzosin): The label says caution is advised, because both can lower blood pressure.
• •Blood pressure medicines (such as amlodipine, angiotensin II receptor blockers, bendrofluazide, enalapril, and metoprolol): The label says small blood pressure reductions occurred when these were combined with tadalafil.
• •CYP3A4 inhibitors (such as ketoconazole and ritonavir): The label says these increase tadalafil levels and require dose limits.
• •CYP3A4 inducers (such as rifampin): The label says these decrease tadalafil levels.
• •GC stimulators (such as riociguat): Contraindicated, as noted above.
• •Alcohol: The label says substantial alcohol use can increase dizziness, headache, and drops in standing blood pressure.

Alcohol and food

The label says tadalafil may be taken without regard to food. The label also says that substantial alcohol use (5 units or greater) with tadalafil can increase dizziness, headache, and drops in standing blood pressure.

🤰 Tadalafil in pregnancy and breastfeeding

Pregnancy

The label says tadalafil is not indicated for use in females. It also says there are no data on use in pregnant women. In animal studies, no harmful developmental effects were seen at high exposures, but the label notes some effects on pup survival at very high doses.

Breastfeeding

The label does not say.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store at 25°C (77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep out of reach of children.

If a dose is missed

The label does not say.

If too much is taken

The label says single doses much higher than recommended have been given to healthy study volunteers, and that adverse events were similar to those seen at lower doses. The label says standard supportive measures should be used as needed. It also says hemodialysis contributes negligibly to tadalafil removal from the body.

🗒️ Questions to ask about Tadalafil

• Which form of tadalafil is right for me: as-needed use or once-daily use?
• Is my heart health stable enough for sexual activity while taking this medicine?
• Do any of my other medicines, including nitrates or alpha-blockers, interact with tadalafil?
• How much alcohol is safe for me to drink while taking this medicine?
• What should I do if I have chest pain, vision changes, or hearing loss while taking it?
• If I take finasteride for BPH, how long should I use tadalafil with it?

❓ Tadalafil: frequently asked questions