Tadalafil

What is Tadalafil?

Tadalafil is a prescription drug for men who wish to improve erections during sexual activity. It belongs to a family of medications called phosphodiesterase inhibitors, or PDE-5 inhibitors. It’s a class of pharmaceuticals that can produce stronger erections by improving blood flow to the penis.

How does Tadalafil work?

Tadalafil enhances erections by increasing the inflow of blood to the penis and decreasing outflow, making the penis hard (engorged with blood.) The response still requires sexual stimulation. The erection process begins when the body is stimulated by an erotic thought or a sexual touch.

Tadalafil also relaxes the smooth muscles in the pelvic area, improving urinary flow and bladder emptying.

What is Tadalafil prescribed for?

Tadalafil is commonly prescribed for men with erectile dysfunction, or ED. It is also approved for usage in men with prostatic enlargement. For prostate related issues, please consult your regular clinician.

Tadalafil does not protect against sexually transmitted disease, HIV or pregnancy.

What are the side effects of Tadalafil?

Like any other prescription medication, Tadalafil has significant side effects, some of which can be serious. These adverse effects and contraindications are listed below and should be discussed with the prescribing health care provider.

The active ingredient in Tadalafil is tadalafil, which is available in strengths of 2.5mg, 5mg, 10mg and 20mg. The inactive ingredients in tadalafil tablets are croscarmellose sodium, hypromellose, iron oxide yellow, iron oxide red (2.5 mg) lactose monohydrate, magnesium stearate, microcrystalline cellulose, pregelatinized starch, sodium lauryl sulfate, talc, titanium dioxide, triacetin.

For Erectile Dysfunction

For most men taking Tadalafil as needed for erectile dysfunction, the starting dose is 10mg, taken one to two hours before sexual activity. The dose may be increased to a max of 20mg if necessary.

Caution: The effects may last for 36 hours. No more than 20 mg should be taken in one 24 hour day  (5mg/day max for kidney dialysis patients).

Once Daily Use For ED

Tadalafil is sometimes prescribed in a once daily low dose (2.5 - 5mg) form, especially for men with ED who are more sexually active (twice a week or more) or who have prostate enlargement (BPH), or both. Low dose Tadalafil should be taken once a day at the same time every day.

Contraindications

1. Do not take Tadalafil if you are a heart patient on nitrates, like nitroglyerin. Nitrates are drugs like nitroglycerin, isordil, Ismo (isosorbide mononitrate), and Transderm-Nitro, and others used primarily for treating heart pain (angina). These drugs lower the blood pressure and may precipitate angina or a heart attack in some patients.

Because Tadalafil dilates arteries throughout the body (not just in the penis), it can cause your blood pressure to drop. Tadalafil may lower blood pressure dramatically when combined with drugs like blood pressure pills like Alpha-Blockers, nitroglycerin tabs (or patches), alcohol and other drugs, such as amyl nitrate (poppers).

Physicians should consider the potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease. Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention.

Seek medical attention immediately if you experience

• chest pain or nausea during sexual activity
• sudden vision loss
• sudden hearing loss
• priapism — a prolonged ( > 4 hr) painful erection that can damage the penis

Drinking alcohol with this medicine can cause a drop in blood pressure, leading to dizziness or fainting.

Also avoid grapefruit while taking this medicine. Grapefruit and grapefruit juice may enhance the effect of tadalafil and lead to unwanted side effects.

2. Do not use if you have hypersensitivity to Tadalafil.

Hypersensitivity reactions have been reported, including Stevens-Johnson syndrome, a severe form of dermatitis (allergic skin condition).

3. Do not take Tadalafil if you take Riociguat (trade name Adempas), a drug that is used to treat two forms of pulmonary hypertension.

Serious cardiovascular events, including myocardial infarction (heart attack), sudden cardiac death, stroke, chest pain, palpitations, and tachycardia, have been reported post-marketing associated with the concomitant use of tadalafil.

Most, but not all, of these patients had pre-existing cardiovascular risk factors. Many of these events were reported to occur during or shortly after sexual activity, and a few were reported to occur shortly after the use of Tadalafil without sexual activity.

It is not clear whether these events are related directly to Tadalafil, to sexual activity, to the patient’s underlying condition.

What are the most common side effects of Tadalafil?

Among the most common side effects are headache, facial flushing (redness, tingling), stomach discomfort, back pain and muscle aches. Less common are nasal congestion, nausea, diarrhea, blurred vision, fainting and changes in color vision or hearing. The discontinuation rate in clinical trials was only 4.1%, compared to 2.8% in the placebo group.

What are the most serious side effects of Tadalafil?

Heart attack and stroke (cardiovascular side effects) are among the most serious. In rare cases, sudden loss of vision or hearing may occur.

Use Tadalafil with caution if you have a bleeding disorder or an ulcer. It may prolong bleeding. Consult with your prescribing physician about these and other drug-drug interactions.

Dosage may need to be adjusted in patients with impaired kidney or liver function. Tadalafil should be limited to 5 mg not more than once in every 72 hours in patients with or end-stage renal disease on hemodialysis.

There are two different ways to take Tadalafil: “as needed” —  before sexual activity, or “low dose daily.”

Low dose daily Tadalafil is used to treat ED, BPH or both.

For ED (Erectile Dysfunction)

For most men taking Tadalafil for erectile dysfunction, the starting dose is 10mg, taken “as needed” 1-2 hours prior to sexual activity. The dose may be increased to a max of 20mg if needed. The effects may last for 36 hours. No more than 20 mg should be taken in one day.

For once daily use for ED, 2.5 mg is the recommended, taken at the same time every day. The dose can be increased to a max of 5mg/day.

For  BPH please consult your regular clinician.