Tadalafil
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PDE5 Inhibitor
Tadalafil
Cialis, Adcirca
Tadalafil's distinguishing feature is its long half-life (~17.5 h) and usable duration up to 36 h, hence "the weekend pill." It is the only PDE5 inhibitor FDA-approved for daily use, both for ED and for BPH. 5 mg daily often provides better continuous coverage than 20 mg PRN.
Blood pressure with concurrent antihypertensives or alpha-blockers.
Contraindicated with any nitrate. Less visual side effect than sildenafil/vardenafil (higher PDE5 vs PDE6 selectivity). Daily dosing provides continuous coverage, useful for spontaneity and BPH symptoms.
Avanafil, Sildenafil, Vardenafil
Experience
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Effects
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Pharmacokinetics
Absorption
Oral; not affected by food (vs sildenafil).Distribution
Plasma protein binding ~94%.Metabolism
Hepatic via CYP3A4.Elimination
Fecal and renal as metabolites.Interactions
No interactions reported yet.
Monitoring
Patient counseling
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See also
References
Summary
Classes
PDE5 Inhibitor
Common uses
Erectile dysfunction0, BPH0, Pulmonary arterial hypertension0
Pharmacy
Starting dose
10 mg PRN; 2.5–5 mg daily for continuous coverage / BPH
Preparations
2.5, 5, 10, 20 mg tabs
US FDA Max
20 mg/d (ED, PRN); 5 mg/d (daily / BPH); 40 mg/d (PAH)
Pharmacology
Routes
Oral
Onset
30 min
Duration
Up to 36 h ("the weekend pill")
Half-life
~17.5 h
Bioavailability
Reasonable (not formally established as a percentage)
Pregnancy
Category B
Legal status
Rx-only in US
Purported mechanism
Selective inhibitor of PDE5 with a substantially longer half-life than other PDE5 inhibitors, allowing once-daily continuous dosing.