ADCIRCA (Tadalafil)

What is this medication?

Tadalafil, Cialis/Adcirca
Phosphodiesterase-5-Inhibitor

Tadalafil/Cialis/Adcirca is officially indicated for treatment of erectile dysfunction or organic, psychogenic, or mixed etiology.

How does this medication work?

Tadalafil/Cialis/Adcirca enhances the physiological erectile response following sexual arousal through the potentiation of nitric oxide effects on vascular smooth muscle.  Nitric oxide is released into the corpus cavernosum in response to sexual stimulation.  This stimulates the production of cGMP, leading to smooth muscle relaxation and subsequently vasodilation and erection of the penis.  Tadalafil/Cialis/Adcirca selectively inhibits cGMP for PDE5 which is main enzyme that metabolizes cGMP in the penis, thus enhancing the erectile response of the penis.

How should I take this medication?

Benign prostatic hyperplasia (with or without concomitant erectile dysfunction) – Cialis/Tadalafil
Oral: 5mg once daily

Note: When Cialis/Tadalafil is used with finasteride to initiate BPH therapy, the recommended duration of therapy is ≤26 weeks.

Erectile dysfunction – Cialis/Tadalafil
Oral:
As needed dosing: 5mg to 20mg at least 30 minutes prior to anticipated sexual activity as a single dose and not more than once daily over 24 hours.  Improvement in the strength and response of erectile function to sexual activity can last up to 36 hours following a single dose.

Once daily dosing: 2.5mg to 5mg daily at approximately the same time each day without regards to the timing of sexual activity.

Pulmonary artery hypertension – Adcirca/Tadalafil
Oral: 40mg once daily.

Raynaud’s disease – Cialis/Tadalafil
Oral: 20mg every other day.

How to Take Cialis/Tadalafil: Do not split the tablet; take the entire tablet and swallow whole.  When used as needed, take at least 30 minutes prior to sexual activity.  When used as once daily basis, try to take the same time each day regardless of sex. 

You Need to Avoid Cialis/Tadalafil: Avoid large amounts of grapefruit and its juice (CYP3A4 inhibitor) and alcohol which may enhance the hypotensive effect.  

What should I watch for while using this medication?

Use with caution or avoid in persons with increased susceptibility to vasodilators including those with aortic stenosis, cardiomyopathy, and impaired autonomic control of blood pressure.

Use with caution in persons who have suffered a myocardial infarction, stroke, or life-threatening arrhythmia within the last six months.

Use with caution in persons with resting hypotension (blood pressure under 90/50) or hypertension (blood pressure 170/110).

Use with caution in persons with heart failure or coronary artery disease.

If You Experience Chest Pain Cialis/Tadalafil: Seek medical attention immediately.

If You Experience Hearing Loss Cialis/Tadalafil: If you experience a sudden decrease or loss in hearing, seek medical attention.

If Your Penile Erection Does Not Go Down Cialis/Tadalafil: Painful erections lasting > 6 hours is known as priapism and is rare.  However, if your erection lasts longer than > 4 hours, seek medical condition.  Certain medical conditions such as sickle cell anemia, multiple myeloma and leukemia have been associated with a higher risk of priapism.

If You Experience Vision Loss Cialis/Tadalafil: Vision loss is rare but may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION).  Please seek medical attention immediately for any sudden loss of vision in one or both eyes.  Risk factors for NAION include coronary artery disease (CAD), diabetes, hypertension, hyperlipidemia, smoking and > 50 years of age.

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible.  However, if it is almost time for your next dose, take only that scheduled dose.  Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times.  Store at room temperature, 59 to 86° F (15 to 30° C).  Protect from light.  Keep the container tightly closed.  Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication?

Well tolerated, most side effects are transient and mild to moderate in nature.  The most common side effects include:

>10%

Cardiovascular: Flushing (2% to 13%)

Central Nervous System: Headache (4% to 42%)

Gastrointestinal: Nausea (<11%)

Neuromuscular & Skeletal: Myalgia (1% to 14%), limb pain (1% to 11%)

Respiratory: Respiratory tract infection (13%), nasopharyngitis (6% to 13%)