Tadalafil (PAH)
ADCIRCA
Pronunciation: ta-DA-la-fil
“See Alice, the Tadophile”
What it isTadalafil 40 mg once daily for pulmonary arterial hypertension, a PDE5 inhibitor that augments nitric oxide–cGMP signaling.
Why this oneIts terminal half-life stretches to ~35 h in PAH patients (vs ~15 h healthy), sustaining pulmonary vasodilation longer than sildenafil.
What limits itNever combine with nitrates: profound, potentially fatal hypotension can persist for up to 48 hours after the last dose.
Tadalafil (PAH) prescription history
Animated chart of estimated U.S. prescriptions per year, BPH meds (1987–2026). Tadalafil (PAH) enters in 2003 (estimated).
FDA-approved for
- pulmonary arterial hypertension (2009)
Principal riskFatal hypotension with nitrates, for up to 48 hours
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Pulmonary arterial hypertension (WHO Group 1) | Adults | 40 mg (two 20 mg tablets) QD | 40 mg QD | 40 mg QD |
Renal Mild/moderate (CrCl 31–80): start 20 mg QD, titrate to 40 mg. Severe (<30 or hemodialysis): avoid.
Hepatic Mild/moderate (Child-Pugh A/B): consider 20 mg QD. Severe (Child-Pugh C): avoid.
Instructions
- Take once daily, with or without food
- Do not divide the 40 mg dose over the day
- With ritonavir: start 20 mg QD (see label for timing)
Available strengths
- tab 20 mg
- susp 20 mg/5 mL
Contraindications
- Concomitant organic nitrates (any form; potentiates hypotension)
- Concomitant guanylate cyclase stimulators (e.g., riociguat)
Cautions
- Hypotension
- Sudden vision loss (NAION)
- Sudden hearing loss
- Priapism
Adverse reactions
- Headache
- Myalgia
- Nasopharyngitis
- Flushing
- Nausea
Pregnancy Limited human data show no clear drug-associated risk; untreated PAH itself carries maternal/fetal risk.
Lactation No human data; present in rat milk.
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 20 mg | tab | 30 qd | $5.01 | offered |
Other forms: Tadalafil (CIALIS)
Open Tadalafil (PAH) in the interactive console ↗
Memory aids: interaction avatars
Open Tadalafil (PAH) in the interactive console ↗
Self-check
- What is ADCIRCA’s stated PAH dose?
40 mg once daily. - Which drugs must never be combined with ADCIRCA?
Nitrates.