Tadalafil (PAH)
ADCIRCA
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.
FDA-approved for
- pulmonary arterial hypertension (2009)
FDA label
Read the full label on DailyMed ↗
| 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)
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.
NO BOXED WARNINGS
Principal riskFatal hypotension with nitrates, for up to 48 hours
Classes and tags
Clinical profile
Mechanism of action: Tadalafil (PAH) ballicule
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