Adult Dosing
Pulmonary arterial hypertension
Adcirca
Erectile dysfunction
Cialis
- PRN dosing schedule
- Usual dose: 5-20 mg PO x 1
- Start dose: 10 mg PO x 1 before sexual activity
- Increase to 20 mg or decrease to 5 mg based upon efficacy/tolerability
- Max: 20 mg/dose; 1 dose/24 hrs; 1 dose/72 hrs if used with strong CYP3A4 inhibitor
- Note: Effects may last 36 hrs post dose. Adjust dose based on individual response
- Daily dosing schedule
- 2.5 mg PO daily without regard to timing of sexual activity
- Increase to 5 mg based upon efficacy/tolerability
- Max: 5 mg/day; 2.5 mg/day if used with strong CYP3A4 inhibitor
Benign prostatic hyperplasia
Cialis
- 5 mg PO qd for patients with or without erectile dysfunction
Pediatric Dosing
- Safety and effectiveness in patients <18 yrs have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
Adcirca
- 31-80 mL/min: Start 20 mg daily; may increase to 40 mg daily
- <30 mL/min: Avoid use
Cialis
- PRN dosing schedule
- 31-50 mL/min: Start 5 mg x 1 PO; Max: 10 mg q48 hrs
- <30 mL/min: Max: 5 mg q72 hrs
- Hemodialysis: No supplement
- Daily dosing schedule
- >30 mL/min: No dose adjustments
- <30 mL/min: Avoid use
Hepatic Dose Adjustment
Adcirca
- Child-pugh class A or B: Start 20 mg daily; use with caution
- Child-pugh class C: Avoid use
Cialis
- PRN dosing schedule
- Child-pugh class A or B: Max 10 mg daily
- Child-pugh class C: Avoid use
- Daily dosing schedule
- Child-pugh class A or B: Use with caution
- Child-Pugh class C: Avoid use
See Supplemental Patient Information
- Undertake medical assessment for identification of potential underlying causes, as well as treatment options for evaluating erectile dysfunction
- Consider the cardiovascular status of patients as certain degree of cardiac risk associated with sexual activity exists. Avoid using treatment for erectile dysfunction in men for whom sexual activity is inadvisable as a result of their underlying cardiovascular status. Advise patients experiencing symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention
- Discuss with patients the appropriate action if they experience anginal chest pain requiring nitroglycerin following intake of this drug; in such patients, who has taken this drug, where nitrate administration is of utmost importance for a life-threatening situation, at least 48 hrs should elapse after the last dose of tadalafil before nitrate administration. Under such circumstances administer nitrates only under close medical supervision with appropriate hemodynamic monitoring. Advise patients experiencing anginal chest pain after taking this drug to immediately seek medical attention
- Patients with left ventricular outflow obstruction are sensitive to the action of this drug
- This drug is not recommended in patients having myocardial infarction within the last 90 days, unstable angina or angina occurring during sexual intercourse, New York Heart Association Class 2 or greater heart failure in the last 6 months, uncontrolled arrhythmias, hypotension (<90/50 mm Hg), or uncontrolled hypertension (>170/100 mm Hg), stroke within the last 6 months
- This drug is associated with mild systemic vasodilatory properties that may result in transient decrease in blood pressure. Prior to prescribing this drug carefully consider whether patients with underlying cardiovascular disease could be affected adversely by vasodilatory effects. Patients with severely impaired autonomic control of blood pressure are particularly sensitive to the actions of this drug
- Consider potential for interactions with nitrates, alpha-blockers, anti-hypertensives, potent inhibitors of CYP3A4 and with substantial consumption of alcohol while considering use of this drug
- Prolonged erections >4 hrs and priapism (painful erections >6 hrs in duration) may occur with this class of compounds. If priapism is untreated promptly it may result in irreversible damage to the erectile tissue. Advise patients having an erection lasting >4 hrs, whether painful or not to seek emergency medical attention
- Advise patients to stop use of this drug and seek medical attention in the event of a sudden loss of vision in one or both eyes. Discuss with patients about the increased risk of non-arteritic anterior ischemic optic neuropathy (NAION) in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of this drug. Use of this drugs in patients with known hereditary degenerative retinal disorders, including retinitis pigmentosa is not recommended
- Advise patients to stop taking this drug and seek prompt medical attention in the event of sudden decrease or loss of hearing. Tinnitus and dizziness may also occur
- Discuss with patients about the potential for this drug to augment the blood-pressure-lowering effect of alpha blockers and antihypertensive medications. Symptomatic hypotension (e.g., fainting) may occur on concomitant use of PDE5 inhibitors and alpha-adrenergic blocking agents
- Stabilize patients on alpha-blocker therapy prior to initiating a PDE5 inhibitor. Patients demonstrating hemodynamic instability on alpha-blocker therapy alone are at higher risk of symptomatic hypotension with concurrent use of PDE5 inhibitors
- In patients stabilized on alpha-blocker therapy initiate PDE5 inhibitors at the lowest recommended dose
- In patients already taking an optimized dose of PDE5 inhibitor initiate alpha-blocker therapy at the lowest dose. Stepwise increase in alpha-blocker dose is associated with further lowering of blood pressure while taking a PDE5 inhibitor
- Safety of concurrent use of PDE5 inhibitors and alpha blockers may be affected by variables including intravascular volume depletion and other antihypertensive agents
- Inform patients that substantial consumption of alcohol (e.g.,
5 units) in combination with this drug may increase the potential for orthostatic signs and symptoms, including increase in heart rate and decrease in standing blood pressure - Limit the dose of tadalafil to 10 mg no more than once q72 hours in patients taking potent inhibitors of CYP3A4 such as ritonavir, ketoconazole, and itraconazole. In patients taking potent inhibitors of CYP3A4 and this drug for once daily use limit the dose of this drug to 2.5 mg
- The safety and efficacy of combinations of tadalafil and other PDE5 inhibitors or treatments for erectile dysfunction is not established. Inform patients to avoid using tadalafil with other PDE5 inhibitors
- Carefully assess risk-benefit ratio while using this drug in patients with bleeding disorders or significant active peptic ulceration
- The use of this drug offers no protection against sexually transmitted diseases. Consider counseling patients about the protective measures necessary to guard against sexually transmitted diseases including HIV
Cautions: Use cautiously in:
- Renal impairment
- Hepatic impairment
- Hypotension
- Uncontrolled hypertension
- Cardiovascular disease
- CAD
- Aortic stenosis
- Idiopathic hypertrophic subaortic stenosis
- Coagulation disorder
- Diabetes mellitus
- Hyperlipidemia
- Manifestations predisposing patients to priapism
- Patients with anatomical deformation of the penis
- Penile deformities
- Retinitis pigmentosa
- Degenerative retinal disorders
- Low optic cup-to-disc ratio
- History of non-arteritic anterior ischemic optic neuropathy
- Concurrent use with alpha blockers
- Active PUD
- Smokers
- Alcohol abuse
- Patients >50 yrs
Supplemental Patient Information
- Inform patients that there blood pressure may drop suddenly to an unsafe level if it is taken with certain other medicines
- Advise patients to avoid concomitant use with nitrates
Pregnancy Category:B
Breastfeeding: Safety unknown; Cialis is not indicated for use in women. Unknown whether tadalafil is excreted into human milk. According to manufacturer's data exercise caution when Adcirca is administered to a nursing woman.
Pricing data from www.DrugStore.com in U.S.A.
- Cialis 10 MG TABS [Bottle] (LILLY)
10 mg = $224.99
30 mg = $659.97 - Cialis 2.5 MG TABS [Box] (LILLY)
15 mg = $75.99
30 mg = $151.98 - Cialis 20 MG TABS [Bottle] (LILLY)
10 mg = $224.99
30 mg = $659.97 - Adcirca 20 MG TABS [Bottle] (LILLY)
60 mg = $1348.95
180 mg = $4008.06 - Cialis 5 MG TABS [Bottle] (LILLY)
10 mg = $49.99
30 mg = $133.97 - Cialis 5 MG TABS [Box] (LILLY)
30 mg = $133.97
90 mg = $389.95
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
