Therapeutic Classification:erectile dysfunction agents, vasodilators
Pharmacologic Classification: phosphodiesterase type 5 inhibitors
Absorption: Well absorbed following oral administration.
Distribution: Extensive tissue distribution; penetrates semen.
Protein Binding: 94%.
Metabolism/Excretion: Mostly metabolized by the liver via the CYP3A4 isoenzyme system; metabolites are excreted in feces (61%) and urine (36%).
Half-life: 17.5 hr.
(vasodilation, improved erectile function)
CV: hypotension, peripheral edema.
Derm: flushing.
EENT: hearing loss, nasal congestion, vision loss.
GI: diarrhea, dyspepsia.
GU: ↓ fertility, priapism.
MS: back pain, limb pain, myalgia.
Neuro: headache.
Cialis (for ED)
- PO (Adults): 10 mg prior to sexual activity (range 5–20 mg; not to exceed one dose/24 hr) or 2.5 mg once daily (max: 5 mg/day); Concurrent use of strong CYP3A4 inhibitors: single dose should not exceed 10 mg in any 72-hr period; for once-daily dose regimen, should not exceed 2.5 mg/day.
Renal Impairment
- PO (Adults): CCr 30–50 mL/min (as-needed dosing): Initial dose should not exceed 5 mg/day; maximum dose should not exceed 10 mg in 48 hr; CCr <30 mL/min (as-needed dosing): Maximum dose should not exceed 5 mg in 72 hr; CCr <30 mL/min (once-daily dosing): Not recommended for use.
Hepatic Impairment
- PO (Adults): Mild or moderate hepatic impairment: Daily dose should not exceed 10 mg (once-daily dose regimen not recommended) Severe hepatic impairment: Not recommended for use.
Cialis (for BPH or ED/BPH)
- PO (Adults): 5 mg once daily; Concurrent use of strong CYP3A4 inhibitors: Should not exceed 2.5 mg once daily.
Renal Impairment
- PO (Adults): CCr 30–50 mL/min: Initial dose should not exceed 2.5 mg/day; maximum dose should not exceed 5 mg/day; CCr <30 mL/min: Not recommended for use.
Hepatic Impairment
- PO (Adults): Not recommended for use.
Adcirca, Alyq, and Tadliq (for PAH)
- PO (Adults): 40 mg once daily; If receiving ritonavir for ≥1 wk: start 20 mg once daily; may then ↑ to 40 mg once daily based on tolerability; If initiating ritonavir while on Adcirca, Alyq, or Tadliq: stop Adcirca, Alyq, or Tadliq ≥24 hr before starting ritonavir; may reinitiate Adcirca, Alyq, or Tadliq at 20 mg once daily after ≥1 wk of therapy with ritonavir; may then ↑ to 40 mg once daily based on tolerability.
Renal Impairment
- (Adults): CCr 31–80 mL/min: Start 20 mg once daily; may then ↑ to 40 mg once daily based on tolerability.
Hepatic Impairment
- PO (Adults): Mild or moderate hepatic impairment: Start with 20 mg once daily.
Adcirca, Alyq, Cialis, Tadliq
