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.
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)
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)
NO BOXED WARNINGS
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.
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