Cialis (Drug Interactions Between Tadalafil and Nitrates)
Like other PDE5 inhibitors, clinical pharmacology studies show that
tadalafil (5–20 mg) potentiates the hypotensive effect of nitrates. This is thought to result from the combined effects of nitrates and tadalafil on the
NO-cGMP pathway. Therefore, administration of tadalafil to patients who
are using any form of organic nitrates, either regularly or intermittently, is
contraindicated.
Results of a recent placebo-controlled study to assess the degree of
interaction between nitroglycerin and tadalafil showed that 20 mg of
tadalafil enhanced the hypotensive effects of sublingual nitroglycerin
(NTG) for up to 24 h after tadalafil dosing. In this study, a significant
interaction between tadalafil and NTG was observed at each time point up
to and including 24 h. At 48 h, by most hemodynamic measures, the interaction
between tadalafil and NTG was not observed, although a few more
tadalafil subjects compared with those receiving placebo experienced a
decrease in blood pressure at this point in time. After 48 h, the interaction
was not detectable. In emergency situations in which nitrate administration
is deemed medically necessary, at least 48 h should elapse after the last
dose of tadalafil before nitrate administration is considered. In such circumstances,
nitrates should still only be administered under close medical
supervision and patient monitoring.
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