Overview of the cardiovascular effects of tadalafil

Emmick, Jeffrey T.; Stuewe, S.; Mitchell, Malcolm I.

doi:10.1016/s1520-765x(02)90050-7

Cited by 74 publications

(50 citation statements)

References 11 publications

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“…14,24 In studies assessing the use of vardenafil in patients on antihypertensive medicines, there was no increase in adverse events. 22 Thus, PDE5 inhibitors can be safely administered with usual antihypertensive agents including diuretics, beta blockers, calcium blockers and angiotensin receptor blockers.…”

Section: Does the Addition Of Pde5 Inhibitors To Antihypertensive Agementioning

confidence: 99%

“…Increases in heart rate tend to be minimal, usually less than 5 beats/min. [10][11][12][13][14][15][16] In general, the effects of the PDE5 inhibitors on BP are more pronounced in the standing position. The reduction in systolic BP with tadalafil 10 mg in coronary artery disease patients (who had higher baseline BP than healthy volunteers) was 7 mm Hg in the standing position and thus greater than in healthy volunteers.…”

Section: The Association Of Hypertension With Edmentioning

confidence: 99%

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Erectile dysfunction and hypertension

Kloner

2006

Int J Impot Res

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Recent analyses suggest that about 67-68% of men with hypertension have some degree of erectile dysfunction (ED). With about 25 million men in the US with hypertension, substantial numbers of hypertension-related ED exist that tend to be of a more severe nature than the general population. Men with ED are also more likely to have hypertension. Thiazide diuretic and beta-blocker therapy may contribute to ED. Phosphodiesterase-5 (PDE5) inhibitors are effective therapy in men with ED owing to hypertension who are taking antihypertensive medicines including those on multiple antihypertensive medicines. The addition of PDE5 inhibitors to usual common antihypertensive medicines (diuretics, beta blockers, calcium blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers) results in either no or small additive reductions in blood pressure (BP) and no increase in serious clinical adverse events. There are however precautions regarding the use of PDE5 inhibitors in patients taking alpha blockers for either hypertension or benign prostatic hypertrophy, as some patients may develop orthostatic hypotension. Organic nitrates remain an absolute contraindication for PDE5 inhibitors because synergistic and symptomatic reductions in BP may occur in some patients with this drug combination.

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Section: Does the Addition Of Pde5 Inhibitors To Antihypertensive Agementioning

confidence: 99%

Section: The Association Of Hypertension With Edmentioning

confidence: 99%

Erectile dysfunction and hypertension

Kloner

2006

Int J Impot Res

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“…In a study involving the use of 10 or 20 mg tadalafil in healthy patients there was a small but statistically significant reduction in systolic and diastolic pressure without adverse effects on hemodynamics. 48 In a crossover study comparing sildenafil (50 mg) and vardenafil (10 mg 49 PDE-5i have been shown to be tolerated with a wide range of concomitant antihypertensive drugs, such as b-adrenergic receptor blockers, calcium channel blockers, and angiotensin converting enzyme inhibitors (ACEi). However, PDE-5i should be used with caution in patients receiving a blocking agents since the combination of both might lead to excessive vasodilatation and hypotension.…”

Section: Effects On Central Hemodynamics and Peripheral Vasculaturementioning

confidence: 99%

The effects of chronic phosphodiesterase-5 inhibitor use on different organ systems

et al. 2006

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Phosphodiesterase-5 (PDE-5) inhibitors selectively inhibit PDE-5 enzymes that are present in various tissues like penile tissue, platelets, vascular, and smooth muscle tissue. The drug's actions on these tissues have lead to the successful therapeutic use in patients suffering from conditions such as erectile dysfunction (ED) and pulmonary hypertension. PDE-5 inhibitors (PDE-5i) act on the erectile tissue causing penile smooth muscle relaxation and vasodilatation leading to penile erection. In addition, in particular when used in conjunction with prostaglandin inhibitors, PDE-5i cause vasodilatation in pulmonary vasculature hence decreasing both the pulmonary arterial pressure and resistance. PDE-5i have also shown to mildly decrease blood pressure, increase cardiac index, and increase coronary blood flow in experimental animals as well as in human studies. The Food and Drug Administration (FDA) has approved three PDE-5i for the treatment of ED: sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) and one for pulmonary hypertension: sildenafil (Revatio). These agents are highly selective for PDE-5 enzymes as compared to other subclasses of PDE enzymes and have the almost identical pharmacological action but slightly different pharmacokinetics. Only little data exist about long-term use of PDE-5i and their effects on different organ system. This paper reviews the current information available on chronic PDE-5 inhibitor use.

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“…Because both PDE5Is and nitrates increase cGMP, coadministration can generate excess accumulation of cGMP and can trigger marked vasodilation and severe hypotension. For instance, when Emmick and colleagues 37 analyzed nitroglycerin 0.4 mg in combination with sildenafil 50 mg, tadalafil 10 mg, and placebo, a potentially clinically significant change in BP was observed more frequently with each PDE5I than with placebo (standing SBP Ͻ85 mm Hg: placebo, 24%; sildenafil, 46%; tadalafil, 47%; supine SBP Ͻ85 mm Hg: placebo, 6%; sildenafil, 36%; tadalafil, 18%). Thus, PDE5Is are contraindicated with all nitrates (eg, nitroglycerin, glyceryl trinitrate, isosorbide mononitrate).…”

Section: Nitrates and Pde5ismentioning

confidence: 99%