From the Guidelines
Tadalafil and Cardiovascular Health
Phosphodiesterase Inhibitors in Heart Failure
Tadalafil's Impact on Heart Failure Patients
Tadalafil should be used with caution in patients with heart failure, as it may exacerbate the condition due to its vasodilatory effects 1. The recommended dose for patients with heart failure is not established, but a lower dose of 10mg may be considered, with close monitoring of the patient's condition. Patients with severe heart failure or those taking nitrates should avoid using tadalafil altogether, as it can cause profound hypotension, MI, and even death when used concomitantly with nitrates 1.
- Key considerations for tadalafil use in heart failure patients include:
- Monitoring for signs of worsening heart failure, such as increased dyspnea, fatigue, or edema
- Avoiding concomitant use with nitrates, as this can lead to severe hypotension
- Starting with a lower dose and titrating up as needed and tolerated
- Regular follow-up with a healthcare provider to assess the patient's condition and adjust the treatment plan as needed It is essential to weigh the potential benefits of tadalafil against the potential risks and to carefully monitor patients with heart failure who are taking this medication 1.
From the FDA Drug Label
Patients with left ventricular outflow obstruction, (e.g., aortic stenosis and idiopathic hypertrophic subaortic stenosis) can be sensitive to the action of vasodilators, including PDE5 inhibitors The following groups of patients with cardiovascular disease were not included in clinical safety and efficacy trials for tadalafil, and therefore until further information is available, tadalafil is not recommended for the following groups of patients: New York Heart Association Class 2 or greater heart failure in the last 6 months As with other PDE5 inhibitors, tadalafil has mild systemic vasodilatory properties that may result in transient decreases in blood pressure
The effect of Tadalafil on heart failure is that it is not recommended for patients with New York Heart Association Class 2 or greater heart failure in the last 6 months due to the potential for adverse effects from its vasodilatory properties. Tadalafil can cause transient decreases in blood pressure, which may be problematic for patients with heart failure. Patients with heart failure should be cautious when using tadalafil, and it should only be used under close medical supervision. 2
From the Research
Effect of Tadalafil on Heart Failure
- The study 3 found that tadalafil does not support its use in patients with heart failure with preserved ejection fraction and combined postcapillary and precapillary pulmonary hypertension, with potential safety concerns and no observed benefits in primary and secondary end points.
- In contrast, the study 4 suggests that tadalafil has a cardiovascular-protective effect and can be a therapeutic option for the treatment of erectile dysfunction patients with cardiovascular disease.
- The study 5 found that exposure to tadalafil was associated with significant and clinically meaningful lower rates of major adverse cardiovascular events and overall mortality in men with erectile dysfunction.
- The study 6 found that tadalafil can be safely used by healthy subjects and by patients with cardiovascular diseases, but its use is contraindicated in patients receiving nitrate therapy due to the potential for significant hypotensive effects.
- The study 7 found that tadalafil exerts a long-standing, potentially beneficial effect on coronary microvasculature in patients with erectile dysfunction and coronary artery disease.
Key Findings
- Tadalafil may have a negative effect on heart failure with preserved ejection fraction and combined postcapillary and precapillary pulmonary hypertension 3.
- Tadalafil may have a cardiovascular-protective effect in patients with erectile dysfunction and cardiovascular disease 4, 5.
- Tadalafil can be safely used by patients with cardiovascular diseases, but with caution in patients receiving nitrate therapy 6.
- Tadalafil may have a beneficial effect on coronary microvasculature in patients with erectile dysfunction and coronary artery disease 7.
Cardiovascular Effects
- Tadalafil can cause small changes in blood pressure, but these are not believed to be clinically relevant 6.
- Tadalafil can cause significant hypotensive effects when used with nitrate therapy, and its use is contraindicated in these patients 6.
- Tadalafil may improve hemodynamic indexes and elevate endothelial cell-derived nitric oxide levels 4.