From the Guidelines
Tadalafil has been shown to have no beneficial effects on activity levels, quality of life, exercise tolerance, or NT-proBNP levels in patients with heart failure with preserved ejection fraction (HFpEF) [ 1 ].
Key Points
- The routine use of phosphodiesterase-5 inhibitors, such as tadalafil, to increase activity or quality of life in patients with HFpEF is ineffective [ 1 ].
- Tadalafil may be used to treat erectile dysfunction in patients with heart failure, but its use should be guided by the need for continued nitrate therapy versus other alternative options available [ 1 ].
- The safety profile of tadalafil in patients with heart failure is similar to that observed in patients with erectile dysfunction [ 1 ].
Considerations
- Tadalafil should not be used concomitantly with nitrate medications, often used to treat chronic coronary disease, because of the potential for severe hypotension [ 1 ].
- Patients on tadalafil should avoid taking nitroglycerine for at least 48 hours due to its long-acting half-life of 17.5 hours [ 1 ].
- The use of tadalafil in patients with heart failure should be considered secondary to maintaining cardiovascular function, and treatment for erectile dysfunction should not negatively affect cardiovascular health [ 1 ].
From the FDA Drug Label
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... 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 As with other PDE5 inhibitors, tadalafil has mild systemic vasodilatory properties that may result in transient decreases in blood pressure
The effects of tadalafil in heart failure are not well established, and it is not recommended for patients with New York Heart Association Class 2 or greater heart failure in the last 6 months due to lack of clinical safety and efficacy trials 2. Tadalafil has mild systemic vasodilatory properties that may result in transient decreases in blood pressure, which could be a concern in patients with heart failure. Caution should be exercised when considering the use of tadalafil in patients with heart failure.
From the Research
Effects of Tadalafil in Heart Failure
- Tadalafil, a phosphodiesterase-5 (PDE-5) inhibitor, has been shown to have cardiovascular-protective effects in patients with cardiovascular diseases, including heart failure 3.
- The enzyme PDE-5 is widely distributed in the heart, smooth muscle, and blood vessels, and tadalafil's inhibition of this enzyme leads to nitric oxide-mediated vasodilation, which can improve hemodynamic indexes 3.
- Studies have demonstrated that tadalafil can improve exercise capacity, delay clinical worsening, and improve quality of life in patients with pulmonary arterial hypertension, a condition often associated with heart failure 4, 5, 6.
- Tadalafil has been shown to be well tolerated and effective in patients with heart failure, with improvements in 6-minute walk distance and time to clinical worsening compared to placebo 4, 5, 6.
- The use of tadalafil in patients with heart failure has been associated with improved endothelial function, increased nitric oxide levels, and activation of protein kinase A, which can lead to improved cardiac function 3.
Specific Patient Populations
- Tadalafil has been shown to be effective in patients with heart failure and comorbidities such as hypertension, cardiac disorder, and hyperlipidemia 7.
- Obese patients, smokers, and those with psychogenic erectile dysfunction may require higher doses of tadalafil (5mg) to achieve clinically important improvements 7.
- Patients with severe baseline erectile dysfunction may achieve significant improvements in erectile function with tadalafil 5mg 7.