From the Guidelines
Tadalafil should be used with caution in patients with heart failure due to its potential to exacerbate the condition.
Key Considerations
- The vasodilatory effect of Tadalafil can lead to a decrease in blood pressure, potentially worsening heart failure symptoms 1.
- Tadalafil can increase cyclic guanosine monophosphate (cGMP) levels, which may have a negative inotropic effect on the heart, further compromising cardiac function in heart failure patients 1.
Patient Evaluation and Monitoring
- Carefully evaluate the benefits and risks of using Tadalafil in patients with heart failure, considering the underlying cause and severity of the condition, as well as the presence of any comorbidities 1.
- Closely monitor patients with heart failure for signs of worsening symptoms, such as increased shortness of breath, fatigue, or swelling, and adjust or discontinue Tadalafil as necessary 1.
Dosing and Treatment
- The typical dose of Tadalafil for erectile dysfunction is 10-20 mg taken as needed, but the dose and duration of treatment may need to be adjusted in patients with heart failure to minimize the risk of adverse effects 1.
- Patients with heart failure with reduced ejection fraction (HFrEF) may be at higher risk of adverse effects from Tadalafil compared to those with heart failure with preserved ejection fraction (HFpEF) 1.
Important Recommendations
- Routine use of phosphodiesterase-5 inhibitors, such as Tadalafil, to increase activity or quality of life in patients with heart failure with preserved ejection fraction (HFpEF) is not recommended due to lack of benefit 1.
- However, Tadalafil may be considered in certain cases, such as pulmonary arterial hypertension, under close medical supervision and with careful monitoring of the patient's condition 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