Can tadalafil (Cialis) be used for urinary problems, specifically urinary retention or benign prostatic hyperplasia (BPH)?

From the Guidelines

Tadalafil can be used for urination problems, particularly in men with benign prostatic hyperplasia (BPH), as it has been shown to improve urinary flow and reduce symptoms like frequent urination, weak stream, straining, and incomplete emptying of the bladder [@104@, @105@, @106@]. The typical dose for BPH symptoms is 5 mg taken once daily at approximately the same time each day. This medication works by relaxing the smooth muscle in the prostate and bladder. Some key points to consider when using tadalafil for urination problems include:

• Tadalafil is FDA-approved specifically for this purpose, either alone or in combination with other BPH medications [@107@].
• While taking tadalafil, you should avoid consuming large amounts of alcohol, which can increase the risk of side effects like dizziness and low blood pressure.
• Common side effects may include headache, indigestion, back pain, muscle aches, flushing, and nasal congestion.
• You should not take tadalafil if you use nitrate medications for chest pain or certain recreational drugs, as this combination can cause a dangerous drop in blood pressure.
• Always consult with your healthcare provider before starting tadalafil to ensure it's appropriate for your specific condition and to review potential drug interactions. It's also important to note that combination therapy with tadalafil and alpha blockers may not offer advantages in symptom improvement over either agent alone, as stated in the AUA guideline 1. However, tadalafil has been shown to be effective in improving lower urinary tract symptoms in men with BPH, and its use should be considered on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and potential drug interactions.

From the FDA Drug Label

The efficacy and safety of tadalafil for once daily use for the treatment of the signs and symptoms of BPH was evaluated in 3 randomized, multinational, double-blinded, placebo-controlled, parallel-design, efficacy and safety studies of 12 weeks duration The primary efficacy endpoint in the two studies that evaluated the effect of tadalafil for the signs and symptoms of BPH was the International Prostate Symptom Score (IPSS), a four week recall questionnaire that was administered at the beginning and end of a placebo run-in period and subsequently at follow-up visits after randomization The IPSS assesses the severity of irritative (frequency, urgency, nocturia) and obstructive symptoms (incomplete emptying, stopping and starting, weak stream, and pushing or straining), with scores ranging from 0 to 35; higher numeric scores representing greater severity Maximum urinary flow rate (Qmax), an objective measure of urine flow, was assessed as a secondary efficacy endpoint in Study J and as a safety endpoint in Study K. In each of these 2 trials, tadalafil 5 mg for once daily use resulted in statistically significant improvement in the total IPSS compared to placebo Tadalafil tablets are indicated for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH). Tadalafil tablets are indicated for the treatment of ED and the signs and symptoms of BPH (ED/BPH).

Tadalafil can be used for urination problems associated with Benign Prostatic Hyperplasia (BPH), as it has been shown to improve the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) in clinical studies 2. Key benefits include:

• Improvement in irritative and obstructive symptoms
• Increase in maximum urinary flow rate
• Statistically significant improvement in total IPSS compared to placebo It is important to note that tadalafil is indicated for the treatment of ED and BPH 2.

From the Research

Tadalafil for Urination Problems

• Tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor, is approved for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTS) 3, 4, 5, 6, 7.
• The mechanism of action underlying PDE5 inhibition includes relaxation of smooth muscle in the prostate, bladder neck, and supporting vasculature, as well as modulation of bladder afferent nerve activity 3, 5, 7.
• Studies have demonstrated that tadalafil 5 mg once-daily results in significant improvements in International Prostate Symptom Scores (IPSS), IPSS storage and voiding subscores, and IPSS quality of life index compared with placebo 3, 4.
• Tadalafil has been shown to be well tolerated and have a favorable safety profile, with common adverse events including back pain, dyspepsia, headache, and nasopharyngitis 4, 5.
• The use of tadalafil for BPH-LUTS is supported by multiple randomized, placebo-controlled trials, including studies in Asian men and men with erectile dysfunction 3, 4, 6, 7.

Benefits of Tadalafil for Urination Problems

• Tadalafil has been shown to improve urinary symptoms, including storage and voiding symptoms, in men with BPH-LUTS 3, 4, 7.
• Tadalafil may also improve erectile function in men with BPH-LUTS and erectile dysfunction 4, 6, 7.
• The ability to treat both BPH-LUTS and erectile dysfunction with one medication is a significant advantage of tadalafil 6, 7.

Considerations for Use

• Tadalafil should be used with caution in men taking certain medications, including nonselective α-adrenergic antagonists, nitrates, and cytochrome P450 inhibitors 5.
• Men with certain medical conditions, including significant cardiovascular disease, should be carefully evaluated before starting tadalafil 5.