Are there any contraindications with tadalafil (Cialis) and fenofibrate (Fenfibraye)?

From the Guidelines

Tadalafil and fenofibrate can be taken together, but caution is advised due to potential interactions, particularly in patients with pre-existing cardiovascular conditions, liver disease, or kidney impairment 1. When considering the use of tadalafil and fenofibrate together, it's essential to weigh the potential benefits against the risks. Fenofibrate, a fibrate, is used to manage lipid metabolism, while tadalafil, a phosphodiesterase-5 inhibitor, is used for erectile dysfunction or benign prostatic hyperplasia.

Key Considerations

• Patients should monitor for symptoms like dizziness, lightheadedness, or fainting, particularly during the initial period of taking both medications.
• Those with pre-existing cardiovascular conditions, liver disease, or kidney impairment need extra caution as these conditions may increase interaction risks.
• It's essential to inform your healthcare provider about all medications you're taking, including over-the-counter drugs and supplements, as they may further influence these interactions.
• Dosage adjustments might be necessary when taking these medications concurrently, and regular follow-up appointments are important to monitor for any adverse effects.

Specific Guidance

• According to the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults, fenofibrate may be considered concomitantly with a low- or moderate-intensity statin only if the benefits from ASCVD risk reduction or triglyceride lowering when triglycerides are 500 mg/dL are judged to outweigh the potential risk for adverse effects 1.
• The AUA guideline part I-initial work-up and medical management for the management of lower urinary tract symptoms attributed to benign prostatic hyperplasia suggests that combination therapy with tadalafil and other medications should be approached with caution due to the higher side effect risk 1.

From the Research

Tadalafil and Fenofibrate Interactions

• There are no direct studies on the interaction between tadalafil and fenofibrate, also known as Fenfibraye, in the provided evidence.
• However, it is known that tadalafil is a phosphodiesterase-5 (PDE5) inhibitor, and its interactions with other drugs are well-documented 2, 3.
• PDE5 inhibitors, including tadalafil, can interact with certain medications, such as nitrates and alpha-blockers, to cause severe hypotension and syncope 2, 3.
• Fenofibrate, on the other hand, is a lipid-regulating drug that can affect the plasma lipid profile and has been shown to be effective in reducing plasma triglyceride and total cholesterol levels 4.
• There is no evidence to suggest a direct contraindication between tadalafil and fenofibrate, but caution should be exercised when using tadalafil with other medications, especially those that can affect blood pressure or have interactions with PDE5 inhibitors 2, 3.

Mechanism of Action

• Tadalafil works by inhibiting the PDE5 enzyme, which increases the levels of cyclic guanosine monophosphate (cGMP) in the blood, leading to smooth muscle relaxation and increased blood flow 2, 3.
• Fenofibrate works by activating the peroxisome proliferator-activated receptor-alpha (PPAR-alpha), which regulates the expression of genes involved in lipid metabolism 4.
• The combination of tadalafil and fenofibrate may not have a direct interaction, but their mechanisms of action should be considered when using them together.

Safety and Efficacy

• Tadalafil has been shown to be effective and safe in treating erectile dysfunction, with a low risk of adverse effects 2, 3, 5.
• Fenofibrate has also been shown to be effective in reducing plasma lipid levels, with a relatively good safety profile 4.
• However, the combination of tadalafil and fenofibrate has not been specifically studied, and their safety and efficacy when used together are unknown.