From the FDA Drug Label
The recommended starting dose of tadalafil tablets for use as needed in most patients is 10 mg, taken prior to anticipated sexual activity. The dose may be increased to 20 mg or decreased to 5 mg, based on individual efficacy and tolerability. Tadalafil tablets for once daily use is 2.5 mg, taken at approximately the same time every day, without regard to timing of sexual activity. The tadalafil tablets dose for once daily use may be increased to 5 mg, based on individual efficacy and tolerability.
The patient is a 73-year-old male post-CABG for CAD. There is no specific dosing recommendation for this patient population. However, considering the patient's age and medical history, a conservative approach would be to start with the lowest recommended dose.
- For use as needed: 10 mg may be considered, but it is recommended to start with a lower dose of 5 mg and adjust based on individual efficacy and tolerability.
- For once daily use: 2.5 mg may be considered, and the dose may be increased to 5 mg based on individual efficacy and tolerability 1.
From the Research
For a 73-year-old male with coronary artery disease (CAD) who has undergone coronary artery bypass grafting (CABG), tadalafil should be initiated at a reduced dose of 5 mg once daily, with a maximum dose of 10 mg in a 24-hour period, as this dosing regimen is supported by the most recent and highest quality study available 2.
Key Considerations
- The patient's age and cardiac history necessitate a lower dosing regimen to minimize potential cardiovascular risks.
- It is essential to ensure the patient has been cleared by his cardiologist for sexual activity and is hemodynamically stable, typically at least 4-6 weeks post-CABG.
- Tadalafil is absolutely contraindicated if the patient is taking any nitrate medications due to the risk of severe, potentially fatal hypotension, as highlighted in a recent study 2.
Administration and Monitoring
- The medication should be taken approximately 30-60 minutes before sexual activity, though its long half-life allows for more spontaneity compared to other erectile dysfunction medications.
- Common side effects include headache, dyspepsia, back pain, myalgia, nasal congestion, and flushing.
- The patient should be instructed to seek immediate medical attention if he experiences chest pain, dizziness, or prolonged erection lasting more than 4 hours.
Quality of Life and Cardiovascular Risks
- A study from 2024 2 found that the use of a PDE5i in combination with nitrate medication in men with stable coronary artery disease may pose an increased hazard for cardiovascular morbidity and mortality, emphasizing the need for careful patient-centered consideration before prescribing PDE5is to patients with cardiovascular disease using nitrate medication.
- Another study from 2017 3 highlighted that patients with multivessel coronary artery disease attain important quality of life benefits following revascularization with either PCI or CABG, with CABG resulting in greater angina relief and improved quality of life compared to PCI 6 months after revascularization and beyond.