From the Guidelines
Tadalafil is likely a better option than sildenafil for patients concerned about tachycardia incidence due to its pharmacokinetic profile, which results in a more gradual onset of action and fewer sudden hemodynamic changes. When comparing tadalafil and sildenafil, it's essential to consider their effects on cardiovascular health, particularly tachycardia incidence. According to the available evidence, low-quality studies comparing tadalafil and sildenafil provided insufficient evidence to determine whether one treatment was more effective than the other in terms of successful sexual intercourse or improvement in erections 1. However, the pharmacokinetic profiles of these medications can provide insight into their potential to cause tachycardia. Some key points to consider when choosing between tadalafil and sildenafil include:
- Tadalafil has a longer half-life of 17.5 hours, which may result in a more gradual onset of action and fewer sudden hemodynamic changes compared to sildenafil's shorter half-life of 4-5 hours.
- The typical dosing for sildenafil is 25-100mg taken approximately 1 hour before sexual activity, while tadalafil is prescribed as either 2.5-5mg daily or 10-20mg as needed.
- Both medications can potentially cause tachycardia, especially when combined with nitrates or alpha-blockers, which is contraindicated.
- Patients with pre-existing cardiovascular conditions should be monitored closely regardless of which PDE5 inhibitor is selected. Given the available information and the importance of minimizing cardiovascular risks, tadalafil may be the preferred option for patients concerned about tachycardia incidence.
From the Research
Tachycardia Incidence Comparison
- The provided studies do not directly compare the incidence of tachycardia between sildenafil and tadalafil 2, 3, 4, 5, 6.
- However, the studies suggest that both sildenafil and tadalafil are generally safe for use in patients with cardiovascular diseases, including those with a risk of tachycardia 3, 5.
- A study on the cardiovascular effects of tadalafil found that it resulted in small changes in blood pressure, which are not believed to be clinically relevant 3.
- Another study found that sildenafil does not increase the risk of myocardial infarction or sudden cardiac death, and may even have a cardioprotective effect 5.
- A longitudinal study found that both tadalafil and sildenafil were associated with reduced risks of all-cause mortality, cardiovascular disease, and dementia in men with erectile dysfunction 6.
Cardiovascular Effects
- Tadalafil has been shown to have cardiovascular benefits, including improved left ventricular function and contractility, and reduced adverse remodeling and hypertrophy in animal models 2.
- Sildenafil has also been found to have a cardioprotective effect, and does not increase the risk of myocardial infarction or sudden cardiac death 5.
- Both tadalafil and sildenafil have been associated with reduced risks of cardiovascular disease, including myocardial infarction and stroke 6.
Safety Profile
- The safety profiles of tadalafil and sildenafil are similar, with both medications being generally well-tolerated and safe for use in patients with cardiovascular diseases 3, 4, 5.
- However, both medications are contraindicated in patients receiving nitrate therapy, due to the potential for significant hypotensive effects 3, 5.