TADALAFIL 20 mg Tablet, 500-count
Other active recalls for Tadalafil (different manufacturers) — 3 · tap to view
🆔 Identity & classification
Where does this data come from?
🏷️ RxNorm drug class
This medicine belongs to the Phosphodiesterase 5 Inhibitor class.
Where does this data come from?
🏭 Manufacturer & labeler
Where does this data come from?
🩺 Clinical
- Tadalafil is the active ingredient in several branded products, each approved for a specific use. Cialis (and generic tadalafil tablets) treat erectile dysfunction, an enlarged pro...
- What exactly is tadalafil used for, and why do I see so many different brand names?
- It depends on what you're taking it for. For erectile dysfunction, your doctor may prescribe it as-needed — taken before sexual activity — or as a lower once-daily dose so you don'...
- Do I take it every day, or just when I need it?
Patient education
Supplement & herbal interactions
Some supplements/herbs that may interact with Tadalafil — tap one for details:
Where does this data come from?
Ask a licensed pharmacist directly — free, answered by our team.
💊 What it looks like
Where does this data come from?
🧪 Inactive Ingredients / Excipients
Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.
💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.
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UNII M28OL1HH48
Croscarmellose sodium is a plant-based substance derived from cellulose. It acts as a disintegrant, helping tablets and capsules break down quickly in the digestive system so the medicine can be absorbed.
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UNII 1K09F3G675
Ferric oxide red is an inorganic iron compound used as a colorant in medicines. It gives tablets, capsules, or other dosage forms a red or reddish tint for identification and appearance.
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UNII EX438O2MRT
Ferric oxide yellow is a naturally occurring iron compound used as a colorant in medications. It gives tablets, capsules, and other forms a yellow or golden hue for identification and appearance.
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UNII XM0M87F357
A dark iron oxide compound that gives medicines their black or dark color. It's used as a colorant in tablets and capsules to help identify the product and make it visually distinctive.
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UNII 0A7M0N7SPE
Hydroxypropyl cellulose is a plant-derived thickener made by chemically modifying cellulose. It acts as a binder to hold tablet ingredients together, a film-former for coatings, and a thickener in liquid formulations.
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UNII EWQ57Q8I5X
Lactose monohydrate is a natural sugar derived from milk. It serves as a filler and binder in tablets and capsules, helping create the proper size, texture, and consistency of the medicine.
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UNII 1DI56QDM62
A natural fatty substance from soybeans that helps mix oil and water-based ingredients together. It acts as an emulsifier and lubricant in medicines to improve texture and help the product break down properly in your body.
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UNII 70097M6I30
Magnesium stearate is a salt made from magnesium and stearic acid, a fatty substance. It's used in tablets and capsules as a lubricant and glidant to help ingredients flow smoothly during manufacturing and prevent sticking.
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UNII OP1R32D61U
Microcrystalline cellulose is a purified form of cellulose, a natural fiber from plant sources. It acts as a binder and filler in tablets and capsules, helping hold ingredients together and give the medicine its shape and size.
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UNII G2M7P15E5P
Polyethylene glycol 3350 is a synthetic polymer used as a solvent, humectant, and thickening agent in medicines. It helps dissolve other ingredients, retain moisture in the product, and achieve the desired consistency.
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UNII 532B59J990
Polyvinyl alcohol is a synthetic polymer made from plant-derived materials. It's used as a binder to hold ingredients together, a film-former in coatings, and a thickener in liquid formulations.
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UNII 368GB5141J
A detergent and foaming agent derived from coconut or palm oil. In medications, it helps break down and mix oil and water-based ingredients, aids in tablet disintegration, and improves how the drug dissolves and spreads in the mouth or digestive system.
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UNII 7SEV7J4R1U
A powder made from a naturally occurring mineral. In medicines, talc works as a glidant and anti-caking agent, helping tablets and capsules flow smoothly during manufacturing and preventing clumping.
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UNII 15FIX9V2JP
Titanium dioxide is a bright white mineral powder commonly used as a colorant and opacifying agent. It makes pills and tablets white or lighter in color and helps make coatings non-transparent.
14 inactive ingredients listed in the exact product block matched to this NDC.
Where does this data come from?
ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.Inactive ingredient FAQ
Are inactive ingredients the same for every manufacturer?
Why might an inactive ingredient be missing?
Can inactive ingredients matter?
💲 Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per each | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | Not in the retail survey — common for institutional, discontinued, or low-volume packs. | |
| Medicaid paysCMS SDUD · 12 mo | No recent Medicaid claims on file for this NDC — rare and low-volume NDCs are suppressed in the public data. | |
| Medicare drug plans payPart D · Q2 2026 | $1.27 | $633.50 / 500 tablets |
Where does this data come from?
🔁 Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Alyq 20 mg 00480-9277-06 | Teva | 60 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 27241-0123-02 | Ajanta | 60 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 31722-0647-30 | Camber | 30 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 65862-0880-60 | Aurobindo | 60 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 69097-0526-03 | Cipla | 60 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 82009-0080-60 | Quallent | 60 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 31722-0646-30 | Camber | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 43598-0573-30 | Dr.Reddys | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 16714-0077-01 | NorthStar | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 27241-0114-03 | Ajanta | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 69238-1349-03 | Amneal | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 43547-0033-03 | Solco | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 60290-0030-01 | Umedica | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 72303-0825-01 | HEC | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 82009-0079-05 | Quallent | 500 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 00480-2311-56 | Teva | 30 tablets | $0.158 | AB1 | Discontinued | — |
| Tadalafil 20 mg 75834-0250-01 | NIVAGEN | 1000 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 43547-0051-03 | Solco | 30 tablets | $0.158 | AB1 | Availability likely | — |
| tadalafil 20 mg 35573-0463-30 | Burel | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 16729-0372-10 | Accord | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 33342-0268-07 | Macleods | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 24979-0730-06 | Upsher-Smith | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 62332-0180-30 | Alembic | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 47335-0012-83 | Sun | 30 tablets | $0.192 | AB1 | FDA listed | — |
| Cialis 20 mg 00002-4464-30 | Eli | 30 tablets | $53.837 | AB1 | Availability likely | — |
| Tadalafil 20 mg 13668-0581-05 | Torrent | 500 tablets | — | — | FDA listed | — |
| Tadalafil 20 mg 33342-0278-07 | Macleods | 30 tablets | — | AB2 | FDA listed | — |
| Tadalafil 20 mgthis 43547-0990-50 | Solco | 500 tablets | — | AB2 | FDA listed | — |
| Tadalafil 20 mg 43598-0578-30 | Dr.Reddys | 30 tablets | — | AB2 | FDA listed | — |
| Adcirca 20 mg 66302-0467-60 | United | 60 tablets | — | AB2 | FDA listed | — |
| Tadalafil 20 mg 70518-3931-00 | REMEDYREPACK | 12 tablets | — | AB2 | FDA listed | — |
| Tadalafil 20 mg 73190-0032-60 | AvKARE | 60 tablets | — | AB2 | FDA listed | — |
| Tadalafil 20 mg 67184-0526-01 | Qilu | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71205-0268-10 | Proficient | 10 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 71821-0009-01 | VKT | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68180-0914-06 | Lupin | 30 tablets | — | AB2 | FDA listed | — |
| Tadalafil 20 mg 68382-0899-01 | Zydus | 100 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 70954-0435-10 | ANI | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71205-0736-30 | Proficient | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71610-0728-04 | Aphena | 4 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 76420-0544-30 | Asclemed | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 76420-0554-05 | Asclemed | 500 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68788-8445-03 | Preferred | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 13668-0568-05 | Torrent | 500 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68071-3753-03 | NuCare | 30 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 68788-4083-01 | Preferred | 15 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71335-1587-01 | Bryant | 30 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 82804-0112-10 | Proficient | 10 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 68071-3777-04 | NuCare | 24 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68071-5186-06 | NuCare | 60 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71335-1491-01 | Bryant | 30 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 76420-0857-01 | Asclemed | 100 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 46708-0180-30 | Alembic | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71335-1255-01 | Bryant | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 35561-0257-10 | Bostal | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 65862-0853-05 | Aurobindo | 500 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 71335-2583-01 | Bryant | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 50090-7152-00 | A-S | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 51655-0473-54 | Northwind | 15 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68788-8664-01 | Preferred | 15 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 70518-4534-00 | REMEDYREPACK | 12 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 72789-0396-15 | PD-Rx | 15 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68071-3781-02 | NuCare | 12 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 70771-1478-00 | Zydus | 1000 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71610-0903-04 | Aphena | 4 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 60219-1349-03 | Amneal | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68788-8153-07 | Preferred | 7 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71610-0567-04 | Aphena | 4 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 82804-0042-30 | Proficient | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 82868-0028-06 | Northwind | 6 tablets | — | AB2 | FDA listed | — |
| Tadalafil 20 mg 82968-0005-01 | FOURRTS | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 42291-0867-30 | AvKARE | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 51655-0063-54 | Northwind | 15 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68071-2553-03 | NuCare | 30 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 72789-0344-15 | PD-Rx | 15 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 80425-0443-01 | Advanced | 7 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 29300-0289-01 | Unichem | 100 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 50090-5641-00 | A-S | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 72865-0108-30 | XLCare | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 72603-0784-01 | NorthStar | 1000 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68071-2421-01 | NuCare | 10 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68071-2632-03 | NuCare | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 50090-6150-00 | A-S | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 50090-8039-00 | A-S | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 50090-8047-00 | A-S | 30 tablets | — | AB1 | FDA listed | — |
Where does this data come from?
⏳ Availability & generic status
This product is an FDA-approved generic. Other versions of the same drug are listed under Therapeutic equivalents, least expensive first.
Where does this data come from?
💊 Medicaid utilization by pack size
📊 Medicare Part D spend CMS · PART D · 2026 (Q1)
🔬 Reported adverse events (FAERS)
Top reported reactions
Age at onset
Reporter sex
Serious outcomes
Where does this data come from?
📦 Packaging — all sizes for this product
| Package NDC | Description | Per unit | Per pack | Marketing start | Status |
|---|---|---|---|---|---|
| 43547-0990-06 | 60 TABLET in 1 BOTTLE (43547-990-06) | $0.1400 / ea | $8.40 | 2022-08-11 | Active |
| 43547-0990-50 You're viewing this | 500 TABLET in 1 BOTTLE (43547-990-50) | — | — | 2022-08-11 | Active |
You're viewing the largest of 2 pack sizes for this product.
This pack shows little to no recent Medicaid volume — the 60 tablets pack carries most fills. See all packs ↓
Pack size FAQ
What quantity is in NDC 43547-0990-50?
What is the difference between NDC 43547-0990-50 and NDC 43547-0990-06?
What NDC number is used to bill for this package of TADALAFIL 20 mg Tablet?
Prices are the latest CMS NADAC pharmacy acquisition cost per NDC; per-pack figures are per-unit × pack quantity, shown only when the pack is denominated in the same measure NADAC prices.
🧭 About this NDC listing & data coverage
What data is (and isn’t) available for this NDC — tap to expand
| NDC identity (package / product / labeler codes) | ✓ Available |
| Labeler | ✓ Available |
| Product & package description | ✓ Available |
| Marketing category & status | ✓ Available |
| Active ingredient / dosage form / route | ✓ Available |
| FDA label (SPL via DailyMed) | ✓ Available |
| Package photos | ✓ Available |
| Inactive ingredients (structured) | ✓ Available |
| NADAC pharmacy acquisition price (CMS) | — Not published for this NDC CMS publishes NADAC only for NDCs reported in its retail-pharmacy survey. |
| Orange Book / therapeutic-equivalence data | ✓ Available |
| HCPCS J-code billing crosswalk | — Not published for this NDC Most self-administered / retail products have no J-code — that is normal. |
| Medicaid utilization (CMS SDUD) | — Not published for this NDC CMS reports utilization only for NDCs with Medicaid claims above its privacy threshold. |
Questions about this listing
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📄 Full prescribing information FDA SPL
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE Tadalafil tablets are a phosphodiesterase 5 (PDE5) inhibitor indicated for the treatment of pulmonary arterial hypertension (PAH) (WHO Group 1) to improve exercise ability. Studies establishing effectiveness included predominately patients with NYHA Functional Class II – III symptoms and etiologies of idiopathic or heritable PAH (61%) or PAH associated with connective tissue diseases (23%). ( 1.1 )
1.1Pulmonary Arterial Hypertension Tadalafil tablets are indicated for the treatment of pulmonary arterial hypertension (PAH) (WHO Group 1) to improve exercise ability. Studies establishing effectiveness included predominately patients with NYHA Functional Class II – III symptoms and etiologies of idiopathic or heritable PAH (61%) or PAH associated with connective tissue diseases (23%).
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION • 40 mg once daily, with or without food. ( 2.1 ) • Dividing the dose (40 mg) over the course of the day is not recommended. ( 2.1 ) • Use with ritonavir requires dosage adjustments. ( 2. 4)
2.1Pulmonary Arterial Hypertension The recommended dose of tadalafil tablets is 40 mg (two 20 mg tablets) taken once daily with or without food. Dividing the dose (40 mg) over the course of the day is not recommended.
2.2Dose Adjustment in Renal Impairment Mild (creatinine clearance 51 to 80 mL/min) or moderate (creatinine clearance 31 to 50 mL/min): Start dosing at 20 mg once daily. Increase to 40 mg once daily based on individual tolerability. Severe (creatinine clearance less than 30 mL/min and on hemodialysis): Avoid use of tadalafil tablets because of increased tadalafil exposure (AUC), limited clinical experience, and the lack of ability to influence clearance by dialysis [see Use in Specific Populations ( 8.6 )] .
2.3Dose Adjustment in Hepatic Impairment Mild or moderate (Child Pugh Class A or B): Because of limited clinical experience in patients with mild to moderate hepatic cirrhosis, consider a starting dose of 20 mg once per day. Severe (Child Pugh Class C): Patients with severe hepatic cirrhosis have not been studied. Avoid use of tadalafil tablets [see Use in Specific Populations (8.7)] .
2.4Dose Adjustment for Use with Ritonavir Co-administration of Tadalafil Tablets in Patients on Ritonavir In patients receiving ritonavir for at least one week, start tadalafil tablets at 20 mg once daily. Increase to 40 mg once daily based upon individual tolerability [see Drug Interactions (7.5) and Clinical Pharmacology (12.3)] . Co-administration of Ritonavir in Patients on Tadalafil Tablets Avoid use of tadalafil tablets during the initiation of ritonavir.
Stop tadalafil tablets at least 24 hours prior to starting ritonavir. After at least one week following the initiation of ritonavir, resume tadalafil tablets at 20 mg once daily. Increase to 40 mg once daily based upon individual tolerability [see Drug Interactions (7.5) and Clinical Pharmacology (12.3)] .
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS 20 mg, orange, film-coated, almond-shaped tablets (not scored) debossed with “990”. Tablets (not scored): 20 mg ( 3 )
⛔ Contraindications ▾
4 CONTRAINDICATIONS • Concomitant organic nitrates ( 4.1 ) • Concomitant Guanylate Cyclase (GC) Stimulators ( 4.2 ) • History of known serious hypersensitivity reaction to tadalafil tablets or CIALIS ( 4.3 )
4.1Concomitant Organic Nitrates Tadalafil tablets are contraindicated in patients who are using any form of organic nitrate, either regularly or intermittently. Do not use nitrates within 48 hours of the last dose of tadalafil tablets. Tadalafil tablets potentiate the hypotensive effect of nitrates.
This potentiation is thought to result from the combined effects of nitrates and tadalafil tablets on the nitric oxide/cGMP pathway [see Clinical Pharmacology ( 12.2 )] .
4.2Concomitant Guanylate Cyclase (GC) Stimulators Coadministration of GC stimulators such as riociguat with tadalafil tablets are contraindicated. Tadalafil tablets may potentiate the hypotensive effects of GC stimulators.
4.3Hypersensitivity Reactions Tadalafil tablets are contraindicated in patients with a known serious hypersensitivity to tadalafil (tadalafil tablets or CIALIS). Hypersensitivity reactions have been reported, including Stevens-Johnson syndrome and exfoliative dermatitis [see Adverse Reactions ( 6.2 )] .
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS • Hypotension: Carefully consider whether patients with certain underlying cardiovascular disease could be adversely affected by vasodilatory effects of tadalafil tablets. Not recommended in patients with pulmonary veno-occlusive disease. ( 5.1 , 5.2 ) • Effects on the eye: Sudden loss of vision could be a sign of non-arteritic ischemic optic neuropathy (NAION) and may be permanent.
( 5.3 ) • Hearing impairment: Cases of sudden decrease or loss of hearing have been reported with CIALIS. ( 5.4 ) • Concomitant PDE5 inhibitors: Avoid use with CIALIS or other PDE5 inhibitors. ( 5.5 ) • Prolonged erection: Advise patients to seek emergency treatment if an erection lasts greater than 4 hours.
( 5.6 )
5.1Hypotension Tadalafil tablets have vasodilatory properties that may result in transient decreases in blood pressure. Prior to prescribing tadalafil tablets, carefully consider whether patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects. Patients with preexisting hypotension, with autonomic dysfunction, with left ventricular outflow obstruction, may be particularly sensitive to the actions of vasodilators.
5.2Worsening Pulmonary Vascular Occlusive Disease Pulmonary vasodilators may significantly worsen the cardiovascular status of patients with pulmonary veno-occlusive disease (PVOD). Since there are no clinical data on administration of tadalafil tablets to patients with veno-occlusive disease, administration of tadalafil tablets to such patients is not recommended. Should signs of pulmonary edema occur when tadalafil tablets are administered, the possibility of associated PVOD should be considered.
5.3Visual Loss When used to treat erectile dysfunction, non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, has been reported postmarketing in temporal association with the use of phosphodiesterase type 5 (PDE-5) inhibitors, including tadalafil. Most, but not all, of these patients had underlying anatomic or vascular risk factors for development of NAION, including but not necessarily limited to: low cup to disc ratio (“crowded disc”), age over 50, diabetes, hypertension, coronary artery disease, hyperlipidemia, and smoking.
Based on published literature, the annual incidence of NAION is 2.5-11.8 cases per 100,000 in males aged ≥50 in the general population. An observational case-crossover study evaluated the risk of NAION when PDE5 inhibitor use, as a class, typical of erectile dysfunction treatment, occurred immediately before NAION onset (within 5 half-lives), compared to PDE5 inhibitor use in a prior time period. The results suggest an approximate 2-fold increase in the risk of NAION, with a risk estimate of 2.15 (95% CI 1.06, 4.34).
A similar study reported a consistent result, with a risk estimate of 2.27 (95% CI 0.99, 5.20). Other risk factors for NAION, such as the presence of “crowded” optic disc, may have contributed to the occurrence of NAION in these studies. Patients with known hereditary degenerative retinal disorders, including retinitis pigmentosa, were not included in the clinical trials, and use in these patients is not recommended.
5.4Hearing Impairment Cases of sudden decrease or loss of hearing, which may be accompanied by tinnitus and dizziness, have been reported in patients taking tadalafil. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors [see Adverse Reactions (6.2)] .
5.5Combination with Other PDE5 Inhibitors Tadalafil is also marketed for erectile dysfunction. The safety and efficacy of taking tadalafil tablets together with another PDE5 inhibitor has not been studied. Inform patients taking tadalafil tablets not to take other PDE5 inhibitors.
5.6Prolonged Erection There have been reports of prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours…
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS The following serious adverse reactions are discussed elsewhere in the labeling: • Hypotension [see Warnings and Precautions ( 5.1 )] • Visual Loss [see Warnings and Precautions ( 5.3 ) and Patient Counseling Information ( 17 )] • Hearing loss [see Warnings and Precautions ( 5.4 )] • Priapism [see Warnings and Precautions ( 5.6 )] The most common adverse reaction is headache. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Solco Healthcare US, LLC. at 1-866-257-2597 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
6.1Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Tadalafil was administered to 398 patients with PAH during clinical trials worldwide. In trials of tadalafil tablets, a total of 311 and 251 subjects have been treated for at least 182 days and 360 days, respectively.
The overall rates of discontinuation because of an adverse event (AE) in the placebo-controlled trial were 9% for tadalafil tablets 40 mg and 15% for placebo. The rates of discontinuation because of AEs, other than those related to worsening of PAH, in patients treated with tadalafil tablets 40 mg was 4% compared to 5% in placebo-treated patients. In the placebo-controlled study, the most common AEs were generally transient and mild to moderate in intensity.
Table 1 presents treatment-emergent adverse events reported by ≥9% of patients in the tadalafil tablets 40 mg group and occurring more frequently than with placebo. Table 1: Treatment-Emergent Adverse Events Reported by ≥9% of Patients in Tadalafil Tablets and More Frequent than Placebo by 2% EVENT Placebo Tadalafil Tablets Tadalafil Tablets (%) 20 mg (%) 40 mg (%) (N=82) (N=82) (N=79) Headache 15 32 42 Myalgia 4 9 14 Nasopharyngitis 7 2 13 Flushing 2 6 13 Respiratory Tract Infection (Upper and Lower) 6 7 13 Pain in Extremity 2 5 11 Nausea 6 10 11 Back Pain 6 12 10 Dyspepsia 2 13 10 Nasal Congestion (Including sinus congestion) 1 0 9
6.2Postmarketing Experience The following adverse reactions have been identified during post-approval use of tadalafil. These events have been chosen for inclusion either because of their seriousness, reporting frequency, lack of clear alternative causation, or a combination of these factors. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to estimate reliably their frequency or establish a causal relationship to drug exposure.
The list does not include adverse events that are reported from clinical trials and that are listed elsewhere in this section. Cardiovascular and cerebrovascular — Serious cardiovascular events, including myocardial infarction, sudden cardiac death, stroke, chest pain, palpitations, and tachycardia, have been reported postmarketing in temporal association with the use of tadalafil [see Contraindications (4.1)] . Most, but not all, of these patients had preexisting cardiovascular risk factors.
Many of these events were reported to occur during or shortly after sexual activity, and a few were reported to occur shortly after the use of tadalafil without sexual activity. Others were reported to have occurred hours to days after the use of tadalafil and sexual activity. It is not possible to determine whether these events are related directly to tadalafil, to sexual activity, to the patient’s underlying cardiovascular disease, to a combination of these factors, or to other factors.
Body as a whole — Hypersensitivity reactions including urticaria, Stevens–Johnson syndrome, and exfoliative dermatitis Nervous — Migraine, seizure and seizure recurrence, and transient global amnesia Ophthalmologic — Visual field defect, retinal vein occlusion, retinal artery occlusion, and NAION [see Warnings and Precautions ( 5.3 ) and Patie…
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS
7.1Nitrates Administration of nitrates within 48 hours after the last dose of tadalafil tablets is contraindicated [see Contraindications (4.1)].
7.2Alpha-Blockers PDE5 inhibitors, including tadalafil tablets, and alpha-adrenergic blocking agents are both vasodilators with blood-pressure-lowering effects. When vasodilators are used in combination, an additive effect on blood pressure may be anticipated. Clinical pharmacology studies have been conducted with coadministration of tadalafil with doxazosin, alfuzosin or tamsulosin [see Clinical Pharmacology (12.2)] .
7.3Antihypertensives PDE5 inhibitors, including tadalafil tablets, are mild systemic vasodilators. Clinical pharmacology studies were conducted to assess the effect of tadalafil on the potentiation of the blood-pressure-lowering effects of selected antihypertensive medications (amlodipine, angiotensin II receptor blockers, bendroflumethiazide, enalapril, and metoprolol). Small reductions in blood pressure occurred following coadministration of tadalafil with these agents compared with placebo [see Clinical Pharmacology (12.2)] .
7.4Alcohol Both alcohol and tadalafil, a PDE5 inhibitor, act as mild vasodilators. When mild vasodilators are taken in combination, blood pressure–lowering effects of each individual compound may be increased. Substantial consumption of alcohol (e.g., 5 units or greater) in combination with tadalafil tablets can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache.
Tadalafil (10 mg or 20 mg) did not affect alcohol plasma concentrations and alcohol did not affect tadalafil plasma concentrations. [See Clinical Pharmacology (12.2)] .
7.5CYP3A Inhibitors/Inducers Ritonavir Ritonavir initially inhibits and later induces CYP3A, the enzyme involved in the metabolism of tadalafil. At steady state of ritonavir (about 1 week), the exposure to tadalafil is similar as in the absence of ritonavir [see Dosage and Administration (2.4) and Clinical Pharmacology (12.3)] . Potent Inhibitors of CYP3A Tadalafil is metabolized predominantly by CYP3A in the liver.
In patients taking potent inhibitors of CYP3A such as ketoconazole, and itraconazole, avoid use of tadalafil tablets [see Clinical Pharmacology (12.3)] . Potent Inducers of CYP3A For patients chronically taking potent inducers of CYP3A, such as rifampin, avoid use of tadalafil tablets [see Clinical Pharmacology (12.3)] .
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS Renal Impairment ( 2.2 , 8.6 , 12.3 ) • Mild or moderate: Start with 20 mg once daily. ( 2.2 , 8.6 ) • Severe: Avoid use of tadalafil tablets. ( 2.2 , 8.6 ) Hepatic Impairment ( 2.2 , 8.7 , 12.3 ) • Mild or moderate: Consider starting dose of 20 mg once daily. ( 2. 3, 8.7 ) • Severe: Avoid use of tadalafil tablets. ( 2.3, 8.7 )
8.1Pregnancy Risk Summary Limited data from case series with tadalafil use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. In animal reproduction studies, no adverse developmental effects were observed with oral administration of tadalafil to pregnant rats or mice during organogenesis at exposures 7 times the exposure at the maximum recommended human dose (MRHD) of 40 mg/day based on AUC (see Data) . The estimated background risk of major birth defects and miscarriage for the indicated population is unknown.
All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15- 20%, respectively. Clinical Considerations Disease-Associated Maternal and/or Embryo/Fetal Risk Pregnant women with untreated pulmonary arterial hypertension are at risk for heart failure, stroke, preterm delivery, and maternal and fetal death.
Data Animal Data Tadalafil and/or its metabolites cross the placenta, resulting in fetal exposure in rats. Animal reproduction studies showed no evidence of teratogenicity, embryotoxicity, or fetotoxicity when tadalafil was given to pregnant rats or mice at unbound tadalafil exposures up to 7 times the exposure at the maximum recommended human dose (MRHD) of 40 mg/day during organogenesis based on AUC. In one of two perinatal/postnatal developmental studies in rats, a reduction of postnatal pup survival was observed at dose levels of 60, 200 and 1000 mg/kg.
The no-observed-effect-level (NOEL) for developmental toxicity was 30 mg/kg, which provided maternal exposure to unbound tadalafil concentrations approximately 5 times the exposure at the MRHD based on AUC. Signs of maternal toxicity occurred at doses greater than 200 mg/kg/day, which produced AUCs greater than 8 times the exposure at the MRHD. Surviving offspring had normal development and reproductive performance.
8.2Lactation Risk Summary There are no data on the presence of tadalafil and/or its metabolites in human milk, the effects on the breastfed child, or the effects on milk production. Tadalafil and/or its metabolites are present in the milk of lactating rats at concentrations approximately 2.4-times that found in the plasma. When a drug is present in animal milk, it is likely that the drug will be present in human milk.
The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for tadalafil tablets and any potential adverse effects on the breastfed child from tadalafil tablets or from the underlying maternal condition.
8.3Females and Males of Reproductive Potential Infertility Males Based on the data from 3 studies in adult males, tadalafil decreased sperm concentrations in the study of 10 mg tadalafil for 6 months and the study of 20 mg tadalafil for 9 months. This effect was not seen in the study of 20 mg tadalafil taken for 6 months. There was no adverse effect of tadalafil 10 mg or 20 mg on mean concentrations of testosterone, luteinizing hormone or follicle stimulating hormone.
The clinical significance of the decreased sperm concentrations in the two studies is unknown. There have been no studies evaluating the effect of tadalafil on fertility in men or women [see Clinical Pharmacology (12.2)] .
8.4Pediatric Use Safety and effectiveness of tadalafil tablets in pediatric patients have not been established.
8.5 Geriatric Use Of the total number of subjects in the clinical study of tadalafi…
🤰 Pregnancy ▾
8.7Hepatic Impairment Because of limited clinical experience in patients with mild to moderate hepatic cirrhosis (Child-Pugh Class A or B), consider a starting dose of tadalafil tablets 20 mg once daily. Patients with severe hepatic cirrhosis (Child-Pugh Class C) have not been studied, thus avoid use of tadalafil tablets in such patients [see Dosage and Administration ( 2. 3) and Clinical Pharmacology ( 12.3 )] .
🆘 Overdosage ▾
10 OVERDOSAGE Single doses up to 500 mg have been given to healthy male subjects, and multiple daily doses up to 100 mg have been given to male patients with erectile dysfunction. Adverse reactions were similar to those seen at lower doses. Doses greater than 40 mg have not been studied in patients with pulmonary arterial hypertension.
In cases of overdose, standard supportive measures should be adopted as needed. Hemodialysis contributes negligibly to tadalafil elimination.
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action Tadalafil is an inhibitor of phosphodiesterase type 5 (PDE5), the enzyme responsible for the degradation of cyclic guanosine monophosphate (cGMP). Pulmonary arterial hypertension is associated with impaired release of nitric oxide by the vascular endothelium and consequent reduction of cGMP concentrations in the pulmonary vascular smooth muscle. PDE5 is the predominant phosphodiesterase in the pulmonary vasculature.
Inhibition of PDE5 by tadalafil increases the concentrations of cGMP resulting in relaxation of pulmonary vascular smooth muscle cells and vasodilation of the pulmonary vascular bed. Studies in vitro have demonstrated that tadalafil is a selective inhibitor of PDE5. PDE5 is found in pulmonary vascular smooth muscle, visceral smooth muscle, corpus cavernosum, skeletal muscle, platelets, kidney, lung, cerebellum, and pancreas.
In vitro studies have shown that the effect of tadalafil is more potent on PDE5 than on other phosphodiesterases. These studies have shown that tadalafil is greater than 10,000-fold more potent for PDE5 than for PDE1, PDE2, PDE4, and PDE7 enzymes, which are found in the heart, brain, blood vessels, liver, leukocytes, skeletal muscle, and other organs. Tadalafil is greater than 10,000-fold more potent for PDE5 than for PDE3, an enzyme found in the heart and blood vessels.
Additionally, tadalafil is 700–fold more potent for PDE5 than for PDE6, which is found in the retina and is responsible for phototransduction. Tadalafil is greater than 9,000-fold more potent for PDE5 than for PDE8, PDE9, and PDE10. Tadalafil is 14-fold more potent for PDE5 than for PDE11A1 and 40-fold more potent for PDE5 than for PDE11A4, two of the four known forms of PDE11.
PDE11 is an enzyme found in human prostate, testes, skeletal muscle and in other tissues. In vitro , tadalafil inhibits human recombinant PDE11A1 and, to a lesser degree, PDE11A4 activities at concentrations within the therapeutic range. The physiological role and clinical consequence of PDE11 inhibition in humans have not been defined.
12.2Pharmacodynamics Effects on Blood Pressure When Administered with Nitrates In clinical pharmacology studies, tadalafil (5 to 20 mg) was shown to potentiate the hypotensive effect of nitrates. Do not use tadalafil tablets in patients taking any form of nitrates [see Contraindications ( 4.1 )] . A double-blind, placebo-controlled, crossover study in 150 male subjects at least 40 years of age (including subjects with diabetes mellitus and/or controlled hypertension) assessed the interaction between nitroglycerin and tadalafil.
Subjects received daily doses of tadalafil 20 mg or matching placebo for 7 days and then were given a single dose of 0.4 mg sublingual nitroglycerin (NTG) at pre-specified timepoints following their last dose of tadalafil (2, 4, 8, 24, 48, 72, and 96 hours after tadalafil). A significant interaction between tadalafil and NTG was observed at each timepoint up to and including 24 hours. At 48 hours, by most hemodynamic measures, the interaction between tadalafil and NTG was not observed, although a few more tadalafil subjects compared to placebo experienced greater blood-pressure lowering effects at this timepoint.
After 48 hours, the interaction was not detectable. [See Contraindications ( 4.1 )] . Effects on Blood Pressure The effects of tadalafil on blood pressure alone and administered with antihypertensives, alcohol, and alpha-blockers is shown in Figure 1. a In some subjects, postural dizziness and orthostatic hypotension were observed. When tadalafil was administered with lower doses of alcohol (0.6 g/kg), hypotension was not observed, and dizziness occurred at a similar frequency to alcohol alone. b In studies of tadalafil co-administration with doxazosin, the number of subjects with potentially clinically significant standing blood pressure decreases was greater for the combination.
Some patients had symptoms associated with the decrease in…
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING
16.1How Supplied Tadalafil Tablets,USP are supplied as follows: 20 mg pale orange, film-coated, almond-shaped tablets (not scored), debossed with “990” Bottles of 60 NDC 43547-990-06 Bottles of 500 NDC 43547-990-50
16.2Storage Store at 20 o C to 25 o C (68 o F to 77 o F); excursions permitted to 15 o C to 30 o C (59 o F to 86 o F) [see USP Controlled Room Temperature]. Keep out of reach of children.
📋 Description ▾
11 DESCRIPTION Tadalafil, an oral treatment for pulmonary arterial hypertension, is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). Tadalafil has the empirical formula C 22 H 19 N 3 O 4 representing a molecular weight of 389.41. The structural formula is: The chemical designation is pyrazino[1´,2´:1,6]pyrido[3,4-b]indole-1,4-dione, 6-(1,3-benzodioxol-5-yl)2,3,6,7,12,12a-hexahydro-2-methyl-, (6R,12aR)-.
It is a crystalline solid that is practically insoluble in water and very slightly soluble in ethanol. Tadalafil tablets, USP are available as orange, film-coated, almond-shaped tablets for oral administration. Each tablet contains 20 mg of tadalafil, USP and the following inactive ingredients: croscarmellose sodium, hydroxypropyl cellulose, iron oxide yellow, iron oxide red, ferrosoferric oxide, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, talc, titanium dioxide, polyvinyl alcohol-partially hydrolyzed, macrogol/PEG 3350 and lecithin (soya). ab0f57c0-figure-01
💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION See FDA-Approved Patient Labeling (Patient Information) • Inform patients of contraindication of tadalafil tablets with any use of organic nitrates or GC stimulators. • Inform patients that tadalafil is also marketed as CIALIS for the treatment of erectile dysfunction (ED) and the signs and symptoms of benign prostatic hyperplasia (BPH). Advise patients taking tadalafil tablets not to take CIALIS or other PDE5 inhibitors. • Advise patients to seek immediate medical attention in the event of a sudden loss of vision in one or both eyes while taking tadalafil tablets.
Such an event may be a sign of NAION. Also discuss with patients that there is an increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE5 inhibitors. • Advise patients to seek prompt medical attention in the event of sudden decrease or loss of hearing while taking tadalafil tablets. These events may be accompanied by tinnitus and dizziness.
The brands listed are trademarks of their respective owners and are not trademarks of Solco Healthcare US, LLC. The makers of these brands are not affiliated with and do not endorse Solco Healthcare US, LLC. or its products. Dispense with Patient Information available at: www.solcohealthcare.com/medguide/tadalafil-tablets-1.pdf Distributed by: Solco Healthcare US, LLC Somerset, NJ 08873, USA Manufactured by: Zhejiang Huahai Pharmaceutical Co., Ltd.
Xunqiao, Linhai, Zhejiang 317024, China Revised: 04/2022 203260-02
💬 Medication Guide ▾
PATIENT INFORMATION Dispense with Patient Information available at: www.solcohealthcare.com/medguide/tadalafil-tablets-1.pdf Tadalafil Tablets (ta da’ la fil) Read this patient information before you start taking tadalafil tablets and each time you get a refill. There may be new information. This information does not take the place of talking with your healthcare provider about your medical condition or treatment.
What is the most important information I should know about tadalafil tablets? Never take tadalafil tablets with any nitrate or guanylate cyclase stimulator medicines: • Your blood pressure could drop quickly to an unsafe level • You could get dizzy, faint and even have a heart attack or stroke. Nitrates include: • Medicines that treat chest pain (angina) • Nitroglycerin in any form including tablets, patches, sprays, and ointments • Other nitrate medicines (isosorbide mononitrate or dinitrate) • Street drugs that are inhaled, called “poppers” (amyl nitrate, butyl nitrate or nitrite) Guanylate cyclase stimulators include: • Riociguat (Adempas ® ) a medicine that treats pulmonary arterial hypertension and chronic-thromboembolic pulmonary hypertension Ask your healthcare provider or pharmacist if you are not sure if you take a nitrate or guanylate cyclase stimulator medicine.
What are tadalafil tablets? Tadalafil tablets are a prescription medicine used to treat pulmonary arterial hypertension (PAH, high blood pressure in your lungs) to improve your ability to exercise. It is not known if tadalafil tablets are safe or effective in children.
Who should not take tadalafil tablets? Do not take tadalafil tablets if you • take any medicines called nitrates. • use recreational drugs called “poppers” like amyl nitrate, butyl nitrate or nitrite. • take any medicines called guanylate cyclase stimulators • are allergic to tadalafil or any other ingredient in tadalafil tablets. See “What are the ingredients in tadalafil tablets?” at the end of this leaflet.
See “What is the most important information I should know about tadalafil tablets?” What should I tell my healthcare provider before taking tadalafil tablets? Before taking tadalafil tablets, tell your healthcare provider about all of your medical conditions, including if you: • are allergic to tadalafil tablets or CIALIS or any of its ingredients. See the end of this leaflet for a complete list of ingredients in tadalafil tablets. • have pulmonary veno-occlusive disease (PVOD) • have heart problems • have low blood pressure • have liver problems • have kidney problems or get dialysis • have retinitis pigmentosa, a rare genetic eye disease • have ever had any sudden vision loss, including any damage to your optic nerve or NAION. • have ever had hearing problems such as ringing in the ears, dizziness, or loss of hearing • have a deformed penis shape or Peyronie’s disease • have had an erection that lasted more than 4 hours • have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia • are pregnant or planning to become pregnant.
Talk to your healthcare provider if you are pregnant or plan to become pregnant. • are breastfeeding or plan to breast feed. If you breastfeed while taking tadalafil, it is likely that tadalafil will passes into your breast milk. You and your healthcare provider should decide if you will take tadalafil tablets or breastfeed.
You should not do both. Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Tadalafil tablets and other medicines may affect each other.
Especially tell your healthcare provider if you take any of these medicines*: • nitrates or guanylate cyclase stimulators (see “What is the most important information I should know about tadalafil tablets?”) • alpha blockers, used to treat prostate disease and high blood pressure. Your blood pressure could suddenly drop. You could get dizzy or faint. • protease inhibitors, use…