Tadalafil 20 mg Tablet, Film Coated, 30-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 (Cialis) is used to treat erectile dysfunction (ED, impotence; inability to get or keep an erection), and the symptoms of benign prostatic hyperplasia (BPH; an enlarged prostate) which include difficulty urinating (hesitation, dribbling, weak stream, and incomplete bladder emptying), painful urination, and urinary frequency and urgency in adult men. Tadalafil (Adcirca) is used to improve the ability to exercise in people with pulmonary arterial hypertension (PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness). Ta...
Read the full MedlinePlus article ↗- 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:
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Ask a licensed pharmacist directly — free, answered by our team.
💊 What it looks like
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🧪 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 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 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 2165RE0K14
A plant-based thickener made from cellulose that helps control how quickly the medicine dissolves and releases its active ingredient. It also binds ingredients together and improves the tablet's texture and handling during manufacturing.
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UNII 9XZ8H6N6OH
A plant-based cellulose derivative used as a binder to hold tablet ingredients together, a thickener in liquids, and a coating agent to control how fast the medicine dissolves.
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UNII 36SFW2JZ0W
Hypromellose 2910 is a plant-based thickening agent derived from cellulose. In medicines, it forms a protective coating on tablets or capsules and controls how quickly the drug dissolves and releases into your body.
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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 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 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.
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UNII XHX3C3X673
Triacetin is a clear, oily liquid made from glycerin and acetic acid. It works as a plasticizer and solvent in medicines, helping soften coatings and improve how liquids mix together in formulations.
11 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 | $0.5398 | $16.19 / 30 tablets |
Where does this data come from?
🔁 Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Tadalafil 20 mg 69097-0526-03 | Cipla | 60 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 31722-0647-30 | Camber | 30 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 27241-0123-02 | Ajanta | 60 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 65862-0880-60 | Aurobindo | 60 tablets | $0.140 | AB2 | Availability likely | — |
| Alyq 20 mg 00480-9277-06 | Teva | 60 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 43547-0990-06 | Solco | 60 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 82009-0080-60 | Quallent | 60 tablets | $0.140 | AB2 | Availability likely | — |
| Tadalafil 20 mg 00480-2311-56 | Teva | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 16714-0077-01 | NorthStar | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 16729-0372-10 | Accord | 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 27241-0114-03 | Ajanta | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 31722-0646-30 | Camber | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 33342-0268-07 | Macleods | 30 tablets | $0.158 | AB1 | Availability likely | — |
| tadalafil 20 mg 35573-0463-30 | Burel | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 43547-0033-03 | Solco | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 43547-0051-03 | Solco | 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 60290-0030-01 | Umedica | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 62332-0180-30 | Alembic | 30 tablets | $0.158 | AB1 | Availability likely | — |
| Tadalafil 20 mg 69238-1349-03 | Amneal | 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 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 13668-0568-05 | Torrent | 500 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 29300-0289-01 | Unichem | 100 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 35561-0257-10 | Bostal | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 42291-0867-30 | AvKARE | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 46708-0180-30 | Alembic | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 50090-5641-00 | A-S | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 50090-7152-00 | A-S | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 51655-0063-54 | Northwind | 15 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 51655-0473-54 | Northwind | 15 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 60219-1349-03 | Amneal | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 65862-0853-05 | Aurobindo | 500 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 67184-0526-01 | Qilu | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68071-2553-03 | NuCare | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68071-3753-03 | NuCare | 30 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 68071-3777-04 | NuCare | 24 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68071-3781-02 | NuCare | 12 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68071-5186-06 | NuCare | 60 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68382-0899-01 | Zydus | 100 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 68788-4083-01 | Preferred | 15 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68788-8153-07 | Preferred | 7 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 68788-8445-03 | Preferred | 30 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 70771-1478-00 | Zydus | 1000 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 70954-0435-10 | ANI | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71205-0268-10 | Proficient | 10 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71205-0736-30 | Proficient | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71335-1255-01 | Bryant | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71335-1491-01 | Bryant | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71335-1587-01 | Bryant | 30 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 71335-2583-01 | Bryant | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71610-0567-04 | Aphena | 4 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71610-0728-04 | Aphena | 4 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 71610-0903-04 | Aphena | 4 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 71821-0009-01 | VKT | 30 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 72789-0344-15 | PD-Rx | 15 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 72789-0396-15 | PD-Rx | 15 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 72865-0108-30 | XLCare | 30 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mgthis 75834-0250-10 | NIVAGEN | 30 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 76420-0857-01 | Asclemed | 100 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 80425-0443-01 | Advanced | 7 tablets | — | AB1 | FDA listed | — |
| Tadalafil 20 mg 82804-0042-30 | Proficient | 30 tablets | — | AB1 | FDA listed | — |
| tadalafil 20 mg 82804-0112-10 | Proficient | 10 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 33342-0278-07 | Macleods | 30 tablets | — | AB2 | FDA listed | — |
| Tadalafil 20 mg 43598-0578-30 | Dr.Reddys | 30 tablets | — | AB2 | FDA listed | — |
| Tadalafil 20 mg 68180-0914-06 | Lupin | 30 tablets | — | AB2 | FDA listed | — |
| Tadalafil 20 mg 13668-0581-05 | Torrent | 500 tablets | — | — | FDA listed | — |
| Tadalafil 20 mg 70518-3931-00 | REMEDYREPACK | 12 tablets | — | AB2 | FDA listed | — |
| Adcirca 20 mg 66302-0467-60 | United | 60 tablets | — | AB2 | FDA listed | — |
| Tadalafil 20 mg 73190-0032-60 | AvKARE | 60 tablets | — | AB2 | 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 | — |
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?
📊 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 |
|---|---|---|---|---|---|
| 75834-0250-01 | 1000 TABLET, FILM COATED in 1 BOTTLE (75834-250-01) | $0.1582 / ea | $158.15 | 2020-11-02 | Active |
| 75834-0250-10 You're viewing this | 30 TABLET, FILM COATED in 1 BLISTER PACK (75834-250-10) | — | — | 2020-11-02 | Active |
| 75834-0250-30 | 30 TABLET, FILM COATED in 1 BOTTLE (75834-250-30) | $0.2714 / ea | $8.14 | 2020-11-02 | Active |
Pack size FAQ
What quantity is in NDC 75834-0250-10?
What is the difference between NDC 75834-0250-10 and NDC 75834-0250-30?
What NDC number is used to bill for this package of Tadalafil 20 mg Tablet, Film Coated?
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 tablet is a phosphodiesterase 5 (PDE5) inhibitor indicated for the treatment of: • erectile dysfunction (ED) ( 1.1 ) • the signs and symptoms of benign prostatic hyperplasia (BPH) ( 1.2 ) • ED and the signs and symptoms of BPH (ED/BPH) ( 1.3 ) If tadalafil tablets are used with finasteride to initiate BPH treatment, such use is recommended for up to 26 weeks ( 1.4 ).
1.1Erectile Dysfunction Tadalafil tablets are indicated for the treatment of erectile dysfunction (ED).
1.2Benign Prostatic Hyperplasia Tadalafil tablets are indicated for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH).
1.3Erectile Dysfunction and Benign Prostatic Hyperplasia Tadalafil tablets are indicated for the treatment of ED and the signs and symptoms of BPH (ED/BPH).
1.4Limitation of Use If tadalafil tablets are used with finasteride to initiate BPH treatment, such use is recommended for up to 26 weeks because the incremental benefit of tadalafil tablets decreases from 4 weeks until 26 weeks, and the incremental benefit of tadalafil tablets beyond 26 weeks is unknown [ see Clinical Studies ( 14.3 )].
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION Do not split Tadalafil tablets; entire dose should be taken. • Tadalafil tablets for use as needed: • ED: Starting dose: 10 mg as needed prior to sexual activity. Increase to 20 mg or decrease to 5 mg based upon efficacy/tolerability. Improves erectile function compared to placebo up to 36 hours post dose.
Not to be taken more than once per day ( 2.1 ). • Tadalafil tablets for once daily use: • ED: 2.5 mg taken once daily, without regard to timing of sexual activity. May increase to 5 mg based upon efficacy and tolerability ( 2.2 ). • BPH: 5 mg, taken at approximately the same time every day ( 2.3 ) • ED and BPH: 5 mg, taken at approximately the same time every day ( 2.3 , 2.4 ). • Tadalafil tablets may be taken without regard to food ( 2.5 ).
2.1Tadalafil tablets for Use as Needed for Erectile Dysfunction • 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. The maximum recommended dosing frequency is once per day in most patients. • Tadalafil tablets for use as needed was shown to improve erectile function compared to placebo up to 36 hours following dosing. Therefore, when advising patients on optimal use of tadalafil tablets, this should be taken into consideration.
2.2Tadalafil tablets for Once Daily Use for Erectile Dysfunction • The recommended starting dose of 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.
2.3Tadalafil tablets for Once Daily Use for Benign Prostatic Hyperplasia • The recommended dose of tadalafil tablets for once daily use is 5 mg, taken at approximately the same time every day. • When therapy for BPH is initiated with tadalafil tablets and finasteride, the recommended dose of tadalafil tablets for once daily use is 5 mg, taken at approximately the same time every day for up to 26 weeks.
2.4Tadalafil tablets for Once Daily Use for Erectile Dysfunction and Benign Prostatic Hyperplasia The recommended dose of tadalafil tablets for once daily use is 5 mg, taken at approximately the same time every day, without regard to timing of sexual activity.
2.5Use with Food Tadalafil tablets may be taken without regard to food.
2.6Use in Specific Populations Renal Impairment Tadalafil tablets for Use as Needed • Creatinine clearance 30 to 50 mL/min: A starting dose of 5 mg not more than once per day is recommended, and the maximum dose is 10 mg not more than once in every 48 hours. • Creatinine clearance less than 30 mL/min or on hemodialysis: The maximum dose is 5 mg not more than once in every 72 hours [see Warnings and Precautions ( 5.7 ) and Use in Specific Populations ( 8.7 )]. Tadalafil tablets for Once Daily Use Erectile Dysfunction • Creatinine clearance less than 30 mL/min or on hemodialysis: Tadalafil tablets for once daily use is not recommended [see Warnings and Precautions ( 5.7 ) and Use in Specific Populations ( 8.7 )].
Benign Prostatic Hyperplasia and Erectile Dysfunction/Benign Prostatic Hyperplasia • Creatinine clearance 30 to 50 mL/min: A starting dose of 2.5 mg is recommended. An increase to 5 mg may be considered based on individual response. • Creatinine clearance less than 30 mL/min or on hemodialysis: Tadalafil tablets for once daily use is not recommended [see Warnings and Precautions ( 5.7 ) and Use in Specific Populations ( 8.7 )]. Hepatic Impairment Tadalafil tablets for Use as Needed • Mild or moderate (Child Pugh Class A or B): The dose should not exceed 10 mg once per day.
The use of tadalafil tablets once per day has not been extensively evaluated in patients with hepatic impairment and therefore, caution is advised. • Severe (Child Pugh Class C): Th…
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS Four strengths of almond-shaped tablets are available in different sizes and yellow color. 2.5 mg tablets debossed with "TAD" 5 mg tablets debossed with "T5" 10 mg tablets debossed with "T10" 20 mg tablets debossed with "T20" Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg ( 3 ).
⛔ Contraindications ▾
4 CONTRAINDICATIONS • Administration of tadalafil tablets to patients using any form of organic nitrate is contraindicated. Tadalafil tablets were shown to potentiate the hypotensive effect of nitrates ( 4.1 ). • History of known serious hypersensitivity reaction to tadalafil tablets or ADCIRCA ® ( 4.2 ). • Administration with guanylate cyclase (GC) stimulators, such as, riociguat ( 4.3 ).
4.1Nitrates Administration of tadalafil tablets to patients who are using any form of organic nitrate, either regularly and/or intermittently, is contraindicated. In clinical pharmacology studies, tadalafil tablets were shown to potentiate the hypotensive effect of nitrates [ see Clinical Pharmacology ( 12.2 )].
4.2Hypersensitivity Reactions Tadalafil tablets are contraindicated in patients with a known serious hypersensitivity to tadalafil (tadalafil tablets or ADCIRCA®). Hypersensitivity reactions have been reported, including Stevens-Johnson syndrome and exfoliative dermatitis [see Adverse Reactions ( 6.2 )].
4.3Concomitant Guanylate Cyclase (GC) Stimulators Do not use tadalafil tablets in patients who are using a GC stimulator, such as riociguat. PDE5 inhibitors, including tadalafil tablets may potentiate the hypotensive effects of GC stimulators.
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS Evaluation of erectile dysfunction and BPH should include an appropriate medical assessment to identify potential underlying causes, as well as treatment options. Before prescribing tadalafil tablets, it is important to note the following: • Patients should not use tadalafil tablets if sex is inadvisable due to cardiovascular status ( 5.1 ). • Use of tadalafil tablets with alpha-blockers, antihypertensives or substantial amounts of alcohol (≥5 units) may lead to hypotension ( 5.6 , 5.9 ). Tadalafil tablets are not recommended in combination with alpha-blockers for the treatment of BPH because efficacy of the combination has not been adequately studied and because of the risk of blood pressure lowering.
Caution is advised when tadalafil tablets are used as a treatment for ED in men taking alpha-blockers ( 2.7 , 5.6 , 7.1 , 12.2 ). • Patients should seek emergency treatment if an erection lasts >4 hours. Use tadalafil tablets with caution in patients predisposed to priapism ( 5.3 ). • Patients should stop tadalafil tablets and seek medical care if a sudden loss of vision occurs in one or both eyes, which could be a sign of non-arteritic anterior ischemic optic neuropathy (NAION). Tadalafil tablets should be used with caution, and only when the anticipated benefits outweigh the risks, in patients with a history of NAION.
Patients with a “crowded” optic disc may also be at an increased risk of NAION ( 5.4 , 6.2 ). • Patients should stop tadalafil tablets and seek prompt medical attention in the event of sudden decrease or loss of hearing ( 5.5 ). • Prior to initiating treatment with tadalafil tablets for BPH, consideration should be given to other urological conditions that may cause similar symptoms ( 5.14 ).
5.1Cardiovascular Physicians should consider the cardiovascular status of their patients, since there is a degree of cardiac risk associated with sexual activity. Therefore, treatments for erectile dysfunction, including tadalafil tablets, should not be used in men for whom sexual activity is inadvisable as a result of their underlying cardiovascular status. Patients who experience symptoms upon initiation of sexual activity should be advised to refrain from further sexual activity and seek immediate medical attention.
Physicians should discuss with patients the appropriate action in the event that they experience anginal chest pain requiring nitroglycerin following intake of tadalafil tablets. In such a patient, who has taken tadalafil tablets, where nitrate administration is deemed medically necessary for a life-threatening situation, at least 48 hours should have elapsed after the last dose of tadalafil tablets before nitrate administration is considered. In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring.
Therefore, patients who experience anginal chest pain after taking tadalafil tablets should seek immediate medical attention. [see Contraindications ( 4.1 ) and Patient Counseling Information ( 17.1 )]. Patients with left ventricular outflow obstruction, (e.g., aortic stenosis and idiopathic hypertrophic subaortic stenosis) can be sensitive to the action of vasodilators, including PDE5 inhibitors. The following groups of patients with cardiovascular disease were not included in clinical safety and efficacy trials for tadalafil tablets, and therefore until further information is available, tadalafil tablets are not recommended for the following groups of patients: • myocardial infarction within the last 90 days • unstable angina or angina occurring during sexual intercourse • New York Heart Association Class 2 or greater heart failure in the last 6 months • uncontrolled arrhythmias, hypotension (<90/50 mm Hg), or uncontrolled hypertension • stroke within the last 6 months.
As with other PDE5 inhibitors, tadalafil has mild systemic vasodilatory properties that may result in transient decreases in blood pressu…
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS Most common adverse reactions (≥2%) include headache, dyspepsia, back pain, myalgia, nasal congestion, flushing, and pain in limb. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact FDA at 1-800-332-1088 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 over 9000 men during clinical trials worldwide. In trials of tadalafil tablets for once daily use, a total of 1434, 905, and 115 were treated for at least 6 months, 1 year, and 2 years, respectively.
For tadalafil tablets for use as needed, over 1300 and 1000 subjects were treated for at least 6 months and 1 year, respectively. Tadalafil tablets for Use as Needed for ED In eight primary placebo-controlled clinical studies of 12 weeks duration, mean age was 59 years (range 22 to 88) and the discontinuation rate due to adverse events in patients treated with tadalafil 10 or 20 mg was 3.1%, compared to 1.4% in placebo treated patients. When taken as recommended in the placebo-controlled clinical trials, the following adverse reactions were reported ( see Table 1) for tadalafil tablets for use as needed: Table 1: Treatment-Emergent Adverse Reactions Reported by ≥2% of Patients Treated with tadalafil tablets (10 or 20 mg) and More Frequent on Drug than Placebo in the Eight Primary Placebo-Controlled Clinical Studies (Including a Study in Patients with Diabetes) for tadalafil tablets for Use as Needed for ED Adverse Reaction Placebo (N=476) Tadalafil 5 mg (N=151) Tadalafil 10 mg (N=394) Tadalafil 20 mg (N=635) Headache 5% 11% 11% 15% Dyspepsia 1% 4% 8% 10% Back pain 3% 3% 5% 6% Myalgia 1% 1% 4% 3% Nasal congestion 1% 2% 3% 3% Flushing a 1% 2% 3% 3% Pain in limb 1% 1% 3% 3% a The term flushing includes: facial flushing and flushing Tadalafil tablets for Once Daily Use for ED In three placebo-controlled clinical trials of 12 or 24 weeks duration, mean age was 58 years (range 21 to 82) and the discontinuation rate due to adverse events in patients treated with tadalafil was 4.1%, compared to 2.8% in placebo- treated patients.
The following adverse reactions were reported ( see Table 2) in clinical trials of 12 weeks duration: Table 2: Treatment-Emergent Adverse Reactions Reported by ≥2% of Patients Treated with Tadalafil tablets for Once Daily Use (2.5 or 5 mg) and More Frequent on Drug than Placebo in the Three Primary Placebo-Controlled Phase 3 Studies of 12 weeks Treatment Duration (Including a Study in Patients with Diabetes) for Tadalafil tablets for Once Daily Use for ED Adverse Reaction Placebo (N=248) Tadalafil 2.5 mg (N=196) Tadalafil 5 mg (N=304) Headache 5% 3% 6% Dyspepsia 2% 4% 5% Nasopharyngitis 4% 4% 3% Back pain 1% 3% 3% Upper respiratory tract infection 1% 3% 3% Flushing 1% 1% 3% Myalgia 1% 2% 2% Cough 0% 4% 2% Diarrhea 0% 1% 2% Nasal congestion 0% 2% 2% Pain in extremity 0% 1% 2% Urinary tract infection 0% 2% 0% Gastroesophageal reflux disease 0% 2% 1% Abdominal pain 0% 2% 1% The following adverse reactions were reported ( see Table 3) over 24 weeks treatment duration in one placebo- controlled clinical study: Table 3: Treatment-Emergent Adverse Reactions Reported by ≥2% of Patients Treated with Tadalafil tablets for Once Daily Use (2.5 or 5 mg) and More Frequent on Drug than Placebo in One Placebo-Controlled Clinical Study of 24 WeeksTreatment Duration for tadalafil tablets for Once Daily Use for ED Adverse Reaction Placebo (N=94) Tadalafil 2.5 mg (N=96) Tadalafil 5 mg (N=97) Nasopharyngitis 5% 6% 6% Gastroenteritis 2% 3% 5% Back pain 3% 5% 2% Upper respiratory tract infection 0% 3% 4% Dyspepsia 1% 4% 1% Gastroesophageal reflux disease 0% 3% 2% Myalgia 2% 4% 1% Hypertension 0% 1% 3% Nasal congestion 0% 0% 4% Tadalafil tablets for Once Daily Use for B…
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS • Tadalafil tablets can potentiate the hypotensive effects of nitrates, alpha-blockers, antihypertensives or alcohol ( 7.1 ). • CYP3A4 inhibitors (e.g. ketoconazole, ritonavir) increase tadalafil tablets exposure ( 2.7 , 5.10 , 7.2 ) requiring dose adjustment: • Tadalafil tablets for use as needed: no more than 10 mg every 72 hours • Tadalafil tablets for once daily use: dose not to exceed 2.5 mg • CYP3A4 inducers (e.g. rifampin) decrease tadalafil tablets exposure ( 7.2 )
7.1Potential for Pharmacodynamic Interactions with Tadalafil Tablets Nitrates — Administration of tadalafil tablets to patients who are using any form of organic nitrate, is contraindicated. In clinical pharmacology studies, tadalafil tablets were shown to potentiate the hypotensive effect of nitrates. In a patient who has taken tadalafil tablets, where nitrate administration is deemed medically necessary in a life-threatening situation, at least 48 hours should elapse after the last dose of tadalafil tablets before nitrate administration is considered.
In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring [see Dosage and Administration ( 2.7 ), Contraindications ( 4.1 ), and Clinical Pharmacology ( 12.2 )]. Alpha-Blockers — Caution is advised when PDE5 inhibitors are coadministered with alpha-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, tamsulosin or alfuzosin. [see Dosage and Administration ( 2.7 ), Warnings and Precautions ( 5.6 ), and Clinical Pharmacology ( 12.2 )]. Antihypertensives — PDE5 inhibitors, including tadalafil, 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, bendrofluazide, enalapril, and metoprolol). Small reductions in blood pressure occurred following coadministration of tadalafil tablets with these agents compared with placebo. [see Warnings and Precautions ( 5.6 ) and Clinical Pharmacology ( 12.2 )]. Alcohol — 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 did not affect alcohol plasma concentrations and alcohol did not affect tadalafil plasma concentrations. [see Warnings and Precautions ( 5.9 ) and Clinical Pharmacology ( 12.2 )].
7.2Potential for Other Drugs to Affect Tadalafil Tablets [See Dosage and Administration (2.7) and Warnings and Precautions ( 5.10 )]. Antacids — Simultaneous administration of an antacid (magnesium hydroxide/aluminum hydroxide) and tadalafil reduced the apparent rate of absorption of tadalafil without altering exposure (AUC) to tadalafil. H 2 Antagonists (e.g.
Nizatidine) — An increase in gastric pH resulting from administration of nizatidine had no significant effect on pharmacokinetics. Cytochrome P450 Inhibitors — Tadalafil tablets are a substrate of and predominantly metabolized by CYP3A4. Studies have shown that drugs that inhibit CYP3A4 can increase tadalafil exposure.
CYP3A4 (e.g., Ketoconazole) — Ketoconazole (400 mg daily), a selective and potent inhibitor of CYP3A4, increased tadalafil 20 mg single-dose exposure (AUC) by 312% and C max by 22%, relative to the values for ta…
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS Hepatic Impairment ( 2.6 , 5.8 , 8.6 ): • Mild or Moderate: Dosage adjustment may be needed. • Severe: Use is not recommended. Renal Impairment ( 2.6 , 5.7 , 8.7 ): • Patients with creatinine clearance 30 to 50 mL/min: Dosage adjustment may be needed. • Patients with creatinine clearance less than 30 mL/min or on hemodialysis: For use as needed: Dose should not exceed 5 mg every 72 hours. Once daily use is not recommended.
8.1Pregnancy Risk Summary Tadalafil tablets are not indicated for use in females. There are no data with the use of tadalafil tablets in pregnant women to inform any drug-associated risks for adverse developmental 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 up to 11 times the maximum recommended human dose (MRHD) of 20 mg/day ( see Data).
Data Animal Data Animal reproduction studies showed no evidence of teratogenicity, embryotoxicity, or fetotoxicity when tadalafil was given orally to pregnant rats or mice at exposures up to 11 times the maximum recommended human dose (MRHD) of 20 mg/day during organogenesis. In a pernatal/postnatal developmental studies in rats, postnatal pup survival decreased following maternal exposure to tadalafil doses greater than 10 times the MRHD based on AUC. Signs of maternal toxicity occurred at doses greater than 16 times the MRHD based on AUC.
Surviving offspring had normal development and reproductive performance. In another rat prenatal and postnatal development study at doses of 60, 200, and 1000 mg/kg, a reduction in postnatal survival of pups was observed. The no observed effect level (NOEL) for maternal toxicity was 200 mg/kg/day and for developmental toxicity was 30 mg/kg/day.
This gives approximately 16 and 10 fold exposure multiples, respectively, of the human AUC for the MRHD of 20 mg. Tadalafil and/or its metabolites cross the placenta, resulting in fetal exposure in rats.
8.2Lactation Risk Summary Tadalafil tablets are not indicated for use in females. There is no information on the presence of tadalafil and/or 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-fold greater than found in the plasma.
8.3Females and Males of Reproductive Potential Infertility 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 [see Clinical Pharmacology ( 12.2 )]. Based on studies in animals, a decrease in spermatogenesis was observed in dogs, but not in rats [see Nonclinical Toxicology ( 13.1 )].
8.4Pediatric Use Tadalafil tablets are not indicated for use in pediatric patients. Safety and efficacy in patients below the age of 18 years have not been established. A randomized, double-blind, placebo-controlled trial in pediatric patients (7 to 14 years of age) with Duchenne muscular dystrophy, who received tadalafil tablets 0.3 mg/kg, tadalafil tablets 0.6 mg/kg, or placebo daily for 48 weeks failed to demonstrate any benefit of treatment with tadalafil tablets on a range of assessments of muscle strength and performance.
Juvenile Animal Study No adverse effects were observed in a study in which tadalafil was administered orally at doses of 60, 200, and 1000 mg/kg/day to juvenile rats on postnatal days 14 to 90. The highest plasma tad…
🤰 Pregnancy ▾
8.1Pregnancy Risk Summary Tadalafil tablets are not indicated for use in females. There are no data with the use of tadalafil tablets in pregnant women to inform any drug-associated risks for adverse developmental 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 up to 11 times the maximum recommended human dose (MRHD) of 20 mg/day ( see Data).
Data Animal Data Animal reproduction studies showed no evidence of teratogenicity, embryotoxicity, or fetotoxicity when tadalafil was given orally to pregnant rats or mice at exposures up to 11 times the maximum recommended human dose (MRHD) of 20 mg/day during organogenesis. In a pernatal/postnatal developmental studies in rats, postnatal pup survival decreased following maternal exposure to tadalafil doses greater than 10 times the MRHD based on AUC. Signs of maternal toxicity occurred at doses greater than 16 times the MRHD based on AUC.
Surviving offspring had normal development and reproductive performance. In another rat prenatal and postnatal development study at doses of 60, 200, and 1000 mg/kg, a reduction in postnatal survival of pups was observed. The no observed effect level (NOEL) for maternal toxicity was 200 mg/kg/day and for developmental toxicity was 30 mg/kg/day.
This gives approximately 16 and 10 fold exposure multiples, respectively, of the human AUC for the MRHD of 20 mg. Tadalafil and/or its metabolites cross the placenta, resulting in fetal exposure in rats.
🧒 Pediatric Use ▾
8.4Pediatric Use Tadalafil tablets are not indicated for use in pediatric patients. Safety and efficacy in patients below the age of 18 years have not been established. A randomized, double-blind, placebo-controlled trial in pediatric patients (7 to 14 years of age) with Duchenne muscular dystrophy, who received tadalafil tablets 0.3 mg/kg, tadalafil tablets 0.6 mg/kg, or placebo daily for 48 weeks failed to demonstrate any benefit of treatment with tadalafil tablets on a range of assessments of muscle strength and performance.
Juvenile Animal Study No adverse effects were observed in a study in which tadalafil was administered orally at doses of 60, 200, and 1000 mg/kg/day to juvenile rats on postnatal days 14 to 90. The highest plasma tadalafil exposures (AUC) achieved were approximately 10-fold that observed at the MRHD.
🧓 Geriatric Use ▾
8.5Geriatric Use Of the total number of subjects in ED clinical studies of tadalafil, approximately 19 percent were 65 and over, while approximately 2 percent were 75 and over. Of the total number of subjects in BPH clinical studies of tadalafil (including the ED/BPH study), approximately 40 percent were over 65, while approximately 10 percent were 75 and over. In these clinical trials, no overall differences in efficacy or safety were observed between older (>65 and ≥75 years of age) and younger subjects (≤65 years of age).
However, in placebo-controlled studies with tadalafil tablets for use as needed for ED, diarrhea was reported more frequently in patients 65 years of age and older who were treated with tadalafil tablets (2.5% of patients) [see Adverse Reactions ( 6.1 )] . No dose adjustment is warranted based on age alone. However, a greater sensitivity to medications in some older individuals should be considered. [see Clinical Pharmacology ( 12.3 )].
🆘 Overdosage ▾
10 OVERDOSAGE Single doses up to 500 mg have been given to healthy subjects, and multiple daily doses up to 100 mg have been given to patients. Adverse events were similar to those seen at lower doses. In cases of overdose, standard supportive measures should be adopted as required. Hemodialysis contributes negligibly to tadalafil elimination.
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action Penile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and corpus cavernosal smooth muscle. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cGMP in smooth muscle cells. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum.
The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP. Tadalafil inhibits PDE5. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 by tadalafil has no effect in the absence of sexual stimulation.
The effect of PDE5 inhibition on cGMP concentration in the corpus cavernosum and pulmonary arteries is also observed in the smooth muscle of the prostate, the bladder and their vascular supply. The mechanism for reducing BPH symptoms has not been established. Studies in vitro have demonstrated that tadalafil is a selective inhibitor of PDE5.
PDE5 is found in the smooth muscle of the corpus cavernosum, prostate, and bladder as well as in vascular and visceral smooth muscle, skeletal muscle, urethra, platelets, kidney, lung, cerebellum, heart, liver, testis, seminal vesicle, 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 >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 >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 >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 (e.g., adrenal cortex). 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 Tadalafil 20 mg administered to healthy male subjects produced no significant difference compared to placebo in supine systolic and diastolic blood pressure (difference in the mean maximal decrease of 1.6/0.8 mm Hg, respectively) and in standing systolic and diastolic blood pressure (difference in the mean maximal decrease of 0.2/4.6 mm Hg, respectively). In addition, there was no significant effect on heart rate. 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.
Therefore, the use of tadalafil tablets in patients taking any form of nitrates is contraindicated [see Contraindications ( 4.1 )]. A study was conducted to assess the degree of interaction between nitroglycerin and tadalafil, should nitroglycerin be required in an emergency situation after tadalafil was taken. This was 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) and receiving daily doses of tadalafil 20 mg or matching placebo for 7 days.
Subjects were administered 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). The objective…
🧬 Mechanism of Action ▾
12.1Mechanism of Action Penile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and corpus cavernosal smooth muscle. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cGMP in smooth muscle cells. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum.
The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP. Tadalafil inhibits PDE5. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 by tadalafil has no effect in the absence of sexual stimulation.
The effect of PDE5 inhibition on cGMP concentration in the corpus cavernosum and pulmonary arteries is also observed in the smooth muscle of the prostate, the bladder and their vascular supply. The mechanism for reducing BPH symptoms has not been established. Studies in vitro have demonstrated that tadalafil is a selective inhibitor of PDE5.
PDE5 is found in the smooth muscle of the corpus cavernosum, prostate, and bladder as well as in vascular and visceral smooth muscle, skeletal muscle, urethra, platelets, kidney, lung, cerebellum, heart, liver, testis, seminal vesicle, 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 >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 >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 >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 (e.g., adrenal cortex). 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.
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING
16.1How Supplied Tadalafil tablets USP are supplied as follows: Four strengths of almond-shaped tablets are available in yellow color and different sizes, and supplied in the following package sizes: 2.5 mg tablets debossed with “TAD” Bottle of 30 with child-resistant closure, NDC 75834-247-30 Bottle of 1000 NDC 75834-247-01 Blisters of 2 x 15 NDC 75834-247-15 5 mg tablets debossed with “T5” Bottle of 30 with child-resistant closure, NDC 75834-248-30 Bottle of 1000 NDC 75834-248-01 Blisters of 2 x 15 NDC 75834-248-15 10 mg tablets debossed with “T10” Bottle of 30 with child-resistant closure, NDC 75834-249-30 Bottle of 1000 NDC 75834-249-01 Blisters of 3 x 10 NDC 75834-249-10 20 mg tablets debossed with “T20” Bottle of 30 with child-resistant closure, NDC 75834-250-30 Bottle of 1000 NDC 75834-250-01 Blisters of 3 x 10 � NDC 75834-250-10
16.2Storage Store at 25°C (77°F); excursions permitted between 15° to 30°C (59° to 86°F) [see USP Controlled Room Temperature]. Bottle of 30s package is child resistant. Keep out of reach of children.
📋 Description ▾
11 DESCRIPTION Tadalafil 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 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 white or almost white powder, freely soluble in dimethylsulphoxide, slightly soluble in methylene chloride and practically insoluble in water.
Tadalafil tablets, USP are available as almond-shaped tablets for oral administration. Each tablet contains 2.5, 5, 10, or 20 mg of tadalafil and the following inactive ingredients: low substituted hydroxypropyl cellulose, hydroxypropyl cellulose, hypromellose, yellow iron oxide, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, talc, titanium dioxide, and triacetin. tadalafil-structure
💬 Information for Patients ▾
17 PAITENT COUNSELLING INFORMATION “See FDA-approved patient labeling (Patient Information)”
17.1Nitrates Physicians should discuss with patients the contraindication of tadalafil tablets with regular and/or intermittent use of organic nitrates. Patients should be counseled that concomitant use of tadalafil tablets with nitrates could cause blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope, or even heart attack or stroke. Physicians should discuss with patients the appropriate action in the event that they experience anginal chest pain requiring nitroglycerin following intake of tadalafil tablets.
In such a patient, who has taken tadalafil tablets, where nitrate administration is deemed medically necessary for a life-threatening situation, at least 48 hours should have elapsed after the last dose of tadalafil tablets before nitrate administration is considered. In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring. Therefore, patients who experience anginal chest pain after taking tadalafil tablets should seek immediate medical attention [see Contraindications ( 4.1 ) and Warnings and Precautions ( 5.1 )].
17.2Guanylate Cyclase (GC) Stimulators Physicians should discuss with patients the contraindication of tadalafil tablets with any use of a GC stimulator, such as riociguat, for pulmonary arterial hypertension. Patients should be counseled that the concomitant use of tadalafil tablets with GC stimulators may cause blood pressure to drop to an unsafe level.
17.3Cardiovascular Considerations Physicians should consider the potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease. Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention [see Warnings and Precautions ( 5.1 )].
17.4Concomitant Use with Drugs Which Lower Blood Pressure Physicians should discuss with patients the potential for tadalafil tablets to augment the blood-pressure-lowering effect of alpha-blockers, and antihypertensive medications [see Warnings and Precautions ( 5.6 ), Drug Interactions ( 7.1 ), and Clinical Pharmacology ( 12.2 )].
17.5Potential for Drug Interactions When Taking tadalafil tablets for Once Daily Use Physicians should discuss with patients the clinical implications of continuous exposure to tadalafil when prescribing tadalafil tablets for once daily use, especially the potential for interactions with medications (e.g., nitrates, alphablockers, antihypertensives and potent inhibitors of cytochrome P450 3A4) and with substantial consumption of alcohol. [see Dosage and Administration ( 2.7 ), Warnings and Precautions ( 5.6 ), Drug Interactions ( 7.1 , 7.2 ), Clinical Pharmacology ( 12.2 ), and Clinical Studies ( 14.2 )].
17.6Priapism There have been rare reports of prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours in duration) for this class of compounds. Priapism, if not treated promptly, can result in irreversible damage to the erectile tissue. Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention.
17.7Sudden Loss of Vision Physicians should advise patients to stop use of all PDE5 inhibitors, including tadalafil tablets, and seek medical attention in the event of a sudden loss of vision in one or both eyes. Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision, including possible permanent loss of vision, that has been reported rarely postmarketing in temporal association with the use of all PDE5 inhibitors. Physicians should discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye.
Physicians should also discuss with patients…