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Indications pulmonary arterial hypertension; erectile dysfunction (section 7.4.5) Cautions hypotension (avoid if systolic blood pressure below 90 mmHg); aortic and mitral valve disease; pericardial constriction; congestive cardiomyopathy; left ventricular dysfunction; life-threatening arrhythmias; coronary artery disease; uncontrolled hypertension; pulmonary veno-occlusive disease; predisposition to priapism; anatomical deformation of the penis; hereditary degenerative retinal disorders; interactions: Appendix 1 (tadalafil) Contra-indications acute myocardial infarction in past 90 days; history of non-arteritic anterior ischaemic optic neuropathy; avoid concomitant use of nitrates

Hepatic impairment initially 20 mg once daily in mild to moderate impairment; avoid in severe impairment Renal impairment initially 20 mg once daily in mild to moderate impairment, increased to 40 mg once daily if tolerated; avoid in severe impairment Pregnancy manufacturer advises avoid Breast-feeding manufacturer advises avoid—present in milk in animal studies Side-effects nausea, vomiting, dyspepsia, gastro-oesophageal reflux, chest pain, palpitation, flushing, hypotension, nasopharyngitis, epistaxis, headache, myalgia, back and limb pain, increased uterine bleeding, blurred vision, facial oedema, rash; less commonly tachycardia, hypertension, seizures, amnesia, priapism, hyperhidrosis; also reported unstable angina, arrhythmia, myocardial infarction, stroke, hearing loss, non-arteritic anterior ischaemic optic neuropathy, retinal vascular occlusion, visual field defect, Stevens-Johnson syndrome Dose

• ADULT over 18 years, 40 mg once daily Adcirca® (Lilly) T A

Tablets, f/c, tadalafil 20 mg (orange), net price 56-tab pack = £491.22

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