- Stock: In Stock
- Brand: Beximco Pharmaceutical
- Product ID: Tadalafil
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Adafil 10mg Tablet — Tadalafil
Generic Name: Tadalafil 10mg
Manufacturer: Beximco Pharmaceuticals Ltd.
Drug Class: Phosphodiesterase Type 5 (PDE5) Inhibitor
Dosage Form: Tablet
Prescription Status: Prescription Only (Rx)
Mechanism of Action
Tadalafil selectively inhibits phosphodiesterase type 5 (PDE5), the enzyme responsible for degradation of cyclic guanosine monophosphate (cGMP) in penile smooth muscle. During sexual stimulation, nitric oxide (NO) is released, activating guanylate cyclase and increasing cGMP, which relaxes smooth muscle and increases blood flow to the corpus cavernosum, facilitating erection. By inhibiting PDE5, tadalafil prolongs cGMP activity and enhances erectile function. Tadalafil requires sexual stimulation to work — it does not cause spontaneous erections.
Tadalafil also inhibits PDE5 in pulmonary vascular smooth muscle, making it effective in pulmonary arterial hypertension (PAH).
Erectile Dysfunction and Diabetes
Erectile dysfunction (ED) affects up to 75% of men with Type 2 Diabetes and is often an early marker of cardiovascular disease. The pathophysiology involves diabetic autonomic neuropathy (reduced NO synthesis), endothelial dysfunction, and microvascular disease. Tadalafil is highly effective in diabetic ED and has the longest duration of action (up to 36 hours) among PDE5 inhibitors, offering spontaneity and flexibility not available with shorter-acting agents.
Indications
- Erectile dysfunction (ED) in adult men — including ED associated with Type 2 Diabetes
- Benign prostatic hyperplasia (BPH) — at 5mg once daily
- Pulmonary arterial hypertension (PAH) — at 40mg once daily (different formulation/indication)
Dosage and Administration
| Use | Dose | Notes |
|---|---|---|
| ED — as-needed (standard) | 10mg taken 30 min before sexual activity | May increase to 20mg or decrease to 5mg |
| ED — as-needed (higher dose) | 20mg taken 30 min before sexual activity | If 10mg insufficient; maximum as-needed dose |
| ED — once daily (low-dose) | 2.5–5mg once daily at the same time | For men who anticipate frequent sexual activity; allows spontaneity |
| Renal impairment (CrCl 31–80 ml/min) | Max 10mg; not more than once in 48 hr | Common in diabetic nephropathy |
| Severe renal impairment (CrCl <30) / Dialysis | Max 5mg; once daily dosing not recommended | Use with caution |
Take with or without food. Effect begins within 30 minutes and can last up to 36 hours — do not take more than once per day.
Critical Warning — Nitrate Interaction
Tadalafil is absolutely contraindicated with nitrates in any form. Combination causes severe, potentially fatal hypotension. Nitrates include:
- Isosorbide mononitrate / dinitrate (oral, sublingual, transdermal)
- Glyceryl trinitrate (GTN) — including sublingual spray used in angina
- Amyl nitrite ("poppers")
Emergency note: If a patient on tadalafil presents with chest pain, notify emergency services that the patient has taken tadalafil — nitrates must not be given for at least 48 hours.
Contraindications
- Concurrent use with nitrates (any form) — absolute contraindication
- Concurrent use with guanylate cyclase stimulators (e.g. riociguat)
- Severe cardiovascular disease (unstable angina, recent MI within 90 days, severe heart failure, uncontrolled arrhythmia)
- Hypotension (BP <90/50 mmHg)
- Severe hepatic impairment (Child-Pugh C)
- Prior non-arteritic anterior ischaemic optic neuropathy (NAION)
- Hypersensitivity to tadalafil or any ingredient
Drug Interactions
| Drug / Class | Interaction |
|---|---|
| Nitrates (all forms) | Absolutely contraindicated — fatal hypotension |
| Alpha-blockers (tamsulosin, doxazosin) | Additive hypotension — start at lowest tadalafil dose; separate doses |
| Strong CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin) | Increase tadalafil plasma levels — max 10mg per 72 hr |
| CYP3A4 inducers (rifampicin, carbamazepine, phenytoin) | Reduce tadalafil levels — reduced efficacy |
| Antihypertensives (ARBs, ACE inhibitors, calcium channel blockers) | Additive BP lowering — clinically significant in diabetic patients on multiple antihypertensives |
| Alcohol | Additive hypotension and dizziness — avoid excessive alcohol |
Side Effects
| System | Side Effects | Frequency |
|---|---|---|
| Head/neck | Headache, flushing | Common |
| GI | Dyspepsia, nausea, back pain | Common |
| MSK | Back pain, myalgia (especially at 20mg) | Common |
| Nasal | Nasal congestion | Common |
| Cardiovascular | Hypotension, palpitations | Uncommon |
| Vision | Blurred vision, colour disturbance (rare) | Rare |
| Urological | Priapism (prolonged painful erection >4 hours — medical emergency) | Very rare |
Special Considerations in Diabetes
- Diabetic autonomic neuropathy may exacerbate hypotension with tadalafil + antihypertensives
- Assess cardiovascular fitness before prescribing — sexual activity has a metabolic cost equivalent to mild-moderate exercise
- Rule out reversible causes of ED first: optimise glycaemic control, blood pressure, testosterone, and review medications (beta-blockers, diuretics, antidepressants can contribute to ED)
- Tadalafil does not affect blood glucose levels
Storage
Store below 30°C. Protect from moisture and direct sunlight. Keep out of reach of children.
Medical Disclaimer
The information provided here is for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Adafil (Tadalafil 10mg) must only be used under the supervision of a qualified physician. Never combine with nitrates — risk of fatal hypotension. Seek immediate medical attention for chest pain, sudden vision/hearing loss, or prolonged erection (>4 hours). DiabetesStore.com.bd does not endorse self-medication.
