- Stock: In Stock
- Brand: Beximco Pharmaceutical
- Product ID: Tadalafil
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Adafil 20mg Tablet — Tadalafil
Generic Name: Tadalafil 20mg
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 GMP (cGMP) in penile smooth muscle. During sexual stimulation, nitric oxide activates guanylate cyclase, increasing cGMP which relaxes smooth muscle and increases penile blood flow, enabling erection. By inhibiting PDE5, tadalafil prolongs cGMP activity and enhances erectile function. Sexual stimulation is required — tadalafil does not produce spontaneous erections.
20mg is the maximum approved as-needed dose of tadalafil. It provides the most potent single-dose effect with the same extended duration (up to 36 hours) that distinguishes tadalafil from all other PDE5 inhibitors.
Erectile Dysfunction and Diabetes
Erectile dysfunction (ED) is among the most prevalent complications of diabetes, affecting up to 75% of diabetic men, often occurring earlier and with greater severity than in non-diabetic men. Diabetic ED is driven by autonomic neuropathy (impaired NO release), endothelial dysfunction, and microvascular disease of penile arteries. Tadalafil 20mg provides the strongest as-needed PDE5 inhibition available, making it particularly effective in patients with moderate-to-severe diabetic ED or those who found 10mg insufficient.
Indications
- Erectile dysfunction in adult men — including moderate-to-severe diabetic ED
- Patients who did not achieve adequate response on Tadalafil 10mg
- Pulmonary arterial hypertension (PAH) — standard dose for PAH indication
Dosage and Administration
| Use | Dose | Notes |
|---|---|---|
| ED — as-needed (maximum) | 20mg taken at least 30 min before sexual activity | Maximum as-needed dose — do not exceed |
| Frequency | Not more than once per 24 hours | Effect lasts up to 36 hours |
| Mild-moderate renal impairment (CrCl 31–80) | Use with caution; not more than once per 48 hr | Dose reduction may be needed |
| Severe renal impairment / Dialysis | Maximum 10mg; not recommended for once-daily use | Common in diabetic nephropathy — caution |
| Strong CYP3A4 inhibitors (ritonavir, ketoconazole) | Maximum single dose 10mg per 72 hr | Drug interaction dose cap |
Take with or without food. Do not take more than one tablet in 24 hours. Effect begins within 30–60 minutes and can last up to 36 hours.
Critical Warning — Nitrate Interaction (Absolute Contraindication)
NEVER combine tadalafil with nitrates in any form. This combination causes severe, potentially fatal hypotension due to synergistic cGMP-mediated vasodilation.
Nitrates include: Isosorbide mononitrate, isosorbide dinitrate, glyceryl trinitrate (GTN/nitroglycerin) — oral, sublingual, transdermal, or spray; amyl nitrite ("poppers").
Emergency protocol: If a patient on tadalafil 20mg presents with cardiac chest pain, inform emergency responders — nitrates must not be administered for at least 48 hours after the last tadalafil dose. Alternative pain management must be used.
Contraindications
- Nitrates in any form — absolute contraindication
- Guanylate cyclase stimulators (e.g. riociguat)
- Unstable angina, recent MI (<90 days), stroke (<6 months), severe heart failure, uncontrolled hypertension or hypotension
- Severe hepatic impairment (Child-Pugh C)
- Previous NAION (non-arteritic anterior ischaemic optic neuropathy)
- Hypersensitivity to tadalafil
Drug Interactions
| Drug / Class | Interaction |
|---|---|
| Nitrates (all forms) | Absolutely contraindicated — fatal hypotension |
| Alpha-blockers | Additive hypotension — caution; start at lowest tadalafil dose |
| CYP3A4 inhibitors (ritonavir, ketoconazole, clarithromycin) | Increase tadalafil levels — reduce to max 10mg per 72 hr |
| CYP3A4 inducers (rifampicin, carbamazepine) | Reduce tadalafil levels — reduced efficacy |
| Antihypertensives | Additive BP lowering — important in diabetic patients on multiple BP agents |
| Alcohol | Potentiates hypotension and dizziness — avoid excessive use |
Side Effects
| System | Side Effects | Frequency |
|---|---|---|
| Head/neck | Headache, flushing | Very common at 20mg |
| GI | Dyspepsia, nausea | Common |
| MSK | Back pain and myalgia (dose-related — more common at 20mg) | Common |
| Nasal | Nasal congestion | Common |
| Cardiovascular | Hypotension, palpitations | Uncommon |
| Vision | Blurred vision, transient colour tinge (rare) | Rare |
| Urological | Priapism — erection >4 hours (medical emergency) | Very rare |
Special Considerations in Diabetes
- Autonomic neuropathy increases hypotension risk — start with 10mg and titrate
- Assess cardiovascular status before prescribing — sexual activity requires exertion equivalent to climbing 2 flights of stairs
- Optimise glycaemic control first — hyperglycaemia worsens endothelial dysfunction and reduces PDE5 inhibitor response
- Diabetic nephropathy: renal dose adjustment required (see dosage table above)
- Tadalafil is metabolically neutral — no effect on blood glucose or HbA1c
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 20mg (Tadalafil) must only be used under the supervision of a qualified physician. Absolutely contraindicated with nitrates — life-threatening hypotension risk. Seek immediate medical attention for chest pain, sudden vision or hearing loss, or erection lasting more than 4 hours. DiabetesStore.com.bd does not endorse self-medication.
