Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (379 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(tah-dal′a-fil)
Adcirca, Cialis
Func. class.:
Impotence agent
Chem. class.:
Phosphodiesterase type 5 inhibitor
Inhibits phosphodiesterase type 5 (PDE5); enhances erectile function by increasing the amount of cGMP, which causes smooth muscle relaxation and increased blood flow into the corpus cavernosum; improves erectile function for up to 36 hr
Treatment of erectile dysfunction, benign prostatic hyperplasia (BPH) with or without erectile dysfunction pulmonary arterial hypertension (PAH) (Adcirca only)
Unlabeled uses:
Sexual dysfunction in males receiving antidepressants
Newborns, children, women, hypersensitivity, patients taking organic nitrates either regularly and/or intermittently, patients taking any α-adrenergic antagonist other than 0.4 mg once-daily tamsulosin
Precautions:
Pregnancy (B) although not indicated for females, anatomic penile deformities, sickle cell anemia, leukemia, multiple myeloma, CV/renal/hepatic disease, bleeding disorders, active peptic ulcer, prolonged erection
Calculator
• Adult:
PO
(Cialis) 10 mg taken before sexual activity, dose may be reduced to 5 mg or increased to max 20 mg; usual max dosing frequency is 1×/day; once-daily dosing 2.5 mg/day at same time each day
• Adult:
PO
5 mg bid at the same time every day
• Adult:
PO
CCr 51-80 ml/min: no adjustment for erectile dysfunction, 20 mg/day initially for pulmonary hypertension; CCr 31-50 ml/min, 5 mg/day, max 10 mg q48hr; CCr <30 ml/min, max 5 mg q72hr
• Adult:
PO
(Child-Pugh A, B) max 10 mg/day or 20 mg/day, (pulmonary hypertension) max 40 mg/day; (Child-Pugh C) not recommended
•
Ketoconazole, itraconazole, ritonavir, max 10 mg q72hr
• Adult:
PO (Adcirca only)
40 mg daily
• Adult taking ritonavir:
PO
20 mg daily initially then increase to 40 mg daily as tolerated
• Adult:
PO
(Cialis) 10-20 mg before sexual activity
Available forms:
Tabs 2.5, 5, 10, 20 mg; PO tab (Adcirca) 20 mg
•
Product should not be used with nitrates in any form
•
Sexual dysfunction:
give before sexual activity; do not use more than 1×/day
•
Pulmonary hypertension:
give Adcirca with/without meals
CNS:
Headache, flushing, dizziness
,
seizures,
transient global amnesia
CV:
Hypotension,
QT prolongation
INTEG:
Stevens-Johnson syndrome, exfoliative dermatitis,
urticaria
MISC:
Back pain/myalgia,
dyspepsia, nasal congestion, UTI
, blurred vision, changes in color vision,
diarrhea
, pruritus, priapism,
nonarteritic ischemic optic neuropathy (NAION),
hearing loss
Rapidly absorbed; metabolized by liver by CYP3A4; terminal half-life 17.5 hr; peak 1/2-6 hr; excreted primarily as metabolites in feces, urine; excreted 61% in feces, 36% in urine; 94% protein bound; rate and extent of absorption not influenced by food
Do not use with nitrates because of unsafe drop in B/P, which could result in MI or stroke
Increase:
tadalafil levels—itraconazole, ketoconazole, ritonavir (although not studied, may also include other HIV protease inhibitors)
Decrease:
B/P—alcohol, α-blockers, amLODIPine, angiotensin II receptor blockers, enalapril
Decrease:
effects of tadalafil—bosentan, antacids
Increase:
tadalafil effect—grapefruit
•
Cialis:
underlying cause of erectile dysfunction before treatment; use of organic nitrates that should not be used with this product; any severe loss of vision while taking this or any similar products
•
Adcirca:
hemodynamic parameters at baseline and periodically
•
Therapeutic response: ability to engage in sexual intercourse, improvement in exercise ability in pulmonary hypertension
•
To take 1 hr before sexual activity
•
Not to drink large amounts of alcohol
•
That product does not protect against sexually transmitted diseases, including HIV
•
That product has no effect in the absence of sexual stimulation; to seek medical help if erection lasts >4 hr
•
To tell physician about all medicines, vitamins, herbs being taken, especially ritonavir, indinavir, ketoconozole, itraconazole, erythromycin, nitrates, α-blockers; that tadalafil is contraindicated for use with α-blockers except 0.4 mg/day tamsulosin
To notify prescriber immediately and to stop taking product if vision, hearing loss occur or if erection lasts >4 hr or if chest pain occurs
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ta-mox′i-fen)
Apo-Tamox
, Nolvadex, Tamofen
Func. class.:
Antineoplastic
Chem. class.:
Antiestrogen hormone