Tadalafil Use Guidelines for Elderly Patients

Hepatic Impairment Considerations

Severe hepatic impairment (Child‑Pugh class C) is a contraindication for both as‑needed and once‑daily tadalafil therapy. (American College of Cardiology) 1
Mild‑to‑moderate hepatic impairment (Child‑Pugh class A or B) permits a maximum as‑needed dose of 10 mg once daily; once‑daily dosing should be used with caution. (American College of Endocrinology & American Association of Clinical Endocrinologists) 2

Concurrent nitrate therapy (any formulation) is an absolute contraindication to tadalafil. (American College of Cardiology; American Urological Association) [1][3]
After taking tadalafil, nitrates must be avoided for at least 48 hours because of tadalafil’s ~17.5‑hour half‑life. (American College of Cardiology) 1
After sildenafil or vardenafil, nitrates must be avoided for at least 24 hours. (American College of Cardiology; American Urological Association) [1][3]

If initial therapy appears ineffective, clinicians should reassess before labeling treatment as a failure. (American Urological Association) 4
Reassessment should include confirming adequate sexual stimulation. (American Urological Association) 4
Verify that the as‑needed dose was taken approximately 1 hour before anticipated sexual activity. (American College of Endocrinology & American Association of Clinical Endocrinologists) 2
Check for potential food or drug interactions that could diminish efficacy. (American Urological Association) 4
Titrate the dose to the maximum tolerated amount before considering a switch to a different phosphodiesterase‑5 inhibitor. (American Urological Association) 4