Tadalafil Use in Ocular Myasthenia Gravis

Introduction to Tadalafil Safety

Tadalafil is generally safe for use in patients with ocular myasthenia gravis, but caution is warranted due to potential risks of worsening visual symptoms in some patients 1

The European Urology guidelines contraindicate tadalafil in patients who report sudden loss of vision due to anterior ischemic optic neuropathy after previous use of PDE5Is 1
The American College of Cardiology recommends avoiding concomitant use of tadalafil with nitrate medications due to risk of severe hypotension 2
Tadalafil should not be used in patients with cardiac disease, hypotension, poorly controlled blood pressure, recent stroke (within 6 months), or significant hepatic or renal insufficiency 1

The American Society of Clinical Oncology (ASCO) guidelines mention that medications such as β-blockers, IV magnesium, fluoroquinolones, aminoglycosides, and macrolides can worsen myasthenia gravis, but do not list PDE5Is among them 3, 4

When considering tadalafil for a patient with ocular myasthenia gravis, it is recommended to assess disease stability, review current medications, and monitor closely for worsening of ocular symptoms, cardiovascular effects, and common side effects 1
Patients should avoid taking nitroglycerin for ≥48 hours after tadalafil use due to its long half-life of 17.5 hours 2

Ocular myasthenia gravis primarily affects the extraocular muscles, causing ptosis and diplopia, and any medication that could potentially impact vision should be used with caution 5

Regular follow-up with both neurology and ophthalmology is recommended to monitor disease stability and medication effects 5