Tadalafil Use in Glaucoma Patients

Contraindications and Precautions

The European Association of Urology guidelines specify that tadalafil is contraindicated only in patients who have experienced sudden vision loss due to anterior ischemic optic neuropathy after previous PDE5 inhibitor use, with a particular concern for those at high risk for acute angle-closure glaucoma 1, 2.
Patients at high risk for acute angle-closure glaucoma should not use tadalafil due to potential vasodilatory effects that could precipitate an acute attack, with risk factors including Asian ethnicity and older age 1, 3, 4.

Tadalafil has a long half-life of 17.5 hours and prolonged presence in the body, necessitating careful follow-up monitoring, especially for patients taking it long-term at higher doses or those with pre-existing glaucoma risk factors 5.

The European Association of Urology and diabetes management guidelines emphasize the importance of distinguishing between open-angle and angle-closure glaucoma when assessing contraindications for tadalafil use, with open-angle glaucoma being considered safe and angle-closure glaucoma being a contraindication 1, 2, 3, 4.
It is crucial not to confuse the absolute contraindication with nitrates, which causes life-threatening hypotension, with the relative caution needed for glaucoma, as the nitrate interaction requires a 48-hour washout period 1, 2, 5.