Tadalafil for Bladder Relaxation in Patients with Lower Urinary Tract Symptoms
Clinical Evidence and Recommendations
- The American Urological Association recommends 5 mg daily tadalafil as a treatment option for patients with LUTS/BPH, regardless of comorbid erectile dysfunction, with a moderate recommendation and Grade B evidence level 1
- Tadalafil resulted in a mean change of -5.4 points in IPSS compared to -3.6 points with placebo, with a difference of -1.74 points, in patients with LUTS/BPH 1
Dosing and Safety Considerations
- The recommended dose for BPH treatment is consistently 5 mg once daily 2
- Clinicians should not offer the combination of low-dose daily 5 mg tadalafil with alpha blockers for LUTS/BPH as it offers no advantages in symptom improvement over either agent alone, and is not recommended due to higher side effect risk 3
- The primary contraindication for tadalafil is concomitant use with nitrate medications, which can cause severe hypotension 5
- Most common adverse effects include headache, flushing, rhinitis, and dyspepsia 2
- Cardiovascular risk assessment should be performed before prescribing tadalafil 5