Last Updated on June 15, 2020 by Douglas C. Goldberg, MD

Tadalafil, which is the main component of Cialis, is used not only for treating male impotence but also for some other health conditions. PAH is one of them.

What is Pulmonary Arterial Hypertension?

Pulmonary arterial hypertension (PAH) is a chronic condition featuring increased resistance in the pulmonary vessels, as well as increased arterial pulmonary pressure. It is worth noting that in recent years, the treatment methods of this disease have significantly improved. Moreover, these methods have become more accessible.

However, specialists are faced with numerous difficulties in the treatment of PAH. This disease is hard to treat, cause severe discomfort to individuals, and ultimately is beyond cure. Patients with PAH experience significant increase in the lung vessels’ resistance and elevated pulmonary arterial pressure due to the impairment of the process of blood flow in the lungs. Ultimately, fibrosis of the pulmonary vasculature and even heart failure (in the right ventricle) may occur.

Pulmonary Arterial Hypertension

Symptoms and Types of PAH

In most cases, patients suffering from PAH complain of shortness of breath even when doing slight physical activity. In addition, the disease is characterized by the following symptoms: fatigue, angina pectoris, weakness, syncope, swelling of the lower extremities, and accelerated heartbeat.

PAH is classified according to the severity of the symptoms, as well as the level of physical activity of the patient.

The classification, formed according to the WHOS’s scheme of functional classification is the following:

  1. Patients, who belong to the 1st WHO Class, are not restricted to have any physical activity. They have no symptoms (fatigue, chest pain, dyspnea or near syncope) while doing general physical exercises;
  2. Patients of the 2nd WHO Class have to follow some insignificant physical activity limitation. They experience slight symptoms during ordinary activity;
  3. Patients, who belong to the 3rd WHO Class have pronounced symptoms while doing slight physical activity;
  4. At last, WHO Class 4 patients suffer from severe symptoms even while carrying out minimal physical activity. Moreover, they suffer from some symptoms even at rest.

How PAH Can be Treated?

Pulmonary hypertension manifests itself differently in different persons. That is why, there is no generally accepted treatment course. Consult your healthcare professional to choose appropriate treatment according to your needs.

Firstly, the doctor should determine the causes of your disease. For instance, you will have to treat emphysema is it is the PAH cause in your occasion.

Most persons want to eliminate their breathing problems, which prevent them from leading an active lifestyle.

If you suffer from the lack of oxygen level and have short breath, you will be prescribed oxygen therapy, which implies breathing pure oxygen with the help of special prongs, which are put into your nose. It will improve your quality of life significantly. In case of the risk of blood clots, you will be advised to take anticoagulant meds. Some medications are aimed at improving the work of patient’s heart and maintaining the necessary level of liquid in the body.

In case of pulmonary hypertension of high severity, you will be probably prescribed meds, which block calcium channels (Ca-antagonists). These medications aimed at lowering pressure of blood in your lungs and other body parts. If calcium antagonists cannot deal with all symptoms, you will be recommended to visit a clinic specialized on treating this medical condition.

PAH treatment algorithm

There you will get more efficient therapies, including pills or breathe medications, injections etc., aimed at improving your blood vessels’ condition.

According to the WebMD they may be as follows:

  • Tabs: selexipag (Uptravi brand name), tadalafil (Cialis brand name), sildenafil (Revatio brand name), and some others;
  • Inhalers: treprostinil (Tyvaso brand name), Iloprost tromethamine (Ventavis brand name);
  • Injection meds: treprostinil, epoprostenol sodium.

If your health condition is more severe and drugs are helpless at treating the disease, you may be advised to undergo a surgery (lung transplantation), which is also called atrial septostomy. The surgery implies making opening between the patient’s heart sides. However, this procedure can cause serious adverse effects.

How Can Tadalafil Help for PAH?

tadalafilAs you have already seen above, special tablet with tadalafil is available for the treatment of this disease. This tablet is called Adcirca but may also be available under generic name (simply tadalafil).

Tadalafil, which is a PDE5 inhibitor, is administered orally once per day for treating PAH. Doctors recommend patients to include tadalafil in their treatment regimen if they belong to 2nd or 3rd PAH classes according to the WOH classification. Unfortunately, it will be ineffective if the disease has already moved to the fourth stage.

Persons, who follow placebo-controlled treatment, experience increasing of their state of health after physical activity (they improved 6-min distance in the middle tempo and do not feel any discomfort) after taking tadalafil. Moreover, patients say that they feel the overall increasing of their life quality and improved dynamics of blood flow.

Generally, there are light side effects, which can occur during the treatment with tadalafil. The rates of therapy termination are not frequent.

The main characteristics of this drug are the following:

  1. Tadalafil is the only PDE-5i drug for PAH trading, which is taken once in a day. For example, Revatio tablet (sildenafil) should be administered 3 times per day every 4 or 6 hours.
  2. Tadalafil is efficient for exercise ability enhancing.
  3. Tadalafil is completely safe and effective for children.
  4. The most widespread side effects the med can cause are flushing, headache, muscle pain, painful sensations in the different body parts, nausea, congested nose and upset stomach.

According to Adam M. Henrie’s research held in 2015, tadalafil can help to improve quality of life and time to worsening of the symptoms.

Safety Considerations

  • First of all, all your conditions/diseases should be discussed with your doctor for the sake of choosing the most appropriate scheme of treatment.
  • Simultaneous taking of tadalafil and any drug with nitrates (such medications are usually used for chest pain elimination) or stimulators of guanylate cyclase (for instance, Adempas) is prohibited. Such a combination can lead to sudden arterial pressure reduction.
  • In case of being allergic to tadalafil or any component of the pill, do not take this medical remedy.
  • Tell your health care provider about any side effect, in particular chest pain, that is caused by tadalafil.
  • PDE-5i meds can lead to blood vessels’ widening, which subsequently decreases blood pressure. That is why, in case of suffering from heart disease or low arterial pressure, make sure to tell your healthcare professional about it. The conditions above may be deteriorated under the tadalafil action.
  • The drug isn’t advised for those persons, who have pulmonary veno-occlusive disease (blockage in lungs veins).
  • In case of combining with alcoholic drinks as well as with antihypertension meds (for example, α-blockers), tadalafil can lead to arterial pressure lowering & hypotension.

ED – the Main Field of Tadalafil Use

PAH is a severe illness but it is relatively rare. Tadalafil (its brand name is Cialis) is used to treat erectile dysfunction (ED) in males more often. While getting into the body of a man, the main active substance of Cialis causes a whole chain of processes that lead to active blood filling of the penis. As a result, relaxation of the cavernous bodies of the genital organ is observed under the action of the drug. The widening of the blood vessels occurs, which leads to an active inflow of blood to the genital area.

Many male persons suffering from erectile problems of varying severity prefer Cialis.

Thanks to many advantages, this medication takes one of the leading positions in its segment.

Here are main advantages of the drug:

  • it has high efficiency;
  • it can be taken daily or on demand;
  • it is well-tolerated by the body, side effects occur rarely;
  • it can be used for a long time without causing addiction;
  • it works quickly (about half an hour after administration);
  • it is compatible with any food and alcohol (in moderate dosages);
  • it has a long-lasting effect (up to thirty-six hours, which is its topmost advantage).

The main disadvantage of Cialis is its high cost. But if you choose the generic Cialis at the Canadian pharmacy, the price will please you nicely.

At the same time, its effectiveness is not lower than that of the original drug. This is due to the fact that it is manufactured by generic drugmakers who simply use the tadalafil formula invented by Eli Lilly (the original developer).

Other medications for the treatment of erection problems include Viagra, Levitra, and Stendra.


Dr. Douglas Goldberg, MD is a Cardiology Specialist in Mineola, NY. He is affiliated with medical facilities Nyu Winthrop Hospital and Mercy Medical Center.