Tadalafil for the treatment of pulmonary arterial hypertension

INTRODUCTION: Pulmonary arterial hypertension (PAH) is a progressive occlusive disease affecting the pulmonary vasculature; it carries a poor prognosis. Because right ventricular failure is the key feature of deterioration in PAH patients, vasodilator treatments relieving right ventricular afterload have gained ground in the treatment of this disorder. Phosphodiesterase-5 inhibitors are effective and well tolerated vasodilators that were originally developed for erectile dysfunction. Tadalafil , the first once-daily drug of this class, was approved by the USFDA in May 2009 for the treatment of patients suffering from PAH. AREAS COVERED: This review outlines the currently available data about tadalafil and its effects in patients with PAH. It also presents evidence from recent clinical trials of tadalafil and discusses potential improvements over existing therapy options and their impact on current treatment strategies. EXPERT OPINION: Tadalafil is an efficacious drug with a favorable side-effect profile and convenient mode of administration. More studies are needed to analyze its impact on survival and to substantiate its role in an upfront combination treatment strategy.