Indications
Nirvana 20 Tablet is used for:
Erectile dysfunction, signs and symptoms of benign prostatic hyperplasia (BPH)
Adult Dose
Oral
Erectile dysfunction
Adult:
For Use as Needed
The recommended starting dose of Tadalafil for use as needed in most patients is 10 mg, taken prior to anticipated sexual activity.
The dose may be increased to 20 mg or decreased to 5 mg, based on individual efficacy and tolerability. The maximum recommended dosing frequency is once per day in most patients.
For Once Daily Use
The recommended starting dose of Tadalafil for once daily use is 2.5 mg, taken at approximately the same time every day, without regard to timing of sexual activity.
The IntimateTM dose for once daily use may be increased to 5 mg, based on individual efficacy and tolerability.
Benign Prostatic Hyperplasia
Treatment of signs and symptoms of benign prostatic hyperplasia (BPH); daily use also indicated for treatment of patients with both BPH and erectile dysfunction
BPH: 5 mg PO once daily
BPH with erectile dysfunction: 5 mg PO once daily, taken at approximately same time each day without regard to timing of sexual activity
With finasteride for BPH: tadalafil 5 mg plus finasteride 5 mg PO once daily for <26 weeks
Pulmonary Arterial Hypertension
40 mg PO once daily; dividing dose for more frequent dosing is not recommended
Patients also taking ritonavir: 20 mg PO once daily initially for >1 week; may be increased to 40 mg/day on basis of tolerability
Hepatic impairment (erectile dysfunction)
Mild-to-moderate (Child-Pugh class A or B): Not to exceed 10 mg PO once daily
Severe (Child-Pugh class C): Not recommended
Hepatic impairment (pulmonary arterial hypertension)
Mild-to-moderate (Child-Pugh class A or B): Consider starting dosage of 20 mg PO once daily
Severe (Child-Pugh class C): Avoid use
Child Dose
Renal Dose
Renal impairment (erectile dysfunction)
Mild (CrCl >51 mL/min): No dosage adjustment needed
Moderate (CrCl 30-50 mL/min): Not to exceed 5 mg PO once daily initially; maximum dosage, 10 mg PO q48hr
Severe (CrCl <30 mL/min and on hemodialysis): Not to exceed 5 mg PO q72hr
Renal impairment (pulmonary arterial hypertension)
Mild-to-moderate (CrCl 31-80 mL/min): 20 mg PO once daily initially; may be increased to 40 mg once daily on basis of tolerability
Severe (CrCl <30 mL/min and on hemodialysis): Avoid use
Administration
May be taken with or without food.
In order for Tadalafil to be effective, sexual stimulation is required.
It can be taken from 30 minutes to 12 hours prior to sexual activity. Efficacy of Tadalafil may persist up to 24 hours post-dose.
Contra Indications
Concurrent use of organic nitrates, nitrates and nitric oxide donors. Men with cardiac disease for whom sexual activity is inadvisable. Recent MI (within 90 days) or stroke (within last 6 mth), hypotension (<90/50 mm Hg), unstable angina, heart failure, uncontrolled arrhythmias or hypertension.
Precautions
Use caution in patients with anatomic deformation of penis, cardiovascular disease, left ventricular outflow obstruction, myocardial infarction in preceding 90 days, unstable angina, angina occurring during sexual intercourse, NYHA class 2 or greater heart failure in preceding 6 months, uncontrolled arrhythmias, hypotension, uncontrolled hypertension, cerebrovascular accident in preceding 6 months, bleeding disorders, active peptic ulcer disease, liver disease, renal impairment, conditions predisposing to priapism, concomitant use of CYP3A4 inhibitors
Hepatic or renal impairment; CV diseases; anatomical penile deformation; predisposition to priapism; child <18 yr. Discontinue and seek medical advice if there is sudden vision loss or decreased vision in one or both eyes or tinnitus, dizziness or sudden loss or decrease in hearing, while taking Tadalafil. Seek immediate medical advice if erection last > 4 hr.
Pregnancy-Lactation
Pregnancy
Not indicated for use in females; there are no data in pregnant women to inform any drug-associated risks for adverse developmental outcomes; in animal reproduction studies, no adverse developmental effects observed with oral administration of tadalafil to pregnant rats or mice during organogenesis at exposures up to 11 times the maximum recommended human dose (MRHD) of 20 mg/day
Lactation
Not indicated for use in females; there is no information on presence of tadalafil and/or metabolites in human milk; effects on breastfed child, or on milk production; drug and/or its metabolites are present in milk of lactating rats at concentrations approximately 2.4-fold greater than found in plasma
Interactions
Concurrent use increased risk of hypotension with beta-blockers; increased risk of priapism with other drugs for erectile dysfunction, e.g. alprostadil; increased heart rate with theophylline; decreased tadalafil serum concentration with CYP 3A4 inducers e.g. rifampicin, efavirenz, carbamazepine, nevirapine, barbiturates, phenobarbital, phenytoin, ribabutin; increased tadalafil serum concentration with CYP3A4 inhibitors e.g. azole antifungals, protease inhibitors, cimetidine, macrolides.
Potentially Fatal: Enhanced hypotensive effect with nitrates and nicorandil.
Side Effects
Side effects of Tadalafil :
>10%
Headache (11-42%), Myalgia (1-14%), Respiratory tract infection (3-13%), Nasopharyngitis (2-13%), Dyspepsia (1-13%), Flushing (1-13%), Back pain (2-12%), Nausea (10-11%)
1-10%
Nasal congestion (<9%), Gastroesophageal reflux disease (1-3%), Hypertension (1-3%), Bronchitis (<2%), Genitourinary tract infection (<2%)
<1%
Amnesia, Angina pectoris, Arthralgia, Change in color vision, Conjunctival hyperemia, Dyspnea, Epistaxis
Potentially Fatal: Stevens-Johnson syndrome, exfoliative dermatitis, severe cardiovascular events e.g. MI, stroke, sudden cardiac death;
Mode of Action
Tadalafil is a phosphodiesterase type-5 inhibitor.
Note
Nirvana 20 20mg Tablet generic name is Tadalafil. Nirvana 20 20mg Tablet is manufactured by Healthcare Pharmaceuticals Ltd.Nirvana 20 is availble in all over Bangladesh.
Mes BD drug index information on Nirvana 20 Tablet is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.