Adcirca

Adcirca is a prescription drug used in the treatment of pulmonary hypertension. The active ingredient is a drug called tadalafil, which is also the same ingredient used in the blockbuster erectile dysfunction medication, Cialis. 

In this guide, we’ll cover everything you need to know about Adcirca, including the potential side effects, where to buy it, and how to use the drug safely.

What is Adcirca? 

Adcirca is a small orange, almond-shaped tablet containing 20 mg of tadalafil — which is a drug owned by the pharmaceutical giant Eli Lilly. 

Tadalafil works by dilating the blood vessels in specific regions of the body — including the penis and pulmonary arteries. Eli Lilly has two versions of this drug: 

  1. Cialis — for the treatment of erectile dysfunction
  2. Adcirca — for the treatment of pulmonary hypertension

Both drugs contain similar doses of the active ingredients but are prescribed for completely separate applications. Both drugs are the same, and thus exert the same effects on the pulmonary arteries and penis. The main difference between these two medications is the color of the pill, and the available dosages. 

Adcirca only comes in one dosage, 20 mg, while Cialis is available in 2.5, 5, 10, and 20 mg versions. 

Adcirca vs. Cialis: Similarities & Differences

Adcirca (Tadalafil)Cialis (Tadalafil)
Approved ApplicationPulmonary HypertensionErectile Dysfunction
ManufacturerEli LillyEli Lilly
Available Dosages20 mg2.5, 5, 10, and 20 mg
Pill AppearanceSmall, dark-orange, almond-shaped tabletSmall, light-orange, almond-shaped tablet

Why Are There Two Brand Names for Tadalafil? 

The concept of providing two versions of the same drug to treat different conditions is relatively common. Pharmaceutical companies do this as a way to speed up the approval process. 

When applying for approval for a drug, companies need to provide evidence in the form of extensive testing through phase I, II, and III clinical trials. The drug needs to be proven safe, as well as effective for a specific condition. 

Drug companies will often create multiple versions of a drug that’s effective for more than one unrelated health condition. This way, if one of the approvals is denied, the company still has a chance for their drug to gain approval for the other condition — which means they can start selling the drug sooner and start earning profit. 

Even though Adcirca and Cialis are the same drug, a doctor can only prescribe Adcirca for pulmonary hypertension, and Cialis for erectile dysfunction or benign prostatic hyperplasia. The two can not be prescribed interchangeably for each condition. 

What’s the Dose of Adcirca?

Adcirca comes with a dose of 20 mg per tablet. The usual dose for pulmonary hypertension is 40 mg (two tablets) per day with meals. This drug should be used everyday at the same time. 

If you miss a dose, take it as soon as possible. If it’s almost time for your next dose, skip the missed dose and take the pill at your normal time. Never take two doses at one time of Adcirca. 

How Long Does it Take to Work?

The effects of Adcirca take roughly 30 minutes. Most patients will experience improved cardiovascular function within the first hour after taking the medication, which lasts up to 24 hours. 

For erectile dysfunction (off-label use), this drug takes roughly 30 minutes before you can expect to see any improvement in your ability to achieve an erection. These effects last anywhere from 6 to 36 hours. 

How Much Does Adcirca Cost? 

Adcirca isn’t cheap. The MSRP for the drug is around $4362 per 60 tablets — which works out to around $73 per pill. This price is on-par with most of the other brand-name PDE5 inhibitors such as Viagra ($67), Cialis ($70), and Levitra ($245). 

It’s not uncommon to find sources of this drug at substantial discounts up to 80% off — but you have to shop around quite a bit to find these deals. 

There are several generic options of Adcirca as well — which tend to be much cheaper than the brand name version. 

The active ingredient in Adcirca, tadalafil, is offered in generic forms by several manufacturers, at prices ranging from $1 per pill, to $30 per pill. 

Companies that make cheaper generic forms of Adcirca:  

  1. Teva Pharmaceuticals
  2. Torrent Pharma
  3. Camber Pharmaceuticals
  4. Dr. Reddy’s Laboratories
  5. Ajanta Pharma
  6. Apotex

The History of Adcirca

The active ingredient in Adcirca (tadalafil) was first discovered in 1993 by ICOS and GlaxoSmithKline and was further developed as a potential treatment for hypertension (high blood pressure). 

Several years later, after the launch of a similar drug, sildenafil (Viagra) by Pfizer, the development team shifted focus and started exploring the effects of tadalafil on erectile dysfunction. 

The drug was later sold to Eli Lilly, who created two versions of the drug — one for erectile dysfunction (Cialis), and another for pulmonary hypertension (Adcirca). 

Who is Adcirca For? 

There’s only one approved use of Adcirca, which is for treating pulmonary hypertension. Doctors will prescribe this medication if your pulmonary blood pressure is above 25 mmHg at rest or 30 mmHg while exercising. 

Off-label, Adcirca is used for treating erectile dysfunction. However, for this application your doctor will likely prescribe a different drug such as Cialis, Viagra, or Levitra that’s already been approved by the FDA or other regulatory bodies for treating this condition. 

What is Pulmonary Hypertension

Pulmonary hypertension (PHT) is a condition involving high blood pressure specifically involving the blood vessels leading from the heart to the lungs. 

Normally, the pressure of the pulmonary artery (delivers blood to the lungs) is between 8 and 20 mmHg at rest. Pulmonary hypertension is diagnosed when the pressure exceeds 25 mmHg at rest, or 30 mmHg while exercising.

The pulmonary system is critically important for our health. The right side of the heart pumps deoxygenated blood from the heart to the lungs via the pulmonary artery. Here, CO2 is released into the lungs, and the blood absorbs fresh oxygen. The blood is then returned to the left side of the heart through the pulmonary vein. 

The Dangers of Pulmonary Hypertension

When pressure in the pulmonary system becomes high, it acts like a bottleneck for the flow of blood around the body. The heart has to beat harder in order to push blood through the pulmonary system, placing strain on this critical organ. 

Pulmonary hypertension also reduces the availability of oxygen in the body, which leads to shortness of breath, fatigue, and increased exertion during exercise. 

Symptoms of Pulmonary Hypertension

Pulmonary hypertension tends to develop gradually over time. There are early symptoms while the disease is first progressing, and later symptoms that occur once the condition has been present for several months or years. 

Early Symptoms of Pulmonary Hypertension Include: 

  • Shortness of breath
  • Reduced endurance while exercising
  • Fatigue and lethargy
  • Chest pain
  • Rapid heartbeat
  • Poor appetite
  • Painful sensation in the right side of the chest

Later Symptoms of Pulmonary Hypertension Include: 

  • Lightheadedness
  • Fainting
  • Swelling in the ankles or legs
  • Cyanosis (blue color in the lips or corners of the eyes)
  • Inability to exercise or move around without resting
  • Enlarged heart

What Are the Causes of Pulmonary Hypertension? 

There are many potential causes for this condition. In some cases, no clear identifiable cause can be found. 

A few potential causes for this condition include: 

  1. Side effects from medications or drugs
  2. HIV infection
  3. Congenital heart disease
  4. Connective tissue disorders
  5. Sickle cell anemia
  6. Schistosomiasis
  7. Liver disease
  8. Mitral valve disorders
  9. Chronic hypertension
  10. Chronic obstructive pulmonary disorder (COPD)
  11. Blood clots
  12. Polycythemia vera
  13. Long-term smoking
  14. Kidney disease
  15. Tumor formation that presses on the pulmonary arteries

Treatment Options for Pulmonary Hypertension

Depending on the cause of pulmonary hypertension, the treatments may vary from medications like Adcirca to surgeries to remove a blockage or tumor from the pulmonary artery. 

In most cases, treatment for this condition is symptomatic only — meaning that they’re used to reduce symptoms, but can’t eliminate the problem completely. 

Lifestyle changes can also go a long way in eliminating the symptoms of pulmonary hypertension, and slowing the progression of the disease: 

  • Quit smoking
  • Follow a healthy diet (plenty of vegetables and avoidance of high-sugar foods)
  • Exercise regularly
  • Maintain a healthy weight
  • Avoid saunas or hot tubs
  • Practice de-stressing techniques and adequate sleep hygiene

How Adcirca Supports Pulmonary Hypertension

Adcirca (tadalafil) works by inhibiting an enzyme called phosphodiesterase. This enzyme is responsible for breaking down a chemical messenger called cyclic-GMP (GMP), which causes blood vessels to widen. When the blood vessels become wider, blood pressure drops. 

There are a few different types of phosphodiesterase in the body, each with a higher v=prevalence in specific organs. Adcirca specifically targets phosphodiesterase 5 (PDE5) — which is most abundant in the pulmonary arteries, eyes, ears, and penis. 

By inhibiting this particular enzyme, Adcirca causes blood pressure in these regions to drop. In the pulmonary system, this provides direct support for pulmonary hypertension, and in the penis it makes it easier to achieve and maintain an erection. This second effect is what makes Adcirca’s sister drug, Cialis, so effective. 

Medical Research Involving Adcirca & Pulmonary Hypertension

A randomized, doule-blind, placebo-controlled trial investigating the effects and safety profile of Adcirca for pulmonary hypertension was officially completed in 2007 [1]. 

The study included 406 patients with confirmed pulmonary hypertension. Each patient was given one of four doses of Adcirca, or a placebo and asked to perform a simple cardio exercise. The patient was given the treatment for 16 weeks and measured to assess how far the patient could walk after the exercise. 

Only the largest dose used in the trial (40 mg) offered significant improvement, increasing the distance walked by about 6 minutes on average. 

A followup trial was later done to assess the long-term safety of using Adcirca [2]. 357 patients were enrolled in this study, each given either 20 or 40 mg of Adcirca daily for exactly 1 year. The results indicated that Adcirca has a high level of safety when used over long-periods of time, and had a significant improvement in exercise scores throughout the course of the trial. 

Adcirca Safety & Side Effects

Adcirca is generally regarded as safe. The most common side effect of the drug is headache and indigestion (dyspepsia), but more severe side effects are also possible. 

There are a few cases where Adcirca may be dangerous — such as combination with other drugs, specific medical conditions, or allergic reactions. 

The side effects of Adcirca (tadalafil) include: 

  • Headache (6% of users)
  • Dyspepsia (Indigestion) (5% of users)
  • Back Pain (3% of users)
  • Upper Respiratory Tract Infection (3% of users)
  • Flushing (3% of users)
  • Myalgia (Muscle Pain) (2% of users)
  • Cough (2% of users)
  • Diarrhea (2% of users)
  • Nasal Congestion (2% of users)
  • Pain in the Extremities (2% of users)
  • Gastroesophageal Reflux Disease (1% of users)
  • Abdominal Pain (1% of users)
  • Priapism (Painful Erection Lasting More Than 6 hours) (<1% of users)
  • Angina or Chest Pain (<1% of users)
  • Vision Disturbances (<1% of users)

Contraindications (When to Avoid Adcirca)

Adcirca isn’t safe for everybody. Certain concomitant drug use or underlying medical conditions could make Adcirca dangerous. 

Negative Drug Interactions

Certain drugs may interact with Adcirca, causing potentially life-threatening side effects. It’s important to consult your doctor before using Adcirca for any reason to frst review your medications. 

  1. Antihypertensives — Adcirca may cause blood pressure to dip too low if combined with other blood pressure medicines. This can lead to dizziness and fainting. 
  2. Nitrates — Nitrates are a treatment for coronary artery disease. Both Adcirca and nitrates have a similar effect on blood pressure and should never be combined.
  3. Alcohol — Taking Adcirca with alcohol is not safe and could lead to dizziness and blackouts. 
  4. CYP3A4 Inhibitors — Drugs that require the same metabolic pathway of Adcirca could interfere with the body’s ability to process the drug. 
  5. Grapefruit Juice (GFJ) — GFJ can cause the rapid metabolism of Adcirca, making it less effective at managing symptoms. 
  6. Erectile Dysfunction (ED) Medications — Adcirca may interact with prescription ED medications that have the same mechanism of action (PDE5 inhibitor).

Underlying Health Conditions

Adcirca has the potential to make symptoms of certain medical conditions worse. Before prescribing the drug, your doctor will weigh the risk to benefit ratio depending on your health condition.

  1. Allergies — Some people may be allergic to the ingredients in Adcirca. If you experience symptoms such as a rash, mouth sores, or difficulty breathing after using Adcirca, contact your doctor immediately. 
  2. Heart Disease — Taking Adcirca with certain heart conditions could increase your risk of severe side effects. 
  3. Kidney Disease — Once Adcirca is processed by the liver, it’s excreted through the kidneys. If you have kidney failure, it could lead to a harmful buildup of Adcirca metabolites in the bloodstream. 
  4. Liver Disease — Adcirca is metabolized in the liver. Patients with liver disease may not be able to process Adcirca properly, leading to toxic buildups in the bloodstream. 
  5. Non-arteritic anterior ischemic optic neuropathy (NAION) — Adcirca also affects the blood vessels in the eyes. These effects could lead to blindness in patients with NAION.
  6. Stomach Ulcers — Adcirca could make stomach ulcers worse. Most doctors will wait until stomach ulcers are cleared up before prescribing the drug.
  7. Peyronie’s Disease (PD) — PD is a condition involving a buildup of scar tissue in the penis. Adcirca could cause painful erections in people with this condition. 

How Does Adcirca Work?

Adcirca works by inhibiting a specific enzyme called PDE5 (phosphodiesterase type 5). 

There are several different forms of this enzyme (PDE 1 through 7), each found more predominantly in specific parts of the body. PDE5 is particularly abundant in the arteries supplying blood to the penis, in the pulmonary arteries, and in the eyes and ears. 

PDE is responsible for deactivating a compound called cyclic GMP (cGMP). This compound is a chemical messenger that causes blood vessels to relax or dilate. As they dilate (expand) blood pressure is reduced and blood flow through the artery is increased. 

By selectively targeting PDE5, Adcirca is able to slow the breakdown of cGMP specifically in the pulmonary arteries, leading to a dilation and reduction of pressure in these arteries. 

This effect has a direct impact on the pressure of the pulmonary arteries, offering effective symptomatic treatment for pulmonary hypertension. 

Adcirca will inhibit other forms of PDE as well, which can lead to changes in blood pressure in other parts of the body — however, the inhibitory effects are much lower for these other forms of the enzyme and side effects are usually mild in nature. 

Adcirca Alternatives

There are several alternative options for Adcirca as a treatment for pulmonary hypertension, and for its off-label use for managing erectile dysfunction. 

Prescription Alternatives

The most direct alternative to Adcirca is Cialis — which is made by the same company, and contains the exact same ingredients. 

Adcirca is prescribed for pulmonary hypertension and contains a higher dose, while Cialis is prescribed for erectile dysfunction. 

There are other prescription alternatives that offer the same effect on erectile function by blocking PDE5, such as: 

  • Sildenafil (Viagra, Kamagra) 
  • Avanafil (Stendra, Spedra)
  • Vardenafil (Levitra, Staxyn, and Vivanza)
  • Mirodenafil (Mvix)
  • Udenafil (Zydena)

Where to Buy Adcirca

Adcirca is available at most pharmacies with a prescription from your doctor. Some of the generic forms of this drug (tadalafil) are offered online without asking for a prescription, but these sources aren’t recommended. 

It’s crucial you’re using the right dose, and buy products that are guaranteed to contain accurate dosing and are completely free from contaminants. It’s also illegal to order prescription medications from unapproved sources. 

The best way to get Adcirca or its sister drug, Cialis, is to make an appointment with your GP and ask. They will do a complete review of your current medications, check your symptoms, and determine whether Adcirca or Cialis is a good option for you. 

You can then use this prescription to order Adcirca from official pharmacies or go in-person to your local CVS or pharmacy. 

References Cited in this Article

  1. Galiè, N., Brundage, B. H., Ghofrani, H. A., Oudiz, R. J., Simonneau, G., Safdar, Z., … & Frumkin, L. (2009). Tadalafil therapy for pulmonary arterial hypertension. Circulation, 119(22), 2894.
  2. Oudiz, R. J., Brundage, B. H., Galiè, N., Ghofrani, H. A., Simonneau, G., Botros, F. T., … & PHIRST Study Group. (2012). Tadalafil for the treatment of pulmonary arterial hypertension: a double-blind 52-week uncontrolled extension study. Journal of the American College of Cardiology, 60(8), 768-774.
  3. Simonneau, G., Gatzoulis, M. A., Adatia, I., Celermajer, D., Denton, C., Ghofrani, A., … & Olschewski, H. (2013). Updated clinical classification of pulmonary hypertension. Journal of the American College of Cardiology, 62(25 Supplement), D34-D41.

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