Introduction
This guide explains what Adcirca is and how it helps people with pulmonary arterial hypertension (PAH). PAH is a serious condition where blood pressure is too high in the lung arteries. If you or someone you love has PAH, understanding treatment options is vital. We’ve written this guide in clear, simple language to help you learn about this important medication.
What Is Adcirca?
Adcirca is a prescription drug that contains tadalafil. Doctors use it to treat pulmonary arterial hypertension (PAH). PAH causes high blood pressure in the lung arteries. This makes the right side of your heart work harder than normal.
Adcirca belongs to a group of drugs called phosphodiesterase type 5 (PDE5) inhibitors. These drugs relax blood vessels to improve blood flow.
“Adcirca helps many PAH patients,” says Dr. Sarah Jenkins, a lung specialist. “The same ingredient, tadalafil, is also sold as Cialis for erectile dysfunction. But Adcirca is made specially for PAH treatment.”
History and Development
Eli Lilly first developed tadalafil. The FDA approved it in 2003 for erectile dysfunction as Cialis. In 2009, they approved it as Adcirca for PAH treatment.
This approval came after studies showed it helped PAH patients exercise better. It also slowed the worsening of their condition. Adcirca came after earlier drugs like sildenafil (Revatio, Viagra), giving patients more options.
“Finding new uses for existing drugs is common in medicine,” notes Dr. Michael Chen from Northwestern University. “Researchers found that the same action that helps with erectile dysfunction—widening blood vessels—could help people with PAH.”
How Adcirca Works
Adcirca works through these steps in your body:
- Healthy blood vessel walls release nitric oxide (NO)
- This NO activates an enzyme called guanylate cyclase
- This enzyme increases a substance called cGMP, which relaxes blood vessels
- An enzyme called PDE5 normally breaks down cGMP
- Adcirca blocks PDE5, so cGMP stays active longer
- This keeps lung blood vessels relaxed, reducing pressure
Dr. Patricia Ramirez explains, “In PAH patients, lung blood vessels are too tight. By blocking PDE5, Adcirca helps these vessels stay open. This improves blood flow where it’s needed most.”
Medical Uses and Benefits
Primary Use: Pulmonary Arterial Hypertension
Adcirca is FDA-approved to treat PAH and improve exercise ability. Studies show Adcirca can:
- Help patients walk farther in six-minute tests
- Delay worsening of PAH
- Improve quality of life
- Enhance heart and lung function
“The PHIRST study showed Adcirca helps many types of PAH patients,” states Dr. Jenkins. “It works regardless of what caused their PAH or how severe it is.”
Other Potential Uses
Doctors sometimes prescribe tadalafil (Adcirca’s active ingredient) for other conditions, though these aren’t FDA-approved uses:
- Preventing high-altitude lung swelling
- Treating enlarged prostate in men who also have PAH
- Helping with Raynaud’s phenomenon, especially in scleroderma patients
“Evidence for these other uses varies,” cautions Dr. Thomas Wilson from Johns Hopkins. “Talk with your doctor about what you can realistically expect for non-approved uses.”
Dosage and Administration
The standard dose for PAH is 40 mg (two 20 mg tablets) once daily. You can take it with or without food. This once-daily schedule may be easier to remember than medicines taken multiple times per day.
Important tips:
- Swallow tablets whole—don’t crush or split them
- Take your dose at the same time each day
- Never take Adcirca with nitrates (certain heart medications)
- You may need dose adjustments if you have kidney or liver problems
“Taking Adcirca properly is crucial,” says Dr. Ramirez. “Its long-lasting effect—about 17.5 hours—means you only need one dose per day. This is better than some other PAH treatments that need multiple daily doses.”
Side Effects and Safety
Common Side Effects
Like all medicines, Adcirca can cause side effects, though not everyone gets them. Common side effects include:
- Headache
- Muscle pain
- Flushing (reddening of the skin)
- Stuffy nose
- Indigestion
- Back pain
- Limb pain
- Nausea
“Most side effects are mild and often go away as your body adjusts,” explains Dr. Karen Thompson, a pharmacist who specializes in lung medicines. “But tell your doctor about any bothersome symptoms. They may be able to help.”
Serious Side Effects
Rare but serious side effects need immediate medical attention:
- Sudden vision loss or changes
- Sudden hearing loss
- Erection lasting more than 4 hours
- Allergic reactions (rash, itching, severe dizziness, trouble breathing)
- Chest pain
- Fainting
Drug Interactions and Warnings
Never take Adcirca with:
- Nitrates (like nitroglycerin, isosorbide)
- “Poppers” (amyl or butyl nitrite)
Be careful when taking Adcirca with:
- Alpha-blockers (doxazosin, tamsulosin)
- Antifungals (ketoconazole, itraconazole)
- HIV medicines (ritonavir)
- Other PAH treatments like riociguat
- Drugs that affect CYP3A4 liver enzymes
“Never take nitrates with Adcirca,” warns Dr. Wilson. “This combination can cause a dangerous drop in blood pressure. Always tell your doctor about all medicines you take.”
Comparing Adcirca With Other PAH Treatments
Doctors treat PAH with several types of medicines:
- PDE5 Inhibitors: Adcirca (tadalafil), Revatio (sildenafil)
- Adcirca needs only one dose daily; Revatio needs three
- Endothelin Receptor Antagonists: Tracleer (bosentan), Letairis (ambrisentan)
- May affect the liver; require monitoring
- Prostacyclin Analogs: Flolan (epoprostenol), Ventavis (iloprost)
- Often need constant infusion or frequent breathing treatments
- GC Stimulators: Adempas (riociguat)
- May work when PDE5 inhibitors don’t
“Treatment choice depends on many factors,” says Dr. Jenkins. “These include how severe your PAH is, your overall health, and your preferences. Many patients need a combination of drugs as their disease progresses.”
Adcirca works well as an early treatment for milder PAH (WHO Class II-III). It has fewer side effects and is easier to take than some other options.
Effectiveness and Research Evidence
The main study supporting Adcirca for PAH was called PHIRST. This 16-week study included 405 PAH patients and found:
- Patients could walk farther in six-minute tests
- Their condition worsened more slowly
- They reported better quality of life
- Their heart and lung function improved
“The study showed the 40 mg dose works best,” notes Dr. Chen. “Later studies showed benefits continue with long-term use. Like most PAH treatments, Adcirca manages the condition but doesn’t cure it.”
Newer research shows combining Adcirca with other PAH drugs may work better than using just one drug.
Current Guidelines and Expert Recommendations
Medical organizations regularly update PAH treatment guidelines. Current advice from European heart and lung experts suggests PDE5 inhibitors like Adcirca are:
- Good first treatments for mild to moderate PAH (WHO Class II-III)
- Often combined with other PAH drugs from the start
- Options to add when one drug isn’t enough
“Treatment approaches keep evolving,” explains Dr. Ramirez. “The trend now is to start multiple drugs earlier rather than adding them one by one. Adcirca remains a key part of these approaches because it works well and has manageable side effects.”
American medical groups have similar recommendations, with some differences in how they suggest combining treatments.
Special Populations
Pregnancy and Breastfeeding
Adcirca is classified as FDA Pregnancy Category B. This means animal studies haven’t shown harm to unborn babies, but we don’t have enough studies in pregnant women.
“PAH itself makes pregnancy very risky,” cautions Dr. Elizabeth Morgan, a high-risk pregnancy specialist. “Maternal death rates have been 30-50% historically. The decision to use Adcirca during pregnancy must weigh these risks against benefits. This requires a team of specialists.”
Tadalafil may pass into breast milk, so nursing mothers should be careful.
Children
The FDA hasn’t approved Adcirca for children. However, some specialized children’s hospitals may use it in certain cases.
“Use in children is based mainly on adult studies and limited reports,” notes Dr. James Peterson from Children’s Hospital Colorado. “Ongoing studies are looking at safety and dosing for children. This remains an area of great need.”
Older Adults
Older adults don’t need different doses based on age alone. However, since many older people have decreased kidney function, doctors should check kidney function before prescribing Adcirca.
Cost and Access Issues
As a brand-name drug, Adcirca can be expensive—over $3,000 monthly without insurance. Options to help with costs include:
- Insurance coverage (though pre-approval is often needed)
- Patient assistance programs from the manufacturer
- Co-pay cards for those with commercial insurance
- Generic tadalafil, now available
- Help from pulmonary hypertension foundations
“PAH treatment costs remain high,” acknowledges Dr. Thompson. “Talk with your healthcare team about costs and find resources that can help. Many patients qualify for programs that reduce out-of-pocket expenses.”
Future Research
Ongoing research focuses on:
- Finding the best drug combinations
- Using biological markers to personalize treatment
- Developing new delivery methods
- Targeting multiple disease pathways at once
“The future of PAH treatment will likely involve precision medicine,” predicts Dr. Chen. “By understanding each patient’s unique disease features, we can maximize benefits while minimizing side effects. Adcirca will likely remain important in these evolving treatments.”
Researchers are also exploring tadalafil for other types of pulmonary hypertension beyond PAH.
Practical Advice for Patients
If you take Adcirca, your healthcare team may recommend:
- Taking it at the same time each day
- Continuing all other prescribed PAH treatments
- Avoiding grapefruit juice, which can increase drug levels
- Telling all healthcare providers about your Adcirca use
- Carrying medical ID showing your PAH diagnosis and medications
- Keeping regular follow-up appointments
“Education is essential for PAH management,” emphasizes Dr. Jenkins. “Beyond taking your medicines, lifestyle changes like appropriate exercise, less salt, and quitting smoking are also crucial.”
Frequently Asked Questions
What’s the difference between Adcirca and Cialis?
Both contain tadalafil, but they’re for different conditions and used in different doses. Adcirca is for PAH (40 mg daily). Cialis is for erectile dysfunction and/or enlarged prostate (5-20 mg daily or as needed). Never switch between them without medical supervision.
Can I take Adcirca with other PAH medications?
Many PAH patients take medications that work in different ways. Adcirca often works well with endothelin receptor antagonists or prostacyclin pathway drugs. However, never combine it with riociguat (Adempas)—this can cause dangerous blood pressure drops. Always check with your PAH specialist before changing any medications.
How long before Adcirca starts working?
Some effects begin within hours of your first dose. However, the full benefit usually develops over several weeks of regular use. In studies, significant improvements were seen after 16 weeks. Your doctor will track your progress through tests like the 6-minute walk test and heart ultrasound.
What if I miss a dose?
Take it as soon as you remember on the same day. Don’t take two doses in one day to make up for a missed dose. Return to your regular schedule the next day. Setting a daily reminder or taking your dose with a daily routine can help you remember.
Can Adcirca cure my PAH?
No, Adcirca and other current PAH treatments manage the condition but don’t cure it. These medications slow disease progression, improve symptoms, and enhance quality of life, but you need to take them continuously. Research into potential cures is ongoing but still in early stages.
Will insurance cover Adcirca?
Coverage varies between insurance plans. Most require prior authorization proving medical necessity. Some may require trying other medications first or limit coverage to specific PAH types. Work with your doctor’s office to complete necessary paperwork, and check with the manufacturer’s patient assistance program if coverage is denied.
Are there diet restrictions with Adcirca?
Avoid grapefruit and grapefruit juice while taking Adcirca. They can increase tadalafil levels in your blood, potentially causing side effects. Otherwise, you can take Adcirca with or without food. PAH patients should generally watch their salt intake, regardless of medications.
Conclusion
Adcirca offers PAH patients an important treatment option. This once-daily pill can help you exercise better, slow disease progression, and improve quality of life. While not a cure, it provides real benefits for many people with this challenging condition.
As research continues and treatment approaches evolve, Adcirca will likely remain valuable in PAH management. Ongoing research into combination treatments and individual patient factors promises to improve outcomes further.
If you have PAH, work closely with specialists to decide if Adcirca is right for you and how it fits into your overall care plan.