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The effect of tadalafil on the time to exercise-induced myocardial ischaemia in subjects with coronary artery disease

  1. Dean Patterson1,*,
  2. Robert Kloner2,
  3. Mark Effron3,
  4. Jeffrey Emmick3,
  5. Alun Bedding4,
  6. Margaret Warner3,
  7. Malcolm Mitchell4,
  8. Simon Braat5,
  9. Thomas MacDonald1

Article first published online: 1 AUG 2005

DOI: 10.1111/j.1365-2125.2005.02479.x

Issue

British Journal of Clinical Pharmacology

British Journal of Clinical Pharmacology

Volume 60, Issue 5, pages 459–468, November 2005

Additional Information

How to Cite

Patterson, D., Kloner, R., Effron, M., Emmick, J., Bedding, A., Warner, M., Mitchell, M., Braat, S. and MacDonald, T. (2005), The effect of tadalafil on the time to exercise-induced myocardial ischaemia in subjects with coronary artery disease. British Journal of Clinical Pharmacology, 60: 459–468. doi: 10.1111/j.1365-2125.2005.02479.x

Author Information

  1. 1

    Hypertension Research Centre, Department of Medicine and Therapeutics, Dundee University, Dundee, UK

  2. 2

    The Heart Institute, Keck School of Medicine, University of Southern California Good Samaritan Hospital, Cardiovascular Division, Los Angeles, USA

  3. 3

    Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA

  4. 4

    Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, UK

  5. 5

    Academic Hospital, Department of Cardiology, Maastricht, Netherlands

*Dr Dean Patterson, Department of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee University, DD1 9SY, UK. Tel: +44 (0)1382 660111 E-mail: d.patterson@dundee.ac.uk

Publication History

  1. Issue published online: 1 AUG 2005
  2. Article first published online: 1 AUG 2005
  3. Received 22 December 2004 Accepted 9 February 2005

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Keywords:

  • phosphodiesterase 5 inhibitors;
  • nitrate;
  • exercise induced ischaemia;
  • tadalafil

Objective

To investigate the effect of tadalafil on the time to exercise-induced myocardial ischaemia in subjects with coronary artery disease (CAD).

Background

CAD and erectile dysfunction (ED) share similar risk factors. It is important to know the cardiovascular effects of tadalafil in patients with CAD during physical exertion that is comparable with sexual activity.

Methods

A randomized, placebo-controlled, double-blind, two-period, crossover study comparing the effects of tadalafil 10 mg and placebo on the time to exercise treadmill test (ETT)-induced myocardial ischaemia in subjects with stable CAD (n = 23; age range: 53–75 years, all exhibited ST-segment depression >1.5 mm at screening ETT at > 5METS). Haemodynamic responses to sublingual nitroglycerin (NTG) were assessed before and after ETT.

Results

Compared with placebo, tadalafil did not significantly affect the time to ETT-induced ischaemia (13 min/31 s vs. 13 min/36 s, respectively). Before exercise, NTG evoked decreases in sitting systolic blood pressure (SBP) that were significantly greater when subjects received tadalafil compared with placebo, and after exercise, more subjects experienced a decrease in SBP <85 mmHg in response to NTG after taking tadalafil vs. placebo. When subjects received tadalafil compared with placebo, SBP was lower at rest (−7 mmHg; −12,-2), during ETT (−10 mmHg; −16, −3), and after ETT (−13 mmHg; −19, −7).

Conclusion

Tadalafil did not significantly alter the time to ETT-induced ischaemia compared with placebo in subjects with CAD. Tadalafil reduced resting and exercise SBP. Due  to the potential for hypotension, the concomitant use of nitrates and tadalafil is contraindicated.

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