Adcirca (previously Tadalafil Lilly)

Adcirca is a medicine that contains the active substance tadalafil. It is available as tablets (20 mg).

Adcirca is used to treat adults with pulmonary arterial hypertension (PAH) to improve exercise capacity (the ability to carry out physical activity). PAH is abnormally high blood pressure in the arteries of the lungs. Adcirca is used in patients with class-II or -III disease. The ‘class’ reflects the seriousness of the disease: ‘class II’ involves slight limitation of physical activity and ‘class III’ involves marked limitation of physical activity. Adcirca has been shown to be effective in PAH with no identified cause and in PAH caused by collagen vascular disease.

The medicine can only be obtained with a prescription.

Adcirca treatment should only be started and monitored by a doctor who has experience in the treatment of PAH.

Adcirca is taken as two tablets (40 mg) once a day, with or without food. Patients with mild or moderate kidney or liver problems should start with a lower dose, but this can be increased if necessary depending on the patient’s response. Adcirca is not recommended for patients with severe kidney or liver problems.

PAH is a debilitating disease where there is severe constriction (narrowing) of the blood vessels of the lungs. It causes high blood pressure in the vessels taking blood from the heart to the lungs. This pressure reduces the amount of oxygen that can get into the blood in the lungs, making physical activity more difficult. The active substance in Adcirca, tadalafil, belongs to a group of medicines called ‘phosphodiesterase-type-5 (PDE5) inhibitors’, which means that it blocks the PDE5 enzyme. This enzyme is found in the blood vessels of the lungs. When the enzyme is blocked, a substance called ‘cyclic guanosine monophosphate’ (cGMP) cannot be broken down and remains in the vessels where it causes the relaxation and widening of the blood vessels. In patients with PAH, Adcirca widens the blood vessels of the lungs, which lowers the blood pressure and improves symptoms.

Four doses of Adcirca (2.5, 10, 20 and 40 mg once a day) have been compared with placebo (a dummy treatment) in one main study involving 406 patients with PAH, most of whom had class-II or class-III disease that was of unknown cause or caused by collagen vascular disease. The main measure of effectiveness was the change in exercise capacity (the ability to carry out physical activity) measured by the distance the patients could walk in six minutes after 16 weeks of treatment.

Adcirca was more effective than placebo at improving exercise capacity. Before treatment, the patients could walk an average of 343 metres in six minutes. After 16 weeks, this distance had increased by 26 metres more in the patients taking 40 mg Adcirca than in the patients taking placebo.

The most common side effects with Adcirca (seen in more than 1 patient in 10) are headache, flushing (reddening of the skin), nasopharyngitis (inflammation of the nose and throat) including a blocked or runny nose and blocked sinuses, nausea (feeling sick), dyspepsia (heartburn) including stomach ache, myalgia (muscle pain), back pain and pain in the extremities (arms, hands, legs and feet).

Adcirca must not be used in patients who have had an acute myocardial infarction (sudden heart attack) within the last three months, or who have severe hypotension (low blood pressure). Adcirca must not be taken with nitrates (a group of medicines used to treat angina) or medicines of the class ‘guanylate cyclase stimulators’ such as riociguat (another medicine to treat pulmonary hypertension). It must not be used in patients who have ever had loss of vision because of a problem called non-arteritic anterior ischaemic optic neuropathy (NAION) that affects the blood flow to the nerve in the eye.

For the full list of all side effects and restrictions with Adcirca, see the package leaflet.

The CHMP decided that Adcirca’s benefits are greater than its risks and recommended that it be given marketing authorisation.

A risk management plan has been developed to ensure that Adcirca is used as safely as possible. Based on this plan, safety information has been included in the summary of product characteristics and the package leaflet for Adcirca, including the appropriate precautions to be followed by healthcare professionals and patients.

The European Commission granted a marketing authorisation valid throughout the EU for Tadalafil Lilly on 1 October 2008. This authorisation was based on the authorisation granted to Cialis in 2002 (‘informed consent’). The name of the medicine was changed to Adcirca on 21 October 2009.

For more information about treatment with Adcirca, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.