Tadalafil 10mg tablets

BackgroundLower urinary tract symptoms (LUTS) are common in men and can lead to impaired quality of life. While phosphodiesterase type 5 inhibitors (PDE5-Is) are established in managing LUTS related to benign prostatic hyperplasia (BPH), their role in non-BPH male LUTS remains unclear. This systematic review aimed to evaluate the efficacy and safety of PDE5-Is in men with LUTS unrelated to prostate enlargement.MethodsA systematic search of four databases (PubMed, Web of Science, ScienceDirect, and EBSCO) identified five eligible clinical trials that enrolled men with LUTS secondary to non-BPH etiologies such as post-prostate brachytherapy, overactive bladder (OAB), and double-J (DJ) ureteral stents. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB-2) tool for randomized trials and the Risk of Bias in Non-randomized Studies of Intervention (ROBINS-I) tool for non-randomized trials. Data were synthesized descriptively due to heterogeneity and limited number of studies. Our review was registered in advance in PROSPERO (CRD420251072896).ResultsFrom 341 identified studies, 5 clinical trials met the inclusion criteria. Interventions included tadalafil, sildenafil, and combination regimens with tamsulosin or solifenacin. PDE5-Is consistently improved urinary symptoms, International Prostate Symptom Score (IPSS) reduction, pain, storage and voiding scores, and sexual function. Tadalafil showed the most consistent benefits, particularly in sexual health and pain relief, while combination therapy (tamsulosin + solifenacin or sildenafil) yielded broader urinary symptom improvement. Objective measures such as the maximum urinary flow rate (Qmax) and post-void residual (PVR) improved modestly but less consistently. This review is limited by the small number of studies and the heterogeneity of participants among the included studies.ConclusionsPDE5-Is, especially tadalafil, are effective and well-tolerated for non-BPH LUTS in men, offering advantages beyond urinary symptom relief, including sexual function preservation and pain reduction. These potential effects should be further explored, particularly when erectile dysfunction (ED) or discomfort is present.

Abstract licence: CC BY-NC-ND

Background and objectivesCerebral small vessel disease (CSVD) represents a major contributor to both cerebral ischemic events and the development of vascular cognitive decline. Based on preclinical evidence, phosphodiesterase-5 inhibitors (PDE5-Is) may benefit neurovascular function, this systematic review and meta-analysis evaluated their effects on cerebral hemodynamics, cognitive function, and safety in patients with cerebral small vessel disease (CSVD).MethodsWe systematically searched four major databases from January 1990 to October 2025 for randomized controlled trials investigating sildenafil or tadalafil in adults with CSVD. Primary outcomes included changes in cerebral blood flow in white matter hyperintensity regions, mean flow velocity in the middle cerebral artery, and performance on standardized cognitive assessments. Data were synthesized using random-effects models.ResultsFour studies involving 236 patients were included. Meta-analysis showed that PDE5-Is significantly increased cerebral blood flow in white matter hyperintensity regions (MD = 1.31 mL/100 g/min, 95% CI: 0.46-2.15, p = 0.002) compared to placebo, but the overall effect of PDE5-Is inhibitors on cerebral blood flow velocity was not statistically significant (p > 0.05). A modest reduction in diastolic blood pressure was also observed (MD = -4.65 mmHg, 95% CI: -5.96 to -3.34, p p = 0.0001), but no severe adverse events were reported. No significant cognitive improvements were found across any domain.ConclusionPDE5-Is significantly improve cerebral hemodynamic parameters in patients with CSVD, alongside a modest reduction in diastolic blood pressure. But current evidence does not support a significant beneficial effect on cognitive function. Treatment is generally well-tolerated, though the increased risk of adverse events warrants attention.Systematic review registrationIdentifier CRD420261360008.

Abstract licence: CC BY

Urolithiasis is a common urinary tract disease. This systematic review and meta-analysis aim to evaluate the effectiveness of alpha-blockers compared to novel therapies. The objective of this systematic review and meta-analysis was to compare the efficacy and safety of emerging pharmacologic therapies, namely tadalafil and mirabegron, with traditional alpha-blockers, such as tamsulosin and silodosin, as medical expulsive therapies (METs) for distal ureteric stones measuring ≤10 or <5 mm. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were implemented during the conduct of this systematic review. A systematic review and meta-analysis of randomized controlled trials was conducted involving adult patients with distal ureteric stones. A total of six studies have been included, and quality assessment has been performed individually. Subgroup analyses were made using forest plots and funnel plots to study the odds ratios (ORs), confidence intervals (CIs), and heterogeneity of the articles. The studies included patients treated with various agents (tamsulosin, silodosin, tadalafil, and mirabegron) for up to four weeks. The primary outcome was the expulsion rate of the stones. Secondary outcomes included stone expulsion time (SET), analgesic use, hospital visits, and adverse effects. For the stone expulsion rate (SER), in the mirabegron subgroup, an overall pooled OR of 0.98 (95% CI: 0.26-3.66) with high heterogeneity was obtained (I² = 79%, p = 0.02), indicating substantial variability among the included studies. This could be due to the limited number of studies that require further investigation through a sensitivity analysis. In the tadalafil subgroup, an overall pooled OR of 1.79 (95% CI: 0.62-5.14) was obtained with tadalafil showing a better trend toward outcomes compared to alpha-blockers, but the result was not statistically significant. For the secondary outcomes, the tadalafil subgroup showed a significant reduction in the SET compared to alpha-blockers, with a pooled mean difference (MD) of -2.08 days (95% CI: -3.14 to -1.02), indicating no heterogeneity. However, the mirabegron subgroup obtained a pooled MD of 0.16 days (95% CI: -6.06 to 6.38) with very high heterogeneity (I² = 97%, p < 0.0001), suggesting large variability between the studies and no statistically significant difference in expulsion time between mirabegron and alpha-blockers. For the amount of analgesia used, an overall MD of 4.54 mg (95% CI: -53.19 to 62.27) was obtained, indicating no statistically significant difference in analgesic use between the newer drugs and alpha-blockers (p = 0.88). The frequency of adverse effects was noted more in the alpha-blocker group, with significant ejaculation and orthostatic hypertension noted in silodosin only, and insignificant side effects in both the mirabegron and tadalafil groups. It is concluded from this study that tadalafil is clinically better than alpha-blockers in the MET of distal ureteric stones of <10 mm. Tadalafil has a higher SER and a lower expulsion time, and requires a reduced amount of analgesia. However, given that pooled results are not statistically significant, the following require further evaluation. On the contrary, alpha-blockers are still better than mirabegron, but again, this is not statistically significant enough to prove their supremacy.

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Introduction: Phosphodiesterase type 5 inhibitors (PDE5-I) has known to be the treatment for erectile dysfunction (ED), whereas tadalafil is a PDE5-I that has a rapid onset of action with a long duration of action and is not affected by dietary intake. L-arginine is a supplement that can improve erectile function by increasing the endogenous amino acids required for ideal nitric oxide (NO) synthesis and production. The combination of tadalafil and L-arginine can improve erectile function and testosterone levels. Thus, we conducted a meta-analysis to determine the efficacy and safety of the tadalafil and L-arginine combination therapy compared to tadalafil monotherapy for ED. Methods: This meta-analysis study is consistent with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A total of four included studies were found by performing a systematic search thoroughly on Embase, MEDLINE, and Scopus databases. This study’s protocol is registered on PROSPERO (CRD42022343590). Result: The study analysis revealed that the The International Index of Erectile Dysfunction 5 (IIEF-5) scores in the tadalafil and L-arginine combination therapy significantly increased the IIEF-5 scores (p < 0.00001; MD 1.64; 95% CI: 1.13-2.15) compared to tadalafil monotherapy. Testosterone levels were also observed to increase in the tadalafil and L-arginine combination therapy group (p < 0.00001; MD 3.05; 95% CI: 2.05-4.04). Conclusion: A significant increase in IIEF-5 score and testosterone level is observed in patients with ED who received combination therapy of tadalafil and L-arginine compared to tadalafil monotherapy.

Abstract licence: CC BY-NC-ND 4.0