Tadalafil
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First report of pulmonary embolism: case report A 54-year-old man developed pulmonary embolism during treatment with oral tadalafil for erectile dysfunction. The man started receiving oral tadalafil 20 mg/day and, within 1 hour of receiving his first dose, he developed sudden onset of left lower chest pain, haemoptysis and dyspnoea on exertion; his symptoms developed before any attempt of sexual contact. He presented to an emergency room, where investigations revealed tachycardia. He had decreased breathing sounds in his left lower lung field. His C-reactive protein level was 51.7 mg/dL. A chest x-ray revealed an illdefined density in his left lower lung along with a blunted costophrenic angle. The man was diagnosed with community-acquired pneumonia and started receiving IV moxifloxacin. However, sputum studies showed negative aerobic culture, Gram stain and acid-fast stain. An ECG revealed the S1Q3T3 pattern. Pulmonary embolism was suspected and a chest CT scan showed bilateral lower lobe segmental emboli with small pleural effusion and dependent atelectasis. Laboratory investigations revealed the following: D-dimer level 254 ng/mL, protein C 50%, protein S 70% and lupus anticoagulant level < 1.2. He received SC enoxaparin sodium for pulmonary embolism, followed by adjusted dose of warfarin. He subsequently showed a complete recovery. Author comment: "[W]e have classified our case as tadalafil-induced possible [pulmonary embolism], because the score is 6 according to the Naranjo probability scale. . . the temporal relationship between the start of taking tadalafil and ischemic symptoms suggests a causal relation." Chen H-C, et al. Pulmonary embolism after tadalafil ingestion. Pharmacy World 801133026 and Science 30: 610-612, No. 5, Oct 2008 - Taiwan
» Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of pulmonary embolism associated with tadalafil. The WHO Adverse Drug Reactions database contained one report of pulmonary embolism associated with tadalafil.
0114-9954/10/1229-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 22 Nov 2008 No. 1229
