A large retrospective cohort study found an erectile dysfunction (ED) drug commonly used to treat urinary symptoms associated with an enlarged prostate may be associated with increased glaucoma risk.
Published in the British Journal of Ophthalmology, the study’s authors suggested that men given tadalafil (Cialis) long term for this indication may need careful eye health monitoring, especially those with glaucoma risk factors such as family history or ocular hypertension.
Tadalafil belongs to a class of drugs called phosphodiesterase type-5 inhibitors (PDE5i), the same group as sildenafil (Viagra). While these medications have previously been linked to certain eye conditions, evidence connecting tadalafil with glaucoma has remained inconclusive, authors said.
Drawing from the TriNetX database, researchers analysed anonymised health data from men aged 40 and over. The cohort included 36,927 tadalafil users and 36,927 matched non-PDE5i users.
Over up to five years of follow-up, tadalafil use was associated with an increased risk of glaucoma (22%) compared with non-PDE5i use. Elevated risks were observed for ocular hypertension (32%), primary open-angle glaucoma (33%) or requiring glaucoma treatment (33%). No significant associations were found for low-tension or primary angle-closure glaucoma.
The associations remained consistent in further analyses, including among men aged 50 and over and those who developed glaucoma within months of beginning treatment. Noting that most participants were European, the findings may not apply equally to other ethnic groups, the authors cautioned.
The results do not mean tadalafil should be avoided, they stressed, but the findings do suggest that long-term PDE5i use may affect eye health and warrant further investigation.
A kiwi ophthalmologist asked Glaucoma NZ to highlight this research having treated a glaucoma patient who was prescribed Cialis. Whilst he was on Cialis he saw his regular ophthalmologist for his glaucoma check and his IOPs (intraocular pressure) had risen from the mid teens to the mid twenties! The doctor at the men’s clinic didn’t ask him about glaucoma or warn him of the possible glaucoma side effects. In his case, he stopped the Cialis, and required SLT (Selective Laser Trabeculoplasty) to get the IOP back to where it had been.
This article and patient story is a reminder of the importance of good (excellent) communication between you and your health professional, or if you are a health professional, between you and your patient.
If you have any questions or concerns, write them down and share these with your health professional during your appointment. If they don’t have time to answer them, they may direct you to their nurse or support staff, download fact sheets, or brochures.
We recommend you take a record of your medications & health issues to all healthcare appointments and seek further evidence based data & understanding from reputable patient organisations, like Glaucoma NZ or in this case, the Mens Health Clinic NZ.