Tadalafil Loin Pain Haematuria Syndrome LPHS

Generic name: Tadalafil What is Tadalafil?

Tadalafil is a medication used to treat erectile dysfunction, benign prostate hyperplasia and pulmonary arterial hypertension (PAH).

What is Loin Pain Haematuria Syndrome?

Loin pain haematuria syndrome (LPHS) is a very rare condition that causes severe pain in the loins or flanks (the part of the lower back below the ribs and above the pelvis) and blood in the urine. LPHS affects around 1 in 1,000,000 people in the UK. It was first identified in 1967 but there has been very little research on the condition so it is not well understood as to its cause.

Why use Tadalafil?

Tadalafil has been used with some success in patients with LPHS. However, its use in LPHS is currently unlicensed. The use of unlicensed medication is permitted providing it justified and in the best interests of the patient especially for rare medical conditions.

Consent will be taken after careful explanation of the risks and benefits by a Clinician who is experienced in the use of this drug. You will be monitored closely for effectiveness and any adverse side effects.

Tadalafil belongs to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors. Tadalafil works by relaxing the blood vessels and this is thought to be of help with the pain associated with LPHS.

How is Tadalafil Taken?

• Tadalafil is taken orally, usually once daily.
• It can be taken with or without food.
• Follow your healthcare provider's instructions carefully. Do not change the dose or stop taking the medication without consulting your Consultant Nephrologist.

Dosage:

• The typical dose for used by our centre is to start at 5mg and increased every two weeks to a maximum daily dose of 20mg once daily.
• Your doctor may vary the dose depending on your pain.
• If you have no response to Tadalafil the drug will be discontinued by your Consultant Nephrologist.

Possible Side Effects:

Common side effects may include:

• Headache
• Muscle aches
• Flushing (redness or warmth in the face, neck, or chest)
• Indigestion or upset stomach
• Nasal congestion
• Back pain

Rare but serious side effects:

• Sudden vision loss (could be a sign of non-arteritic anterior ischemic optic neuropathy, NAION)
• Sudden hearing loss or ringing in the ears
• Chest pain, irregular heartbeat, or shortness of breath (seek immediate medical attention)
• Prolonged or painful erection (priapism)

Precautions:

Inform your doctor if you have a history of heart disease, liver or kidney problems, or if you are taking nitrates (e.g., nitro-glycerine) or alpha-blockers. Tadalafil can interact with these medications and cause a dangerous drop in blood pressure.

Avoid alcohol, as it may increase the risk of side effects like dizziness or low blood pressure.

Tadalafil has not been licensed for patients under 18 years but has been used safely for children and young adults with pulmonary arterial hypertension.

Drug Interactions:

• Nitrates (e.g., nitro-glycerine, isosorbide)
• Alpha-blockers (e.g., doxazosin, tamsulosin)
• Antihypertensive medications
• Certain antifungal or antibiotic medications (e.g., ketoconazole, rifampin)
• Grapefruit juice may increase the risk of side effects.