Regional cerebral blood flow following single-dose and continuous-dose tadalafil after stroke.
Level 2 - randomized trial
Small randomized trial comparing two dosing regimens with pre-post imaging
PubMed 25208597 · doi:10.1111/ane.12279
What was done
Thirty male patients (mean age 58.3 ± 7.9 years) with erectile dysfunction and a prior stroke underwent baseline Tc-99m-HMPAO SPECT imaging to assess regional cerebral blood flow (rCBF). Patients were randomized to either a single 20 mg dose of tadalafil (n = 15; follow-up SPECT 6 hours post-dose) or 5 mg daily for 7 consecutive days (n = 15; follow-up SPECT 6 hours after the final dose). Perfusion images were evaluated using Statistical Parametric Mapping software.
What was found
All patients exhibited areas of reduced relative rCBF in the stroke-affected hemisphere following tadalafil administration compared to baseline (P < 0.001). There was no statistically significant difference in rCBF changes between the 5 mg daily and single 20 mg dose groups. No specific numeric perfusion values or percentages were reported in the abstract. Perfusion changes were not associated with measured baseline comorbidities or risk factors.
Why it matters
Tadalafil may decrease regional cerebral perfusion in brain tissue adjacent to prior stroke lesions, indicating potential hemodynamic risk when prescribing phosphodiesterase type 5 inhibitors to stroke survivors.
Limits
The study had a small sample size (n = 30) of exclusively male participants and lacked a placebo control group to rule out non-pharmacological or temporal scan-to-scan variations. The abstract does not provide absolute quantitative blood flow values, long-term clinical outcomes, or neurological safety endpoints.
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