Subarachnoid hemorrhage associated with tadalafil

Abstract

Tadalafil is a phosphodiesterase type-5 (PDE5) inhibitor indicated for the treatment of erectile dysfunction. Inhibition of the PDE5 isoenzyme, which is responsible for degradation of cyclic guanosine monophosphate in the corpus cavernosum, will ultimately enhance the effect of nitric oxide and, consequently, the relaxation of the vascular smooth muscle in the corpus cavernosum and penile erection after sexual stimulation. Tadalafil is the longest-acting PDE5 inhibitor, with an elimination half-life of 17.5 hours and up to 36 hours’ duration of effect. The drug has been associated with headache, flushing, dizziness, visual disturbances, and hypotension.1

A 45-year-old previously healthy man arrived at the emergency department with a severe headache of five hours’ duration associated with one episode of vomiting. There was no decrease in the level of consciousness, no focal neurologic deficit, and no convulsive activity. The patient was...