Pediatric Cardiology

, Volume 35, Issue 4, pp 699–704 | Cite as

Comparison of the Therapeutic and Side Effects of Tadalafil and Sildenafil in Children and Adolescents with Pulmonary Arterial Hypertension

  • Mohammad Reza Sabri
  • Elham BeheshtianEmail author
Original Article


Pulmonary arterial hypertension (PAH) is a progressive disease. In recent years, phosphodiesterase type 5 inhibitors such as sildenafil have been used to treat this disease in children. Recently, tadalafil has been used in adults with similar efficacy but it has been used less often in children. This experimental study was carried out in 18 known patients aged 4–24 years in the Emam Hossein Hospital of Isfahan, Iran. All patients had been taking sildenafil for a few months to years. Patients underwent echocardiographic study, the 6-minute walk test (6MWT), and non-invasive pulse oximetry before and after the 6MWT. These tests were repeated again after sildenafil had been switched to tadalafil for 6 weeks. After 6 weeks of tadalafil prescription, the severity of some of the patients’ symptoms decreased, but the New York Heart Association class of the patients did not change more. Mean ± standard deviation (SD) oxygen saturation while taking sildenafil and after 6 weeks of tadalafil were significantly different (p = 0.005). Furthermore, mean ± SD oxygen saturation after the 6MWT while taking sildenafil and after 6 weeks of tadalafil were significantly different (p = 0.036). The mean ± SD distances walked in this test while taking sildenafil and tadalafil were significantly different (p = 0.005). No significant side effects were seen; 15 patients continued tadalafil. Tadalafil may be a safe drug to treat children and young adults with PAH. We did not observe any significant side effects during usage; it improves functional capacity and oxygen saturation better than sildenafil in these patients, and requires fewer daily doses than sildenafil.


Pulmonary arterial hypertension Sildenafil Tadalafil 6-minute walk test 



The Isfahan University of Medical Sciences financially supported this study. We thank the University authorities who offered critical administrative support and managerial services in carrying out the study, and also all the researchers for their help and support.

Conflict of interest

All authors state that they have no conflicts of interest.

Ethical Standards

The authors assert that all procedures contributing to this work complied with the ethical standards of the relevant national guidelines on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008, and has been approved by the institutional committees of Isfahan University of Medical Sciences.


  1. 1.
    Affuso F, Palmieri EA, Di Conza P et al (2006) Tadalafil improves quality of life and exercise tolerance in idiopathic pulmonary arterial hypertension. Int J Cardiol 108:429–431CrossRefPubMedGoogle Scholar
  2. 2.
    Arif SA, Poon H (2011) Tadalafil: a long-acting phosphodiesterase-5 inhibitor for the treatment of pulmonary arterial hypertension. Clin Ther 33:993–1004CrossRefPubMedGoogle Scholar
  3. 3.
    Badesch DB, Champion HC, Gomez Sanchez MA et al (2009) Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol 54:S55–S66CrossRefPubMedGoogle Scholar
  4. 4.
    Barst RJ, McGoon M, Torbicki A et al (2004) Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol 43:S40–S47CrossRefGoogle Scholar
  5. 5.
    Berger RMF, Bonnet D (2010) Treatment options for paediatric pulmonary arterial hypertension. Eur Respir Rev 19(118):321–330CrossRefPubMedGoogle Scholar
  6. 6.
    Cameron IT, Campbell S (1998) Nitric oxide in the endometrium. Hum Reprod Update 4(5):565–569CrossRefPubMedGoogle Scholar
  7. 7.
    Chwalisz K, Garfield RE (2000) Role of nitric oxide in implantation and menstruation. Hum Reprod 15:96–111CrossRefPubMedGoogle Scholar
  8. 8.
    Douwes JM, van Loon RL, Roothooft MT, Berger RM (2011) Pulmonary arterial hypertension in childhood. Ned Tijdschr Geneeskd 155(49):A3901PubMedGoogle Scholar
  9. 9.
    European Medicines Agency.
  10. 10.
    Fraissea A, Jais X, Schleich J-M et al (2010) Characteristics and prospective 2-year follow-up of children with pulmonary arterial hypertension in France. Arch Cardiovasc Dis 103:66–74CrossRefGoogle Scholar
  11. 11.
    Galiè N, Palazzini M, Manes A (2010) Pulmonary arterial hypertension: from the kingdom of the near-dead to multiple clinical trial meta-analyses. Eur Heart J 31:2080–2086PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Garg N, Sharma MK, Sinha N (2007) Role of oral sildenafil in severe pulmonary arterial hypertension: clinical efficacy and dose response relationship. Int J Cardiol 120:306–313CrossRefPubMedGoogle Scholar
  13. 13.
    Hawkins A, Tulloh R (2009) Treatment of pediatric pulmonary hypertension. Vasc Health Risk Manag 5:509–524PubMedCentralPubMedGoogle Scholar
  14. 14.
    Levin YD, White RJ (2011) Novel therapeutic approaches in pulmonary arterial hypertension: focus on tadalafil. Drugs Today (Barc) 47(2):145–156CrossRefGoogle Scholar
  15. 15.
    Roofthooft MT, van Loon RL, Berger RM (2010) Management of pulmonary arterial hypertension in children. Paediatr Respir Rev 11:240–245CrossRefPubMedGoogle Scholar
  16. 16.
    Simonneau G, Robbins IM, Beghetti M et al (2009) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 54(1):S43–S54CrossRefPubMedGoogle Scholar
  17. 17.
    Takatsuki S, Calderbank M, Dunbar Ivy D (2012) Initial experience with tadalafil in pediatric pulmonary arterial hypertension. Pediatr Cardiol 33(5):683–688PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    US Department of Health and Human Services, US Food and Drugs Administration (2012) FDA drug safety communication: FDA recommends against use of Revatio (sildenafil) in children with pulmonary hypertension.
  19. 19.
    van Loon RL, Roofthooft MT, van Osch-Gevers M et al (2009) Clinical characterization of pediatric pulmonary hypertension: complex presentation and diagnosis. J Pediatr 155:176–182CrossRefPubMedGoogle Scholar
  20. 20.
    van Loon RL, Roofthooft MT, Delhaas T et al (2010) Outcome of pediatric patients with pulmonary arterial hypertension in the era of new medical therapies. Am J Cardiol 106:117–124CrossRefPubMedGoogle Scholar
  21. 21.
    Yu YP, Huang XM (2012) Progress in pharmacotherapy of pulmonary arterial hypertension in children. Zhongguo Dang Dai Er Ke Za Zhi 14(3):236–240PubMedGoogle Scholar
  22. 22.
    Yung D (2011) An update on therapies for pediatric pulmonary arterial hypertension. Adv Pulm Hypertens 10(2):9–114Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Pediatrics, and Child Growth and Development Research CenterIsfahan University of Medical SciencesIsfahanIran
  2. 2.School of MedicineIsfahan University of Medical SciencesIsfahanIran

Personalised recommendations