Similar to sildenafil and vardenafil, tadalafil is a type 5 selective PDE inhibitor. It is given orally to treat male erectile dysfunction (ED), pulmonary arterial hypertension (PAH), benign prostatic hypertrophy (BPH), or to treat both ED and BPH simultaneously. Unlike several impotence medications, tadalafil does not suppress prostaglandins (e.g., alprostadil). Tadalafil, which is more selective for PDE5 than for PDE6 found in the retina, has not been associated with visual abnormalities, in contrast to sildenafil. Tadalafil appears to have a longer half-life of effect than sildenafil and vardenafil for the treatment of ED (up to 36 hours). Tadalafil’s longer duration of action permits more spontaneity in sexual engagement because PDE inhibitors only induce erection when sexual stimulation is present. Oral phosphodiesterase type 5 inhibitors (PDE5 inhibitor) are the first-line treatment for ED, according to therapeutic recommendations. 1 Phase II clinical trials for the treatment of female erectile dysfunction with tadalafil were terminated. Male erectile dysfunction (ED) was given FDA approval in November 2003, and in January 2008, approval for once-daily usage without consideration to timing of sexual activity was given. In May 2009, the FDA granted approval for the use of tadalafil (Adcirca) to treat pulmonary arterial hypertension (PAH). Patients receiving tadalafil had better exercise tolerance and less clinical deterioration compared to placebo in clinical tests of people with pulmonary arterial hypertension (PAH). Tadalafil was given FDA approval in October 2011 to treat both erectile dysfunction and benign prostatic hyperplasia (BPH), as well as its symptoms and signs.