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What is Use of tadalafil is contraindicated in: and explain in detail?
Ans. b. Unstable/Symptomatic anginaRef: Goodman Gilman 12th e/P. 841Nitrates increase cyclic GMP production by stimulation of guanylate cyclase via NO. This cyclic GMP is responsible for vasodilation.Cyclic GMP is metabolized by PDE-5 and hence PDE-5 inhibitors like sildenafil and tadalafil can significantly increase cyclic GMP producing fatal hypotension.Thus tadalafil is contraindicated with nitrates and hence unstable/symptomatic angina is the best answer.