| Pulmonary arterial hypertension

Adcirca vs Letairis

Side-by-side clinical, coverage, and cost comparison for pulmonary arterial hypertension.

Deep comparison between: Adcirca vs Letairis with Prescriber.AI

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Safety signalsLetairis has a higher rate of injection site reactions vs Adcirca based on FDA-approved prescribing information

Coverage gaps3 major payers require step therapy for Letairis but not Adcirca, including UnitedHealthcare

Category

Adcirca

Letairis

At A Glance

RouteOral

FrequencyDaily

ClassPDE5 inhibitor

RouteOral

FrequencyDaily

ClassEndothelin receptor antagonist

Indications

Pulmonary arterial hypertension

Pulmonary arterial hypertension

Dosing

Pulmonary arterial hypertension 40 mg (two 20 mg tablets) once daily with or without food; dividing the dose over the course of the day is not recommended. Start at 20 mg once daily for mild or moderate renal impairment (creatinine clearance 31 to 80 mL/min), increasing to 40 mg based on tolerability; avoid use in severe renal impairment. Start at 20 mg once daily for mild or moderate hepatic impairment (Child Pugh Class A or B); avoid in severe hepatic impairment. For patients on ritonavir >=1 week, start at 20 mg once daily and increase to 40 mg based on tolerability.

Pulmonary arterial hypertension Initiate at 5 mg once daily, with or without tadalafil 20 mg once daily; titrate at 4-week intervals as needed and tolerated to Letairis 10 mg or tadalafil 40 mg; do not split, crush, or chew tablets.

Contraindications

Concomitant use of any form of organic nitrate, regularly or intermittently
Concomitant use of guanylate cyclase (GC) stimulators such as riociguat
Known serious hypersensitivity to tadalafil (ADCIRCA or CIALIS), including Stevens-Johnson syndrome and exfoliative dermatitis

Pregnancy (Letairis may cause fetal harm when administered to a pregnant female)
Idiopathic Pulmonary Fibrosis, including IPF patients with pulmonary hypertension (WHO Group 3)

Drug Interactions

1155View drug interactions

1116View drug interactions

Adverse Reactions

Most common (>=9%) Headache, myalgia, nasopharyngitis, flushing, respiratory tract infection (upper and lower), pain in extremity, nausea, back pain, dyspepsia, nasal congestion

Serious Hypotension, visual loss, hearing loss, priapism

Postmarketing Serious cardiovascular events (myocardial infarction, sudden cardiac death, stroke, chest pain, palpitations, tachycardia), hypersensitivity reactions (urticaria, Stevens-Johnson syndrome, exfoliative dermatitis), migraine, seizure, transient global amnesia, visual field defect, retinal vein occlusion, retinal artery occlusion, NAION, sudden decrease or loss of hearing, priapism

Most common (>3% placebo-adjusted) Peripheral edema, nasal congestion, sinusitis, flushing

Postmarketing Anemia requiring transfusion, heart failure (associated with fluid retention), symptomatic hypotension, hypersensitivity (angioedema, rash), liver aminotransferase elevations (ALT, AST)

Pharmacology

Tadalafil is a selective inhibitor of phosphodiesterase type 5 (PDE5), the enzyme responsible for degradation of cyclic guanosine monophosphate (cGMP) in pulmonary vascular smooth muscle; by inhibiting PDE5, tadalafil increases cGMP concentrations, resulting in relaxation of pulmonary vascular smooth muscle cells and vasodilation of the pulmonary vascular bed.

Ambrisentan is a high-affinity, selective ETA receptor antagonist that blocks the vasoconstriction and cell proliferation mediated by endothelin-1 (ET-1) in pulmonary vasculature, where ET-1 concentrations and mRNA are markedly elevated in PAH patients.

View Full FDA Information

View full FDA information

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Most Common Insurance

Anthem BCBS

Adcirca