Coital hemorrhage of an arteriovenous malformation after premedication with tadalafil (Cialis)

Thomas D.L. Steeves, Lyell K. Jones, Robert D. Ecker, Edward M. Manno

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Phosphodiesterase type 5 (PDE 5) inhibitors are widely used in the treatment of erectile dysfunction. However, the results on the cerebral vasculature are unknown. Several cases of intraparenchymal hemorrhage in the setting of PDE 5 inhibitor use have been reported. The effect of these agents on the risk of arteriovenous malformation (AVM) hemorrhage is speculative. This report illustrates a possible association between tadalafil (Cialis, Lilly ICOS, Indianapolis, IN), a new long-acting PDE 5 inhibitor, and AVM hemorrhage during coitus. A 59-year-old male suffered a coital intraparenchymal hemorrhage after premedication with tadalafil. Angiography and magnetic resonance imaging demonstrated an underlying right temporoparital AVM. The AVM was excised, and the patient made an uneventful recovery. AVMs are felt to be dynamic lesions that evolve in response to changes in blood flow. Repeated use of PDE 5 inhibitors could induce changes in an AVM that would make it more likely to hemorrhage, particularly in the setting of additional stress from coitus and elevated blood pressure. The potential for risk of devastating neurovascular complications related to PDE 5 inhibitors should be monitored.

Original languageEnglish (US)
Pages (from-to)179-181
Number of pages3
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number4
StatePublished - Jul 1 2005


  • Arteriovenous malformation
  • Coital hemorrhage
  • Tadalafil

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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