M Toronto Myositis Centreat St. Michael's Hospital
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PDE5 inhibitors

sildenafil (Revatio), tadalafil (Cialis) · say “sil-DEN-a-fil, ta-DAL-a-fil”
For severe Raynaud's & finger ulcers
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For more severe Raynaud's or finger ulcers.

These open blood vessels to improve blood flow to the fingers and toes. They are usually added to, or used after, a calcium channel blocker.

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What it is

More blood flow to fingers and toes.

These medicines widen blood vessels and improve blood flow to the fingers and toes. In myositis and overlap conditions they are used for more severe Raynaud's, and to help prevent and heal finger ulcers. They are usually added to or used after a calcium channel blocker. This use is based on specialist experience.

How to take it
  • A tablet one to three times a day (sildenafil) or once a day (tadalafil). Follow your prescription.
  • Take it consistently at the same times.
  • Your doctor sets the dose to balance benefit against headache or flushing.
What to expect
  • Better blood flow and fewer, milder attacks over a few weeks.
  • It can help finger ulcers heal.
  • The dose is balanced against side effects like headache and a stuffy nose.
Benefits

How it helps you.

Improves blood flow

Opens blood vessels so more blood reaches the fingers.

Helps finger ulcers

Can help prevent and heal painful fingertip ulcers.

A tablet

Taken by mouth.

Combines well

Works alongside a calcium channel blocker.

Adds an option

Useful when the first medicine is not enough.

Risks & side effects

What you should know.

Your doctor chose this because the likely benefits outweigh the risks for you. Here is the honest, full picture.

Common side effects
Headache
Common, and often eases with time.
Flushing
A warm, red face after a dose.
Stuffy nose
A blocked or runny nose.
Indigestion
Mild heartburn or upset stomach.
Serious but uncommon
Low blood pressure
Blood pressure can drop, causing faintness, especially if combined with nitrate medicines.
Vision or hearing changes
Very rarely, sudden vision or hearing changes. Report these right away.
!
Never combine with nitrate medicines.

Do not take a PDE5 inhibitor with any nitrate, such as nitroglycerin ointment, spray, or tablets. Together they can drop your blood pressure to a dangerous level. Tell your team, and any emergency staff, every medicine you take.

Staying safe

Monitoring and precautions.

Regular monitoring
  • Blood pressure is checked.
  • How your fingers and any ulcers are doing is reviewed at visits.
Everyday precautions
  • Never use with nitrates. If you ever need nitroglycerin for chest pain, tell staff you take this medicine.
  • Keep warm and stop smoking.
  • Rise slowly to avoid dizziness.
  • Tell all providers you take it.
When to call your doctor

Contact the clinic if you notice:

Chest pain
Do not take nitroglycerin. Go to the emergency department and tell staff you take a PDE5 inhibitor.
Fainting or severe dizziness
Report this promptly.
A worsening finger ulcer
An ulcer that looks red, swollen, or infected.
Sudden vision or hearing loss
Seek care right away.

Pregnancy & breastfeeding

There is limited information in pregnancy. Tell your doctor if you are pregnant or planning, and your team will weigh the options with you.

!

This guide is for learning, not medical advice. Myositis care is different for everyone, and many of these medicines are used based on specialist experience rather than a formal Canadian myositis approval. Never start, stop, or change a medicine without your own doctor. Your doses are decided with your care team at the Centre.

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