A Case of Central Serous Chorioretinopathy after Tadalafil Treatment

PURPOSE: To describe a patient who presented with central serous chorioretinopathy after 2 months of tadalafil administration without any other underlying disease or medication. CASE SUMMARY: A 49-year-old male patient was transferred from a local clinic with metamorphopsia and decreased visual acuity in the right eye. His visual acuity was 6/20 in the right eye and 18/20 in the left eye. The fundus examination showed a large serous detachment between the superior and inferior blood vessel arcades in the right retina. In his medical history, he used tadalafil three times a week for 2 months. His medication was then stopped, and a follow-up examination was scheduled. After 2 months, a fundus examination showed resolution of the subretinal fluid, and his corrected visual acuity recovered to 20/20. CONCLUSIONS: Tadalafil (Cialis®) is a phosphodiesterase (PDE)-5 inhibitor and predominantly prescribed for the treatment of erectile dysfunction. PDE–5 inhibitors may be potent vasodilators in the retina and choroid, and may induce choroidal vessel engorgement leading to leakage across the retinal pigment epithelium and accumulation of subretinal fluid in selected patients. When making a diagnosis as central serous chorioretinopathy, the physician should confirm the causative drugs that are easy to miss, by performing a thorough review of the patient's medical history and promptly terminating the causative drugs.

Physical profile of counterfeit tablets Viagra® and Cialis®

The profile of tablets containing an active pharmacological ingredient can be obtained using different sets of properties, including physical and chemical aspects. The first measurements carried out on tablets are the physical characteristics also called post-tabletting batch (post-TB) characteristics. These data may be valuable to assist in the detection of pharmaceutical product forgery and may also be used in a forensic intelligence perspective when inserted into databases. This work is focused on the physical characteristics of Cialis® and Viagra® tablets seized by the Brazilian Federal Police in the Rio Grande do Sul state. Using the F-test (ANOVA), all samples of counterfeit Viagra® (n = 28) and Cialis® (n = 40) were well distinguished from authentic samples by the following post-TB characteristics: length (major and minor), thickness, and mass. Using the exploratory statistical technique of Hierarchical Cluster Analysis (HCA), tablets with similar physical profiles were grouped. This result may indicate a common illicit production. We observed the validity of using post-TB properties to generate - in a fast and reliable manner and with no sample preparation - a technological profile that joins itself to the other analytical methods assisting in routine forensic detection of counterfeit Viagra® and Cialis®.

Perfil para medicamentos na forma farmacêutica comprimidos contendo uma substância ativa pode ser obtido usando diferentes conjuntos de propriedades, incluindo aspectos físicos e químicos. As primeiras medições realizadas em comprimidos são de características físicas, também chamadas características pós-compressão. Tais dados podem ser valiosos para auxiliar na detecção de falsificações de medicamentos e ser utilizados em uma perspectiva de inteligência forense, quando inseridos em bancos de dados. Este trabalho está focado nas características físicas dos comprimidos de Cialis® e Viagra® apreendidos pela Polícia Federal no Estado brasileiro do Rio Grande do Sul. Com o emprego do Teste de Fisher (ANOVA), todas as amostras falsificadas de Viagra® (n = 28) e de Cialis® (n = 40) foram diferenciadas das amostras autênticas pelas seguintes características pós-compressão: comprimento (maior e menor), espessura e massa. Utilizando-se a Análise Hierárquica de Cluster (AHC), os comprimidos com perfis físicos semelhantes foram agrupados, o que pode indicar uma produção ilícita em comum. Observou-se a validade da utilização das características pós-compressão para gerar, de um modo rápido, confiável e sem preparo de amostra, um perfil tecnológico que se una aos demais métodos analíticos utilizados na rotina forense de detecção de falsificações de Cialis® e de Viagra®.