Tadalafil for Sarcoidosis Associated Pulmonary Hypertension

Inclusion Criteria: * Biopsy proven sarcoidosis * Mean pulmonary artery pressure \> 25 mmHg at rest or greater than 30 mmHg with exercise by right heart catheterization within 1 year prior to entry into study * Pulmonary capillary wedge pressure ≤ 15 mmHg * PVR values ≥ 3.0 Woods units * Forced vital capacity (FVC) \> 40% predicted * Forced expiratory volume in 1 second (FEV1) \> 40% predicted * WHO functional class II or III * Stable sarcoidosis treatment regimen for three months prior to entry into study * 6 minute walk distance between 150-450 meters * Stable dose of antihypertensive medications * On no other medication to treat PAH (sildenafil, vardenafil, treprostinil, epoprostenol, iloprost, bosentan, ambrisentan) within one month prior to enrollment and during duration of the study * Non-pregnant females Exclusion Criteria: * Exercise limitation related to a non-cardiopulmonary reason (e.g. arthritis) * Severe systemic hypertension \> 170/95 * Severe systemic hypotension \< 90/50 * History of priapism * Patients with congestive heart failure (left ventricular dysfunction) LVEF \< 45% by echocardiogram * Anticipation by the investigator for escalation in sarcoidosis treatment during the course of the study * Pulmonary hypertension related to etiology other than sarcoidosis (i.e. HIV, scleroderma, chronic thromboemboli) * Use within 1 month of an sildenafil or vardenafil * WHO functional class IV status * Patients with severe other organ disease felt by investigators to impact on survival during the course of the study * Subjects with liver function abnormalities (ALT or AST \> 3 times the upper limit of normal at screening or at baseline) or chronic liver disease * Advanced kidney failure (GFR \< 30 ml/min at screening or at baseline) * History of hypersensitivity reaction or adverse effect related to tadalafil * Pregnant or lactating women * Concomitant use of nitrates (any form) either regularly or intermittently * Concomitant use of potent CYP3A inhibitors (eg, ritonavir, ketoconazole, itraconazole) * Any additional contraindications and precautions specified in the package inserts for Tadalafil (Adcirca) not listed above