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    Tadalafil is an annulated 2,5-diketopiperazine. [25] It is also a 1,2,3,4-tetrahydro-β-carboline. Tadalafil can be synthesized starting from (D)-tryptophan methyl ester and piperonal via a Pictet–Spengler reaction. This is followed by condensations with chloroacetyl chloride and methylamine to complete the diketopiperazine ring: [26]

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    Macitentan/tadalafil, sold under the brand name Opsynvi, is a fixed dose combination medication used for the treatment of pulmonary arterial hypertension. [3] It contains macitentan , an endothelin receptor antagonist (ERA); and tadalafil , a phosphodiesterase 5 (PDE5) inhibitor .

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