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drug interaction(s) of nitrates with phosphodiesterase-5-inhibitors

Drug interactions: - hypotension can be life threatening. Management: 1) not taking the two medications in close temporal proximity may minimize interaction [3] 2) allow 24 hours after sildenafil (Viagra) or vardenaril (Levitra) or 48 hours after Cialis prior to administering a nitrate (longer if hepatic or renal insufficiency) - ok to prescribe sildenafil or vardenaril for elderly prescribed nitroglycerin provided patient is cautioned not to take sildenafil or vardenari within 24 hours of nitroglycerin use [2]* 3) allow 5 days after stopping long-acting nitrate prior to taking Viagra, Levitra or Cialis * says nothing about the case of patient sensing a need for nitroglycerin after taking sildenafil or vardenaril

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DRUGS: nitrate phosphodiesterase-5 inhibitor

References

  1. Prescriber's Letter 11(8): 2004 Nitrates and Phosphodiesterase Type Five Inhibitors Detail-Document#: 200812 (subscription needed) http://www.prescribersletter.com
  2. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  3. Holt A et al. Adverse events associated with coprescription of phosphodiesterase type 5 inhibitors and oral organic nitrates in male patients with ischemic heart disease: A case-crossover study. Ann Intern Med 2022 Apr 19; [e-pub]. PMID: 35436155 https://www.acpjournals.org/doi/10.7326/M21-3445