Sildenafil citrate and blood-pressure–lowering drugs: results of drug interaction studies with an organic nitrate and a calcium antagonist

Webb, David J.; Freestone, S.; Allen, Michael J.; Muirhead, Gary J.

doi:10.1016/s0002-9149(99)00044-2

Cited by 311 publications

(196 citation statements)

References 15 publications

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“…Concomitant use of both nitrates and sildenafil is strictly contra-indicated, as sildenafil potentiates the hypotensive effects of nitrates. 18 The observation that nitrate use was a determinant for sildenafil discontinuation is therefore consistent with the perception that co-use between both products should be avoided.…”

Section: Discussionsupporting

confidence: 76%

Incidence and determinants of sildenafil (dis)continuation: the Dutch cohort of sildenafil users

et al. 2002

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Sildenafil utilization was prospectively evaluated among 153 men with a history of erectile dysfunction (ED)-prescription drug use prior to starting sildenafil and 164 men who were new starters of ED-prescription drugs. Further, some determinants of sildenafil discontinuation were identified. During a median follow-up period of 18 months 45% of all patients discontinued sildenafil treatment, regardless of earlier treatment history. However, patients with a history of drug treatment for ED were nearly eight times as likely to switch or re-start another EDprescription drug after discontinuing sildenafil compared to previously untreated users. Age > 60 y, diabetes medication, nitrate use, and use of incontinence pads (a proxy for disease=surgery in the pelvic region) were associated with an increased likelihood of discontinuing sildenafil. Although the introduction of sildenafil reduced the barrier to seek medical help for erectile problems, sildenafil treatment failure in previously untreated patients results in a high dropout rate from further ED drug treatment of any kind.

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Section: Discussionsupporting

confidence: 76%

Incidence and determinants of sildenafil (dis)continuation: the Dutch cohort of sildenafil users

et al. 2002

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“…Occasionally, sildenafil can induce reductions in blood pressure, which are generally modest and not associated with cardiovascular compromise. 13 The exception is in patients taking nitrates in whom a synergistic hypotensive effect can occur that could potentially be clinically significant. 13,14 The concurrent use of nitrates and sildenafil is therefore contraindicated.…”

Section: Discussionmentioning

confidence: 99%

“…13 The exception is in patients taking nitrates in whom a synergistic hypotensive effect can occur that could potentially be clinically significant. 13,14 The concurrent use of nitrates and sildenafil is therefore contraindicated. 15 Although over one-third of the patients in the sildenafil group (n ¼ 97, 36%) had either stabilized hypertension or a past or present history of ischemic heart disease concurrent with ED, cardiovascular AEs of all causalities (other than flushing) occurred at comparable rates in the sildenafil (5.9%) and placebo (5.5%) treatment groups.…”

Section: Discussionmentioning

confidence: 99%

Tolerability and safety profile of sildenafil citrate (Viagra®) in Latin American patient populations

2002

Int J Impot Res

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Safety data from 546 men with erectile dysfunction (ED) enrolled in three double-blind, placebocontrolled studies conducted in distinct regions of Latin America were pooled and analyzed. The most commonly reported adverse events of all causalities associated with sildenafil treatment were headache (19%), flushing (14%), dyspepsia (6%), and nasal congestion (4%), reflecting the inhibitory effects of sildenafil on cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5) in the peripheral vasculature, gastroesophageal sphincter, and nasal mucosa. Visual symptoms were reported in 5.5%, reflecting sildenafil's minor inhibitory effects on cGMPspecific PDE6 in the retina. These adverse events were generally transient and mild, and rarely resulted in discontinuation of sildenafil therapy. Thus, in this representative sample of Latin American men with ED, including those with concomitant stable cardiovascular disease, sildenafil treatment was well tolerated with an incident rate of adverse events similar to reports from other patient populations.

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“…Furthermore, Webb et al [24] reported that the concomitant use of glyceryl trinitrate and sildena®l caused systolic blood pressure decreases of >25 mmHg or severe hypotensive symptoms in 11 of 12 healthy men. Therefore, the combination of SNP and sildena®l should not be recommended as an alternative in patients with ED, although signi®cant synergistic effects for such patients based on the present in vitro results would be expected.…”

Section: Discussionmentioning

confidence: 99%

Synergistic effects of sildenafil on relaxation of rabbit and rat cavernosal smooth muscles when combined with various vasoactive agents

Seo¹,

Kim²,

Jun³

et al. 2001

BJU International

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Objective To evaluate which vasoactive agents have synergistic effects on the cavernosal smooth muscles of rabbits and rats when the agents are combined with sildena®l. Materials and methods Relaxation responses of cavernosal smooth muscle to single agents (phentolamine, moxisylyte, sodium nitroprusside, forskolin, vasoactive intestinal peptide, VIP, papaverine and sildena®l) in the rabbit, and prostaglandin-E 1 and sildena®l in the rat, and to combinations of each agent plus sildena®l, were assessed in vitro. The response to sildena®l of the rabbit strips with and without incubation with L-arginine (1 mmol/L) for 20 min was also evaluated. The effective concentrations for a half-maximal response of single agents and combination solutions were compared. Results All single agents induced concentrationdependent relaxation of the rabbit and rat cavernosal smooth muscles. There was signi®cant synergism on rabbit cavernosal smooth muscle when the sildena®l was combined with forskolin, sodium nitroprusside, VIP or phentolamine.There was also signi®cant synergism with sildena®l plus prostaglandin-E 1 in rat cavernosal muscles. There were no synergistic effects of combinations of sildena®l plus moxisylyte, papaverine or L-arginine.Conclusions These results suggest potentially effective combined therapies of sildena®l and intraurethral or intracavernosal prostaglandin-E 1 , intracavernosal forskolin or VIP, or oral phentolamine for patients with erectile dysfunction who have no success after monotherapy with these agents.

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Sildenafil citrate and blood-pressure–lowering drugs: results of drug interaction studies with an organic nitrate and a calcium antagonist

Cited by 311 publications

References 15 publications

Incidence and determinants of sildenafil (dis)continuation: the Dutch cohort of sildenafil users

Incidence and determinants of sildenafil (dis)continuation: the Dutch cohort of sildenafil users

Tolerability and safety profile of sildenafil citrate (Viagra®) in Latin American patient populations

Synergistic effects of sildenafil on relaxation of rabbit and rat cavernosal smooth muscles when combined with various vasoactive agents

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