Use of sildenafil (Viagra) in patients with cardiovascular disease

Cheitlin,; Am, Hutter; Rg, Brindis; Ganz, Patricia A.; Kaul, Sanjay; Ro, Russell; Rm, Zusman

doi:10.1016/s0735-1097(98)00656-1

Cited by 431 publications

(220 citation statements)

References 22 publications

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“…The action of GTN is potentiated by any intervention that may delay breakdown of cGMP, notably by any drug that inactivates phosphodiesterase in smooth muscle, including sildenafil. 5 In clinical studies, leading up to release of sildenafil interaction between nitrates and sildenafil, both drugs were administered in conventional dosages to volunteers. Clinically significant hypotension was noted in a substantial number.…”

Section: Discussionmentioning

confidence: 99%

“…Sildenafil has been shown to be effective and well tolerated in individuals with and without cardiovascular disease 1,2 and in patients receiving concomitant antihypertensive medication including arterial vasodilators. 3,4 However, since sildenafil inhibits PDE 5 to a lesser degree at other sites than the corpus cavernosum, it has the potential to exaggerate the vasodilator effects of nitric oxide donor drugs such as glyceryl trinitrate (GTN). 5 Therefore, it has been recommended that sildenafil should not be administered to patients taking nitrates since the combination of the two drugs may cause major drops in arterial blood pressure.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 However, since sildenafil inhibits PDE 5 to a lesser degree at other sites than the corpus cavernosum, it has the potential to exaggerate the vasodilator effects of nitric oxide donor drugs such as glyceryl trinitrate (GTN). 5 Therefore, it has been recommended that sildenafil should not be administered to patients taking nitrates since the combination of the two drugs may cause major drops in arterial blood pressure. 6,7 The American College of Cardiology/American Heart Association (ACC/AHA) Expert Consensus Document 5 warns that "the vasodilator actions of nitrates are profoundly amplified with concomitant use of sildenafil, resulting in major hemodynamic compromise and potentially fatal events."…”

Section: Introductionmentioning

confidence: 99%

“…5 Therefore, it has been recommended that sildenafil should not be administered to patients taking nitrates since the combination of the two drugs may cause major drops in arterial blood pressure. 6,7 The American College of Cardiology/American Heart Association (ACC/AHA) Expert Consensus Document 5 warns that "the vasodilator actions of nitrates are profoundly amplified with concomitant use of sildenafil, resulting in major hemodynamic compromise and potentially fatal events." The document warns that administration of a nitrate within 24 h of using sildenafil is contraindicated.…”

Section: Introductionmentioning

confidence: 99%

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Potential for use of pulse wave analysis in determining the interaction between sildenafil and glyceryl trinitrate

O’Rourke

Nichols

2002

Clinical Cardiology

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Background: The early part of the central aortic pressure pulse, with amplitude (PI – Pd), is generated by left ventricular ejection, while the latter part (or augmented pressure), with amplitude (Ps – Pi), is generated by the reflected wave arriving during systole. The effects of arterial vasodilator agents, especially nitrates, on central aortic systolic blood pressure are grossly underestimated by sphygmomanometric measurements of brachial artery pressure. Hypothesis: The objective of this study was to investigate the potential for use of central arterial pulse wave analysis, obtained noninvasively from the radial pulse, in determining the interaction between sildenafil and the nitric oxide donor drug glyceryl trinitrate (GTN). Methods: Central aortic pressure waveforms were generated from noninvasively measured radial artery pressure waveforms and subjected to pulse wave analysis to determine the interactionbetween sildenafil and transdermally applied GTN. Results: Transdermal GTN (2.5, 5.0, and 15 mg per 24‐h patches) alone caused no consistent change in sphygmomanometer‐determined systolic or diastolic pressures, but there was a consistent, dose‐related fall in amplitude of the augmented systolic pressure, (Ps – Pi), of 4.0,7.0, and 11 mmHg, respectively, with little change in diastolic pressure. The 2.5 mg patch caused a fall of 4.0 mmHg in aortic systolic pressure, while augmentation index (AIx) fell from 20 to 11% and pulse pressure fell 18%. When oral sildenafil (50 mg) was administered after GTN (2.5 mg), aortic systolic pressure fell another 4.0 mmHg. This decrease in systolic pressure caused a fall in AIx to almost 0.0%; pulse pressure fell another 9.0%. Conclusion: These modifications in aortic systolic and pulse pressure are due primarily to reduction in wave‐reflection amplitude and are not detected by sphygmomanometer‐measured brachial artery pressure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Potential for use of pulse wave analysis in determining the interaction between sildenafil and glyceryl trinitrate

O’Rourke

Nichols

2002

Clinical Cardiology

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“…Viagra is metabolized predominantly by cytochrome P450 3A4 hepatic microsomal enzymes, and effects can, therefore, be potentiated by such inhibitors. 1 Cannabidiol is a major constituent of cannabis and is a known inhibitor of the cytochrome 3A4 isoenzyme. 2 Following up on the case described recently by Porter et al, 3 we report the case of a relatively young man with no history of ischemic heart disease and a low risk factor profile, who presented with a myocardial infarction 12 h after taking Viagra in combination with cannabis.…”

Section: Introductionmentioning

confidence: 99%

Myocardial infarction following the combined recreational use of viagra® and cannabis

McLeod

McKenna

Northridge

2002

Clinical Cardiology

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SummarySildenafil citrate (Viagra ® ,Pfizer, Inc., New York, N.Y.) is widely prescribed as a treatment for male erectile dysfunction. It is metabolized predominantly by the cytochrome P450 3A4 hepatic microsomal isoenzyme and effects can, therefore, be potentiated by such inhibitors. The vasodilatory effects of Viagra necessitate caution in its use in patients with cardiovascular disease and it is contraindicated in patients receiving nitrates. Previous literature has drawn attention to Viagra use and myocardial infarction. This paper reports the case of a young man who presented with a myocardial infarction after taking Viagra in combination with cannabis, a known inhibitor of the cytochrome P450 3A4 isoenzyme.

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Assessing Sexual Dysfunction, Part 1: Male Sexual Dysfunction

Cohen¹,

Mandel²,

Samadi³

2016

AMA Guides® Newsletter

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To properly assess men and women with sexual dysfunction, evaluators should take a biopsychosocial approach that may require consultation with multiple health care professionals from various fields in order to get to the root of the sexual dysfunction; this multidisciplinary methodology offers the best chance of successful treatment. For males, this article focuses on erectile dysfunction (ED) and hypogonadism. The initial evaluation of ED involves a thorough case history, preferably taken from the patient and partner, physical examination, and proper laboratory and diagnostic tests, including an acknowledgment of the subjective complaint. The diagnosis is established on the basis of an individual's report of the consistent inability to attain and maintain an erection sufficient to permit satisfactory sexual intercourse. Initial workups for ED should entail a detailed history that can be obtained from a validated questionnaire such as the International Index of Erectile Function and the Sexual Health Inventory for Men. Hypogonadism is evaluated using the validated Androgen Deficiency in the Aging Male questionnaire and laboratory testing for testosterone deficiency. Treatments logically can begin with the least invasive and then progress to more invasive strategies after appropriate counseling. The last and most important treatment component when caring for men with sexual dysfunction—and, arguably, the least practiced—is close follow-up.

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Use of sildenafil (Viagra) in patients with cardiovascular disease

Cited by 431 publications

References 22 publications

Potential for use of pulse wave analysis in determining the interaction between sildenafil and glyceryl trinitrate

Potential for use of pulse wave analysis in determining the interaction between sildenafil and glyceryl trinitrate

Myocardial infarction following the combined recreational use of viagra® and cannabis

Assessing Sexual Dysfunction, Part 1: Male Sexual Dysfunction

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