Urology Medical News about Erectile Dysfunction; Cardiovascular Diseases; Phosphodiesterase-5 Inhibitors

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Managing Erectile Dysfunction in Patients With Cardiovascular Diseases: The Efficacy and Safety of Phosphodiesterase-5 Inhibitors
American Journal of Lifestyle Medicine, 05/13/09

Cheng JWM et al. - Patients with cardiovascular disease have a high prevalence of erectile dysfunction. Recent evidence demonstrated that erectile dysfunction is an early indication of coronary artery disease. Phosphodiesterase-5 (PDE-5) inhibitors when used together with nitrates or other vasodilators such as alpha-antagonists may cause hypotension. Clinical studies demonstrated that in patients with stable coronary artery disease, heart failure, and hypertension controlled by medications who were not receiving nitrates, PDE-5 inhibitors were well tolerated. PDE-5 inhibitors are absolutely contraindicated with concurrent nitrate use. No PDE-5 inhibitors should be administered within 12 hours after the last nitrate dose. If a patient develops chest pain while taking PDE-5 inhibitors, nitrates should be administered only after the PDE-5 inhibitors have been washed out of the system, based on the half-life of individual agents (washed-out period for sildenafil 20 hours; vardenafil 24 hours; tadalafil 88 hours). If symptomatic hypotension occurs, patients should be put in a Trendelenburg position. Fluid resuscitation therapy and alpha-agonists should be used to support blood pressure, if necessary.

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