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Phosphodiesterase Type 5 Inhibitors and Oral Nitrates in Male Patients with Ischemic Heart Disease

  • Ischemic Heart Disease (D Mukherjee, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review sought to define the mechanism of the drug-drug interaction between phosphodiesterase-type-5 (PDE-5) inhibitors and organic nitrates as well as the clinical impact and recommended management across different clinical scenarios.

Recent Findings

This drug-drug interaction results in hemodynamically significant hypotension during episodic PDE-5 use and acute nitrate administration mainly during cardiovascular emergencies with multiple studies describing the expected impact. Chronic co-administration of long-acting nitrates and PDE-5 inhibitors has been observed in practice in a small percentage of patients despite the labeled contraindication without noted adverse effects.

Summary

Acute nitrate therapy should be avoided in the context of episodic PDE-5 exposure, likely identified through systematic processes. Few data exist defining risk with lower-intensity daily PDE-5 administration. Chronic co-administration is not recommended but may be navigated with careful risk-benefit determination. Future directions also aim to identify potential areas where nitrate synergy may achieve clinical benefit.

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Authors and Affiliations

  1. Roper St. Francis Healthcare, Charleston, SC, USA

    Matthew J. Morrisette

  2. Department of Pharmacy Services, UVA Health, University of Virginia, PO Box 800674, Charlottesville, VA, 22908-0674, USA

    Steven P. Dunn

Authors
  1. Matthew J. Morrisette
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Correspondence to Steven P. Dunn.

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Morrisette, M.J., Dunn, S.P. Phosphodiesterase Type 5 Inhibitors and Oral Nitrates in Male Patients with Ischemic Heart Disease. Curr Cardiol Rep 25, 553–560 (2023). https://doi.org/10.1007/s11886-023-01873-y

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  • DOI: https://doi.org/10.1007/s11886-023-01873-y

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