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Managing Erectile Dysfunction in Patients With Cardiovascular Diseases: The Efficacy and Safety of Phosphodiesterase-5 Inhibitors

Massachusetts College of Pharmacy and Health Sciences, Boston, judy.cheng{at}mcphs.edu, Brigham and Women's Hospital, Boston

Selamawit R. Berhane, PharmD

Massachusetts College of Pharmacy and Health Sciences, Boston

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 are effective in managing erectile dysfunction due to cardiovascular disease. However, when used together with nitrates or other vasodilators such as alpha-antagonists, they 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. Therefore, it is important for clinicians to carefully evaluate each patient before initiating PDE-5 inhibitors. 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 20hours; vardenafil 24 hours; tadalafil 88 hours [or 3-4 days]). 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. PDE-5 inhibitors have not been studied in patients with severe and unstable cardiac conditions.

Key Words: phosphodiesterase-5 inhibitors • cardiovascular diseases • safety • erectile dysfunction

This version was published on May 1, 2009

American Journal of Lifestyle Medicine, Vol. 3, No. 3, 201-211 (2009)
DOI: 10.1177/1559827608331164


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