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

^* To whom correspondence should be addressed. E-mail: judy.cheng{at}mcphs.edu.

	Abstract

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 ~20 hours; 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.

First published on February 3, 2009, doi:10.1177/1559827608331164

American Journal of Lifestyle Medicine 2009;3:201.

A more recent version of this article appeared on May 1, 2009


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