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

Purpose of ReviewThis 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 FindingsThis 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.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.

Automated summary

The review aims to define the mechanism of drug-drug interaction between PDE-5 inhibitors and organic nitrates, as well as its clinical impact and recommended management in different clinical scenarios. Studies have shown that this interaction can cause significant hypotension during episodic PDE-5 use and acute nitrate administration, particularly in cardiovascular emergencies. Despite contraindication, some patients have been observed to chronically co-administer long-acting nitrates and PDE-5 inhibitors without adverse effects. Acute nitrate therapy should be avoided when PDE-5 exposure is present, and the risk of lower-intensity daily PDE-5 administration needs further investigation.