Strategies for Managing the Nitroglycerin Sildenafil Drug Interaction

Every now and again, I will run into patients with both angina as well as erectile dysfunction.  The nitroglycerin sildenafil drug interaction is one that should be taken seriously.  Coadministration of these medications should be avoided.  The possible end result of taking these together is very significant hypotension.  Here’s a few considerations I think of when trying to figure out how to manage this drug interaction.

  1. Is the sildenafil really necessary?  Many patients may be on drugs that contribute to erectile dysfunction and those should be assessed/reassessed.  Certain antidepressants and antihypertensives are a couple classic examples of medications that could contribute to erectile dysfunction.  Make sure the patients other medications aren’t causing the problem. With antidepressants and antihypertensives, it isn’t always easy to transition these to another agent, but it is worthwhile to ask the patient about if other options exist.
  2. How often is the patient needing nitroglycerin?  If the patient was prescribed nitroglycerine 10 years ago and has never used it, the likelihood of coadministration is very low.  As long as the patient understands the interaction and is comfortable with the situation, it is likely ok.
  3. How often is the sildenafil being used.  I’ve met with numerous patients that have sildenafil (or other PDE-5) on their medication list, but they haven’t used the medication in years. In that situation, stopping the sildenafil may be a possibility.
  4. If a patient believes that they can manage both, obviously we have to do our best job of educating the patient that coadminstration should be avoided.

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  1. Corey

    Do you have any review items for board for psychiatry pharmacist? I have bought a few of your other items and sample tests in past and will be studying for this now looking for resources

    • Eric Christianson

      I don’t at this time. The stats study guide would be helpful for stats related questions that are on the psych exam, but obviously not the clinical content. Something to think about for sure! Thanks for reaching out! Eric

  2. Chad

    Hey Eric!

    Overall great blog man! Just an observation to try and help…I don’t think there should be an “e” at the end of nitroglycerin the whole way through. I enjoy your passion/enthusiasm for pharmacy and helping others understand topics. I’m a military pharmacist and just took BCPS this past fall after becoming eligible and being back from a deployment. Always enjoy your stuff as I wanted to do something similar, but never followed through. At least your posts keep me engaged! If you ever want help with topics, happy to collaborate. I’d like to be find ways to be more active professionally outside the usual weekday grind. 🙂

  3. Terri

    How close together can they be administered?(sildenafil and nitro)

  4. Bill Jones

    The is a LEGAL issue. The combination is contraindicated. Since CONTROL of the combination once in the patient’s hands is gone, no amount of education can prevent the combination from being taken. Your bulletin points are good, but this is STILL a contraindication. NO ONE would say it is OK for the patient to BELIEVE they can anaphylaxis to beta-lactam antibiotics and go ahead and give the drug, we just need to DO OUR BEST and educate the patient. I heard cardiologists tell me that “THEY WERE GOOD” and knew the combination was OK. Sorry. YOU DO NOT KNOW, because there are NO DATA to say what is safe.

  5. Sandy

    Spelling correction – It should be Nitroglycerin, not Nitroglycerine

    • Eric Christianson

      Thanks guys, error on my part for sure! Will update accordingly…thanks!



  1. Recommended Separation for Nitrates and PDE-5 Inhibitors - Med Ed 101 - […] We have discussed management strategies of the nitrate PDE-5 interaction; you can find that article … […]

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Written By Eric Christianson

March 11, 2018

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