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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Written By Eric Christianson

March 11, 2018

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