A recent study published in the Journal of the American College of Cardiology has found that taking phosphodiesterase-5 inhibitors (PDE5i), commonly used to treat erectile dysfunction (ED), along with nitrates, a medication for chest pain, can increase the risk of negative health outcomes such as heart failure and early death. The study, which involved over 60,000 men, highlights the need for careful consideration before prescribing PDE5i medication to men receiving nitrate treatment.
The use of PDE5i in individuals with both ED and cardiovascular disease has been a topic of controversy due to the fact that both medications induce low blood pressure. Previous studies on the simultaneous use of these drugs have yielded mixed results. Despite existing research and clinical guidelines discouraging the concurrent use of these medications, physicians have reported an increase in requests for ED drugs from men with cardiovascular diseases.
The study examined data from the National Swedish Patient Registry and included men with stable coronary artery disease and a history of myocardial infarction or percutaneous coronary intervention. Participants had received prescriptions for both nitrates and PDE5i medications. The study found that the group receiving both medications had a slightly higher risk of premature death from all causes and a doubled risk of undergoing revascularization compared to the group receiving nitrates alone.
Dr. Howard C. Herrmann, an expert in cardiovascular diseases at the University of Pennsylvania, expressed that the potential risk of low blood pressure with this combination of therapies has been known for decades. He emphasized the need for physicians to be cautious about co-prescribing these medications. However, the study has limitations, including not knowing the exact details of how patients took both medications and the inability to prove causality.
To draw more definitive conclusions about the effects of this medication combination, a randomized study would be necessary. In the meantime, physicians should advise patients with ED who want to use PDE5i medications to discuss other treatment options and the need for nitrates with their healthcare provider. Patients should also be instructed on the timing of taking both medications and seek medical attention if they experience angina after taking a PDE5i.
Overall, this study highlights the potential risks associated with combining PDE5i medications and nitrates and underscores the importance of careful consideration and patient-centered decision-making when prescribing these drugs to men with cardiovascular disease.