#AskDrKK: Can patient with high blood pressure take Viagra group of drugs?

#DrKKAnswers:
Viagra group of drugs are typically well tolerated with only minor reductions in blood pressure in patients taking conventional antihypertensive drugs (ACE inhibitors, AR blockers, calcium blockers, beta blockers, and diuretics), even when used in combination.
Source:
1. Sildenafil Study Group. Am J Hypertens 2001; 14:70.
2. Am J Hypertens 2004; 17:1135.

#AskDrKK:How to handle patients on nitrates who wants to take Viagra group of drugs?

#DrKKAnswers:
1. Men treated with PDE-5 inhibitors (Viagra group of drugs) and nitrates are at risk for severe hypotension and syncope (loss of consciousness).
2. Co-administration of Viagra group of drugs (sildenafil) with isosorbide mononitrate or sublingual nitroglycerin lowers blood pressure (52/29 mmHg with isosorbide mononitrate and 36/21 mmHg with sublingual nitroglycerin).
3. In men on Viagra group of drugs with chest pain nitrates should not be administered for 24 hours (or longer in patients with renal or hepatic dysfunction) of sildenafil, 24 hours of vardenafil, or up to 48 hours of tadalafil.

#AskDrKK:Can heart patients take Viagra group of drugs Vardenafil and tadalafil?

#DrKKAnswers:
Tadalafil has the advantage of a longer duration of action.
Both drugs and sildenafil potentiate the BP lowering response to nitrates. This interaction lasts 24 hours with vardenafil and up to 48 hours with tadalafil.
Tadalafil, vardenafil and sildenafil are contraindicated with concomitant nitrate use.

#AskDrKK:Can heart patients take Viagra or Sildenafil?

#DrKKAnswers:
Sildenafil improves erectile function in patients with stable heart blockages. It is also effective in patients with hypertension, diabetes, and nonvascular organic or psychogenic causes for erectile dysfunction.
However it can lower blood pressure and interact with nitrates.
It lowers the systolic upper blood pressure by about 8 mmHg.
The BP lowering is not more when given with amlodipine.
Sildenafil also improves endothelial dysfunction and inhibits platelet activation.

#AskDrKK:Can patient with hypertrophic cardiomyopathy be given Viagra or Sildenafil?

#DrKKAnswers:
The decrease in preload and after load by Viagra can increase the outflow obstruction in patients with hypertrophic cardiomyopathy culminating in an unstable hemodynamic state.

Source: N Engl J Med 1999; 341:700.