Potential Risks of Combining Erectile Dysfunction Medications with Chest Pain Medications

Phosphodiesterase type 5 inhibitors (PDE5i)-an erectile dysfunction drug sold under the names Viagra, Levitra, Cialis, and others-are a common medical treatment for erectile dysfunction (ED) in men with cardiovascular disease (CVD). However, a new Swedish study published today in the Journal of the American College of Cardiology suggests that patients are at higher risk for morbidity and mortality over time when PDE5is and nitrate medication are both prescribed.

Erectile dysfunction is a common condition in middle-aged and older men and is a strong predictor of coronary artery disease. Nitrates are medications commonly used to treat angina, or chest pain. Both can cause drops in blood pressure, so they are contraindicated for use together. However, there is little real-world data on the implications of using both and the number of people who are prescribed both is growing.

The study included 61,487 men with a history of myocardial infarction (MI) or percutaneous coronary intervention (PCI) who had received two nitrate prescriptions within six months. Exposure was defined as having received at least two filled prescriptions of any PDE5i medications. Among these men, 55,777 men were treated with nitrates and 5,710 were treated with both nitrates and PDE5i. Median follow-up time for the entire cohort was 5.7 years in nitrate only users and 3.4 years in nitrate users with PDE5i treatment. The nitrate plus PDE5i group was younger at 61.2 years compared to 70.3 years in the nitrate only users.

The results of the study indicate that the combined use of PDE5i treatment with nitrates is associated with a higher risk for all health outcomes compared to those taking nitrates alone. In those taking both PDE5i and nitrates, few events occurred 28 days after dispensing the PDE5is, with lower incidence rates than in subjects taking nitrates, indicating that there is low immediate risk for an event.

“Our goal is to underscore the need for careful patient-centered consideration before prescribing PDE5i medication to men receiving nitrate treatment,” Andersson said. “Furthermore, it justifies our efforts for continued research into the ambiguous effects of ED drugs on men with CVD.”

Reference: Erectile dysfunction medications may increase risk of death when combined with common chest pain medication; Journal of the American College of Cardiology