Concomitant use of erectile dysfunction medications and common chest pain medications may increase risk of death
Phosphodiesterase type 5 inhibitors (PDE5i), marketed under names such as Viagra, Levitra and Sialis, are common drugs for the treatment of erectile dysfunction (ED) in men with cardiovascular disease (CVD). However, a new Swedish study published in the Journal of the American College of Cardiology suggests that patients are at risk for higher long-term morbidity and mortality when PDE5 inhibitors and nitrates are prescribed concomitantly.
Erectile dysfunction is common in middle-aged and elderly men and is a strong predictor of the development of coronary heart disease. Nitrates are commonly used to treat angina pectoris, or chest pain. Their concomitant use is contraindicated because both drugs can cause a decrease in blood pressure. However, there is little real clinical data on the effects of using them together, and the number of people prescribed both drugs continues to grow.
In this study, updated from a previous study using the same Swedish national dataset from the Swedish Patient Registry, we analyzed the association between PDE5i treatment and cardiovascular outcomes in men with stable coronary heart disease (CHD) treated with nitrates. PDE5i treatment is associated with cardiovascular morbidity and mortality The aim of the study is to resolve conflicting results regarding the effect of PDE5i treatment on the Daniel Peter Andersson, MD, associate professor of medicine at Karolinska Institute in Stockholm and senior author of the study, said: “Physicians are seeing an increasing demand for erectile dysfunction drugs from men with cardiovascular disease.” ED medications have a positive effect on men with CVD, but patients taking nitrates may be at increased risk for adverse health effects.”
The study included 61,487 men with a history of myocardial infarction (MI) or percutaneous coronary intervention (PCI) who received two prescriptions for nitrates within six months. Exposure was defined as at least two prescriptions for PDE5i drugs.
Of these men, 55,777 were treated with nitrates and 5,710 were treated simultaneously with nitrates and PDE5i. The median follow-up time for the entire cohort was 5.7 years for those taking nitrates alone and 3.4 years for those taking nitrates and PDE5i. The group taking nitrates with PDE5i was 61.2 years younger than the group taking nitrates alone, at 70.3 years.
The researchers performed multivariate Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for various outcomes, including all-cause mortality, cardiovascular and non-cardiovascular mortality, myocardial infarction (MI), heart failure, cardiac revascularization, and major cardiovascular events (MACE).
Results of the study showed that the combination of PDE5i and nitrate treatment was associated with a higher risk of all outcomes compared with those taking nitrates alone: 28 days after PDE5i administration, few events occurred in those taking both PDE5i and nitrates, and fewer events occurred in those taking nitrates. The incidence of events was lower in those taking nitrates than in those taking nitrates, indicating a lower immediate risk of events.
Our aim is to emphasize the need for careful patient consideration before prescribing PDE5i to men taking nitrates. In addition, it justifies our efforts to continue to investigate the equivocal effects of ED medications in men with CVD.”
Limitations of this study include the inability to learn about patients’ adherence and medication habits, and the inability to infer a causal relationship between deaths from the data.
Researchers assessed medication use from filled prescriptions, but could not determine patients’ adherence to medication regimens and habits. The patient population also included high-risk individuals who had already undergone myocardial infarction or revascularization procedures. In addition, contrary to the guideline recommendations, they were prescribed nitrates at least twice and PDE5i at least twice.
Therefore, the findings cannot be fully generalized to the general population. Therefore, the findings cannot be fully generalized to the general population.
Glenn N. Levine, MD, of Baylor College of Medicine and Michael E. DeBakey Medical Center in Houston, stated in an accompanying editorial that ED administration of PDE5i is reasonably safe in patients with ischemic heart disease and mild angina pectoris and adequate exercise capacity – but not in patients not taking chronic nitrate therapy. Provided the patient is not taking chronic nitrate therapy,” he states. However, in patients taking chronic oral nitrate therapy, the use of PDE5i is at best disadvantageous and generally contraindicated.”
ED and SAD are, unfortunately, all too common conditions. However, as in most relationships, they can coexist for many years, and possibly a lifetime, with appropriate precautions and care.”
More information: Journal of the American College of Cardiology (2024).
Journal information: Journal of the American College of Cardiology
Brazilian Banana Spider Helps Treat Erectile Dysfunction.
Thirty years ago, Brazilian researchers began studying the strange side effects of banana spider bites. The scientists came up with the idea of developing a synthetic molecule that would exploit the properties of the spider’s venom to create a gel to treat erectile dysfunction. This spider, which is covered with thick brown hairs and can […]
The Efficacy and Side Effects of Antidepressants in the Treatment of Major Depressive Disorder: A Systematic Review and Meta-Analysis.
Antidepressants in the Treatment of Major Depressive Disorder What is the efficacy of antidepressants in treating major depressive disorder? Antidepressants are common prescription medications used to treat major depressive disorder and other conditions. Antidepressants have been shown to be effective in treating depressive symptoms and may be more effective than other medications in some individuals. […]
Miami Company Recalls Erectile Dysfunction Capsules: Might Work, Might Not
A Miami Gardens company has recalled a libido enhancer that was deemed an “unapproved drug” by the FDA. The FDA did not say that Noah Wholesale’s “The Rock” does not work, and according to Noah’s recall notice, “The Rock” contains sildenafil, the active ingredient that makes Viagra work. That is the problem. The recall notice […]
Drug makers raise prices of more than 700 drugs, including Ozempic and Monjaro.
Pharmaceutical companies have raised the prices of more than 700 drugs, including the popular weight-loss drugs Ozempic and Monjaro, an industry survey found. According to 46 Brooklyn’s analysis, the average price increase at the beginning of the year was about 4.5%. This is a somewhat slower pace than in the previous five years, when drug […]
Sildenafil in the treatment of erectile dysfunction: an overview of the clinical evidence
Erectile dysfunction (ED) is a very common condition associated not only with aging but also with risk factors such as hypertension, heart disease, obesity, dyslipidemia, diabetes, hypogonadism, medications and pelvic surgery. Many of these factors are components of metabolic syndrome, a multiple risk factor for cardiovascular disease (CVD) ED is one of the common risk […]
Penile fibroblasts are more important for erectile function than previously thought
Regular erections may be important for maintaining erectile function, a new study on mice by scientists from Karolinska Institutet has found. We found that when the frequency of erections increases, the number of erection-supporting fibroblasts increases, and conversely, when the frequency of erections decreases, the number of these cells decreases,” says principal investigator Christian Gerrits. […]
Exercise may ameliorate one of the most common and devastating side effects of prostate cancer treatment.
Prostate cancer, one of the most common cancers in the world, not only puts the lives of diagnosed patients at risk, but the side effects of treatment can severely impact their quality of life. However, a new long-term clinical trial led by Edith Cowan University (ECU) and presented at the American Society of Clinical Oncology’s […]
Higher rates of sexual dysfunction in schizophrenic patients
Patients with schizophrenia have a higher prevalence of sexual dysfunction, according to a review in the September 13 online issue of JAMA Psychiatry. Théo Korchia, M.D., of the University of Aix-Marseille, France, and colleagues conducted a systematic literature review and meta-analysis to assess sexual dysfunction and associated factors in patients with schizophrenia spectrum disorders. According […]
Exercise found to be almost as effective as Sildenafil in overcoming erectile dysfunction.
A trio of medical scientists have found that many men with erectile dysfunction can solve many of their problems simply by doing aerobic exercise In this study, reported in the Journal of Sexual Medicine, Mohit Khera, Sameer Bhattacharya and Larry Miller analyzed the results of 11 randomized controlled trials that examined the effects of exercise […]