ED Drugs Can Be Safely Used by Many Men with Stable CHD
ED Drugs Can Be Safely Used by Many Men with Stable CHD
the majority of men with heart disease who have erectile dysfunction
(ED) can safely use one of the phosphodiesterase type 5 (PDE-5) inhibitors,
by discontinuing nitrate therapy, while continuing beta-blocker or calcium
antagonist therapy, experts suggest based on new results just published in The Journal
of Sexual Medicine (2005;2:513-516). In the largest study of its kind, 425 men
being treated for coronary heart disease (CHD) and ED in a specialized clinic in
Englandwere recruited. Of these, 88 patients with stable CHD were using oral
nitrates. Some 55 of these men who demonstrated good exercise ability were
told to stop taking their nitrates but to continue channel blocker. A week later, 3 patients reported that they had resumed nitrate therapy because of an increase in their symptoms. Of the
remaining 52 men still not taking nitrates, 49 were given a PDE-5 inhibitor. Among the 26 men who have completed the follow-up (this phase is ongoing), use of a PDE-5 inhibitor was effective
in restoring sexual function in 22 men. No adverse cardiac events have been reported among any of the men who discontinued nitrates and started PDE-5 inhibitor therapy. “This is a huge, groundbreaking advance…. We now know that oral nitrates can be discontinued in the presence of continuing beta blockade and/or calcium antagonist therapy in stable heart disease
patients with ED to allow for safe use of PDE-5 inhibitors,” said Irwin Goldstein,
MD, Urology Department, Boston University, and editor-in-chief of The Journal of Sexual Medicine. The 3 PDE-5 inhibitors—sildenafil (Viagra), vardenafil (Levitra), and tadalafil
(Cialis)—which have the potential to cause a severe hypotensive interaction with
nitrates, are contraindicated in patients taking nitrates. “Coordinating care between the sexual
medicine physician and the cardiologist has provided new evidence-based, prospective
data to support better clinical care for those men with ED and cardiac disease who, historically,
have been denied such care,” Dr Goldstein said.
