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January 17, 2024
A recent Swedish registry study published in the Journal of the American College of Cardiology (JACC) warns of significant risks associated with co-prescribing potency drugs like Viagra and organic nitrates for angina. The study reveals a 35 to 40 percent increased risk of death and approximately 70 percent higher risks of heart attack and heart failure when these drugs are combined.
Phosphodiesterase inhibitors type 5, found in erectile dysfunction drugs, are contraindicated when treating angina with organic nitrates. Combining these medications enhances their antihypertensive effects, potentially leading to severe side effects, including death.
Organic nitrates are often used as emergency relief for sudden angina onset, with a quick onset and short duration of action. However, many patients using nitrates are also prescribed potency drugs. Although both medications can be theoretically separated in time to avoid side effects, the study indicates that this does not necessarily mitigate the associated risks.
Ylva Trolle Lagerros, Associate Professor at the Department of Medicine at Karolinska Institutet and the study’s first author, emphasizes the growing demand for erectile dysfunction medications from men with cardiovascular disease. While these drugs benefit most men with cardiovascular issues, those concurrently treated with nitrates need to weigh the benefits against the cardiovascular risks.
The study utilized Swedish health registers between 2005 and 2013, identifying nearly 61,500 men prescribed organic nitrates, with over 5,700 also prescribed potency drugs. Adjusting for differences, the results showed a 35 to 40 percent increased risk of death and approximately 70 percent increased risks of heart attack and heart failure for those prescribed both medications.
The researchers stress the importance of careful and patient-centered consideration before prescribing potency medication to men treated with nitrates. Funding for the study was provided by Region Stockholm, the Center for Innovative Medicine (CIMED), and Karolinska Institutet, with no reported conflicts of interest.
Publication Details: Title: Risk of Death in Patients With Coronary Artery Disease Taking Nitrates and Phosphodiesterase-5 Inhibitors Authors: Ylva Trolle Lagerros, Alessandra Grotta, Sara Freyland, David Grannas, Daniel Peter Andersson. Journal: Journal of the American College of Cardiology (JACC) Online: January 15, 2024 DOI: 10.1016/j.jacc.2023.10.041
Medications Discussed: Organic Nitrates:
- Glyceryl nitrate (Glytrin, Nitroglycerin Karo Bio, Nitrolingual, Suscard)
- Isosorbide mononitrate (Imdur, Ismo, Ismo Retard, Isomex, Monoket OD)
Erectile Dysfunction Drugs:
- Sildenafil (Viagra, Granpidam, Mysildecard, Revastad, Revatio, Vizarsin)
- Tadalafil (Cialis, Ciastad, Talmanco)
- Vardenafil (Levitra)
Source: Fass.se
