ED drugs Flashcards
CI for sildenafil when used for ED
Avoid if systolic blood pressure below 90 mmHg (no information available); patients in whom vasodilation or sexual activity are inadvisable; recent unstable angina
Patient would like to buy some sildenafil. You look at their PMR and see they were recently issued Rx’s for ramipril 10mg OD, bisoprolol 5mg OD, aspirin 75mg OD + clopidogrel and atorvastatin 80mg.
Is this appropriate
No not appropriate if they have recently had unstable angina/MI/stroke. Contraindicated!
These drugs above are given for secondary prevention of CV events following an ACS (STEMI, NSTEMI, unstable angina)
sildenafil dose reduction in moderate to mild HI
25mg
dose of sildenafil in RI
initial dose 25mg if CrCl <30
should you take with food
onset of effect may be delayed if taken with food
common symptoms of all
vasodilation
nasal complaints
flushing
headache
PPD5 inhibtors + nicorandil
Nicorandil is predicted to increase the risk of hypotension when given with Avanafil. Manufacturer advises avoid.
can PPD5i be given with alpha blockers e.g. tamsulosin
alpha blockers causes significant hypotensive effects when given with Avanafil. Manufacturer advises patient should be stabilised on first drug then second drug should be added at the lowest recommended dose.
avoid all PPD5 inhibitors if systolic BP is
Avoid if systolic blood pressure below 90 mmHg
Can PPD5 inhibitors be used with alpha blockers such as alfuzosin
Alfuzosin causes significant hypotensive effects when given with Sildenafil. Manufacturer advises patient should be stabilised on first drug then second drug should be added at the lowest recommended dose.
miconazole and sidenafil
Miconazole is predicted to increase the exposure to Sildenafil. Manufacturer advises use with caution and adjust dose.
Are they affected by inducers and inhibitors
YES
avoid with inhibitors such as clarithromycin, ketoconazole etc because it will increase levels
avoid with inducers e.g. carbamazepine, phenytoin etc because it will decrease levels
