Guidelines for Use of Sildenafil

American Family Physician,  Feb 15, 1999  

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The American Heart Association (AHA) and the American College of Cardiology (ACC) have issued an expert consensus document with recommendations for the safe and appropriate use of sildenafil (Viagra) when treating sexual dysfunction in patients at clinical risk of cardiovascular effects. Published in the January 1999 issue of the Journal of the American College of Cardiology and the January 5, 1999, issue of Circulation: Journal of the American Heart Association, the 10- page document covers the following topics: erectile dysfunction; pharmacokinetics, metabolism, mechanism of action and pharmacodynamics of sildenafil; drugEdrug interactions and concomitant disease states; and cardiovascular effects of sexual intercourse in patients with coronary artery disease.

"We formulated these recommendations to appropriately caution, and not to unduly alarm, physicians who may wish to prescribe the drug to their patients with cardiovascular disease," explained Melvin D. Cheitlin, M.D., emeritus professor of medicine at the University of California, San Francisco. Dr. Cheitlin cochaired the document's writing group with Adolph M. Hutter, Jr., M.D., a cardiologist at Massachusetts General Hospital.

The primary recommendation of the consensus panel is that sildenafil should not be used by patients taking organic nitrates. Concomitant use of the two drugs can result in dangerously low blood pressure. An appendix in the report contains a list of representative organic nitrates.

The consensus document also advises physicians to perform an individual clinical assessment before prescribing sildenafil to the following types of patients:

*Those with angina or a positive exercise stress test.

*Those with congestive heart failure with borderline low blood volume and low blood pressure.

*Those who are taking multiple medications to control high blood pressure.

*Those taking other medications or have conditions that can prolong the duration of action of the drug.

COPYRIGHT 1999 American Academy of Family Physicians
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