Nitrate + PDE5 inhibitor
- Nitrates ↑ cGMP
- PDE5 inhibitors prevent cGMP breakdown
- combination can crash blood pressure
- Contraindicated combination
- Sildenafil/vardenafil: no nitrate ≥24 h
- Tadalafil: no nitrate for ≥48 h
Interaction at a glance
- PDE5 inhibitors prevent cGMP breakdown
- combination can crash blood pressure
- Contraindicated combination
Clinical consequence
- Nitrates ↑ cGMP
- PDE5 inhibitors prevent cGMP breakdown
- combination can crash blood pressure
Management
- Contraindicated combination
Timing / washout
- Sildenafil/vardenafil: no nitrate ≥24 h
- Tadalafil: no nitrate for ≥48 h
Self-check
- Why are nitrates contraindicated with PDE5 inhibitors?
Profound hypotension from excessive cGMP-mediated vasodilation.
- How long should nitrates be avoided after sildenafil or vardenafil?
At least 24 hours.
- How long should nitrates be avoided after tadalafil?
At least 48 hours.
Drugs in this interaction (8)
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