Can PDE5 Inhibitors Be Coprescribed with Nitrates?

Combining phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil) with oral nitrate medications is formally contraindicated due to risk for hypotension and other severe adverse cardiac events. Nonetheless, in Denmark, prescription of PDE5 inhibitors to patients who were taking oral nitrates for ischemic heart disease (IHD) increased 20-fold from 2000 to 2018. Using nearly 20 years of nationwide data, Danish investigators examined associations between PDE5 use (defined as prescriptions filled within 14 days prior to an outcome event) and adverse cardiovascular outcomes among 42,000 patients with IHD who were receiving prescribed oral nitrate medications and among ≈200,000 IHD patients who were not receiving oral nitrates.

Risk for…