viagra-not-with-nitrates

Nitrates and Sildenafil


Nitrates and Sildenafil, taken together causes

severe drop in blood pressure that can cause death.
Same thing happens with Sildenafil's cousins,
Tadalafil and Vardenafil.



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What would happen if anti anginal medicine Nitrate is taken with Sildenafil?

Sudden life threatening fall in blood pressure occurs.

What we are not discussing in this post?
Side effects or bad side effects or adverse side effects, behavioral side effects or anti-depressant sexual side effects of viagra® or swelling prostrate pain or longterm side effects of viagra® or snorting viagra®.
We are not discussing side effects caused by drug-drug interaction between viagra® and other medicines like paxil®, but only viewing the dangers of interaction of viagra® and Nitrates.

What does the official pfizer site say about Viagra® and nitrates?
IMPORTANT SAFETY INSTRUCTION
If you take any medicines that have nitrates in them (like nitroglycerin for chest pain)—every day or even once in a while—you should NOT take VIAGRA® .

What are nitrates?

What are nitrates used for?
[A] Nitrates are medicines used in the treatment of angina, heart failure as well as [B] treatment of anal fissures. It is used as a
=cream that is applied in chronic anal fissure because chronic fissure does to respond to dietary advice.
[A]Organic nitrites and nitrates, such as glyceryl trinitrate (nitroglycerin), sodium nitroprusside, amyl nitrite ("poppers") are all nitric oxide donors and hence not to be taken with Viagra® /Sildenafil.

What is Angina?
Angina is peculiar kind of chest pain or discomfort. The chest pain may sometimes be mistaken to be due to acidity or gas. However, the pain of
Angina can be differentiated by its characteristics.
Angina Pain
1 Sudden chest pain that may also be felt in the shoulder, arm, jaw, neck, back, or other area
2 Pain that feels like tightness, squeezing, crushing, burning, choking, or aching
3 Pain that occurs at rest and does not easily go away when using medicine

Angina occurs when heart does not get sufficient oxygen. Angina alarms us of the possibility of heart attack (Acute Myocardial Ischemia)
AMI.

Nitrates are more useful in preventing angina attacks than reversing them once they have commenced.
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In what form is the medicine Nitrate available in market?
=Patches of glyceryl trinitrate with a long activity duration are commercially available. Glyceryl trinitrate is also indicated for heart attack (Acute Myocardial Ischemia)AMI and pulmonary edema. It may also be given as a
=sublingual dose in the form of a tablet placed under the tongue or a
=spray into the mouth for the treatment of an angina attack.

Glyceryl Trinitrate GTN is used as a medicine and also as an explosive.

Who are the people likely to get Angina?
The people with following features may get Angina and may need Nitrates.
* Being male
* Diabetes
* Getting older
* Family history of coronary heart disease before age 50
* High blood pressure
* High LDL cholesterol
* Low HDL cholesterol
* Not getting enough exercise
* Smoking
* Obesity

What is the danger if Sildenafil/Viagra® is taken with nitrates medicine?
There is a sudden fall in blood pressure from which survival is difficult.
The official website of Pfizer Inc informs the health care professionals that
VIAGRA® was shown to potentiate the hypotensive effects of nitrates.
How soon can the Medicine Nitrate be given safely after taking Viagra® ?

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Parmacokinetics of Sildenafil 100 mg

When 100 mg oral dose of Sildenafil is given to healthy normal volunteers, the plasma levels of sildenafil at 24 hours post dose are approximately 2 ng/mL. The peak plasma levels of sildenafil is approximately 440 ng/mL.
Although plasma levels of sildenafil at 24 hours post dose are much lower than at peak concentration, it is unknown whether nitrates can be safely coadministered at this time point.(1)
What are the other anti-anginal medicines?
The following is a list of 23 Anti Anginal Medicines.

Refer Wikipedia for details.
A

* Amyl nitrite
* Antianginal

B

* Butyl nitrite

C

* Cyclohexyl nitrite

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D

* Diethylene glycol dinitrate

E

* Ethyl nitrite
* Ethylene glycol dinitrate


G

* Glyceryl trinitrate (pharmacology)

I

* Isopropyl nitrite
* Isosorbide
* Isosorbide dinitrate
* Isosorbide mononitrate
* Ivabradine

M

* Methyl nitrite

N

* Nicorandil


N cont.

* Nifedipine
* Nitroglycerin

P

* PETN
* Perhexiline
* Poppers
* Propylene glycol dinitrate

R

* Ranolazine

T

* Trimetazidine

Clinical Pharmacology of Sildenafil (1)
In the following patients:
---age >65,
---hepatic impairment (e.g., cirrhosis),
---severe renal impairment (e.g., creatinine clearance <30 mL/min), and
---concomitant use of potent cytochrome P450 3A4 inhibitors (erythromycin),
plasma levels of sildenafil at 24 hours post dose have been found to be
3 to 8 times higher than those seen in healthy volunteers.
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