ED Drugs Can Be Safely Used by Many Men with Stable CHD

ED Drugs Can Be Safely Used by Many Men with Stable CHD

the majority of men with heart disease who have erectile dysfunction

(ED) can safely use one of the phosphodiesterase type 5 (PDE-5) inhibitors,

by discontinuing nitrate therapy, while continuing beta-blocker or calcium

antagonist therapy, experts suggest based on new results just published in The Journal

of Sexual Medicine (2005;2:513-516). In the largest study of its kind, 425 men

being treated for coronary heart disease (CHD) and ED in a specialized clinic in

Englandwere recruited. Of these, 88 patients with stable CHD were using oral

nitrates. Some 55 of these men who demonstrated good exercise ability were

told to stop taking their nitrates but to continue channel blocker. A week later, 3 patients reported that they had resumed nitrate therapy because of an increase in their symptoms. Of the

remaining 52 men still not taking nitrates, 49 were given a PDE-5 inhibitor. Among the 26 men who have completed the follow-up (this phase is ongoing), use of a PDE-5 inhibitor was effective

in restoring sexual function in 22 men. No adverse cardiac events have been reported among any of the men who discontinued nitrates and started PDE-5 inhibitor therapy. “This is a huge, groundbreaking advance…. We now know that oral nitrates can be discontinued in the presence of continuing beta blockade and/or calcium antagonist therapy in stable heart disease

patients with ED to allow for safe use of PDE-5 inhibitors,” said Irwin Goldstein,

MD, Urology Department, Boston University, and editor-in-chief of The Journal of Sexual Medicine. The 3 PDE-5 inhibitors—sildenafil (Viagra), vardenafil (Levitra), and tadalafil

(Cialis)—which have the potential to cause a severe hypotensive interaction with

nitrates, are contraindicated in patients taking nitrates. “Coordinating care between the sexual

medicine physician and the cardiologist has provided new evidence-based, prospective

data to support better clinical care for those men with ED and cardiac disease who, historically,

have been denied such care,” Dr Goldstein said.