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Sildenafil and Heart

PDE5 Inhibitors (e.g.Viagra) and Heart Status

Millions of men worldwide are suffering from erectile dysfunction, and this is only going to be increased with increasing ageing population. The present estimates of erectile dysfunction range from 12.9% to 28.1%. Erectile dysfunction or ED is a measure of endothelial dysfunction and therefore before prescribing any form of treatment, it is important to assess the functional status of a man .This is especially relevant in men who have not been undertaking any physical activity, so that they may not be allowed into performing strenuous activity, which may be life threatening. Occult cardiac insufficiency can not only cause serious harm to such a patient but also bring disrepute to the treating physician and the treatment modality used. It is therefore necessary to consider the cardiovascular status of their patients prior to initiating any treatment for erectile dysfunction especially PDE5 inhibitors. Certain underlying conditions could be adversely affected by vasodilatory effects of sildenafil, especially in combination with sexual activity. The following precautions must be taken before prescribing PDE5 inhibitors, keeping in mind the cardiac status.

  1. Use of PDE 5 inhibitors along with nitrates in any form is contraindicated. It is best to replace nitrates with other medication such that PDE5 inhibitors may be used.
  2. Performance status may be judged as the ability 
    a) To walk for 15 minutes at a pace of 4 km/hr, or
    b) Climb two flights of (20) stairs without any angina or angina equivalent.

In men with borderline performance status, sexual activity may be allowed with the “usual partner” in usual circumstances.

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