ORIGINAL RESEARCH—PHARMACOTHERAPY: Successful Withdrawal of Oral Long-Acting Nitrates to Facilitate Phosphodiesterase Type 5 Inhibitor Use in Stable Coronary Disease Patients with Erectile Dysfunction


Dr. Graham Jackson, MD, Cardiothoracic Centre, 6th floor, East Wing, St. Thomas’  Hospital, Lambeth Palace Road, London, SE1 7EH, UK. Tel: +44 (0) 20-7188-1055; Fax: +44 (0) 20-7188-1011; E-mail: gjcardiol@talk21.com


Introduction.  Vascular disease is the most common cause of male erectile dysfunction (ED). Phosphodiesterase type 5 (PDE5) inhibitors are effective in up to 80% of men but are contraindicated in the presence of oral nitrates, because of a potentially severe hypotensive interaction.

Aims.  To see if stable coronary disease patients with ED could have their oral nitrates discontinued to allow safe use of a PDE5 inhibitor.

Methods.  Prospective study of 425 men with ED and cardiac disease conducted in an outpatient cardiac sexual advice clinic.

Main Outcome Measures.  Discontinuation of oral nitrates to facilitate subsequent use of PDE5 therapy.

Results.  Oral nitrates were being used by 88 (21%) coronary artery disease patients all of whom were clinically stable. Fifty-five (63%) of these men with a good exercise ability had their nitrates discontinued in the presence of continuing beta-blockade or calcium antagonist therapy. They were reviewed 1 week later. Only three restarted their nitrate therapy because of an increase in symptoms. Forty-nine of the 52 men no longer taking nitrates were treated with a PDE5 inhibitor which was effective in 22 out of 26 (85%) patients who have completed follow-up. Fifteen patients are currently undergoing clinic follow-up in order to optimize treatment, and nine patients have continued therapy with their family doctors. Importantly, there have been no adverse cardiac events.

Conclusion.  Oral nitrates can be discontinued in the presence of continuing beta-blockade and/or calcium antagonist therapy in stable coronary disease patients with ED to allow for the safe use of PDE5 inhibitors.