OBJECT DRUGS

Nitrates:

• Isosorbide Dinitrate (Isordil, etc.)
• Isosorbide Mononitrate (Ismo, etc.)
• Nitroglycerin (Nitrogard, etc.)

PRECIPITANT DRUGS

• Sildenafil (Viagra, etc.)
• Tadalafil (Cialis, etc.)
• Vardenafil (Levitra, etc.)

Comment:

Sildenafil, tadalafil, and vardenafil may markedly enhance the hypotensive effects of nitrates. Fatalities have been reported, although a causal relationship was not established in some cases. Other vasodilators such as terazosin (Hytrin) and doxazosin (Cardura) have also been reported to produce hypotensive episodes when coadministered with phosphodiesterase inhibitors.

Class 1: Avoid Combination

• Avoid: Patients taking nitrates by any route of administration should avoid taking phosphodiesterase inhibitors.