OBJECT DRUGS
Phosphodiesterase Inhibitors:
- Avanafil (Stendra)
- Sildenafil (Viagra, etc.)
- Tadalafil (Cialis, etc.)
- Vardenafil (Levitra, etc.)
PRECIPITANT DRUGS
Enzyme Inhibitors:
- Amiodarone (Cordarone, etc.)
- Amprenavir (Agenerase)
- Aprepitant (Emend)
- Atazanavir (Reyataz)
- Boceprevir (Victrelis)
- Ceritinib (Zykadia)
- Cobicistat (Stribild)
- Conivaptan (Vaprisol)
- Cyclosporine (Neoral, etc.)
- Darunavir (Prezista)
- Delavirdine (Rescriptor)
- Dronedarone (Multaq)
- Grapefruit
- Indinavir (Crixivan)
- Lomitapide (Juxtapid)
- Mifepristone (Korlym)
- Nelfinavir (Viracept)
- Ritonavir (Norvir)
- Saquinavir (Invirase)
- Telaprevir (Incivek)
Comment:
The phosphodiesterase inhibitors are metabolized by CYP3A4; concurrent administration with CYP3A4 inhibitors could produce increased plasma concentrations. Increased side effects may occur during coadministration with CYP3A4 inhibitors.
Class 3: Assess Risk & Take Action if Necessary
- Consider Alternative:
- Grapefruit: Orange juice does not appear to inhibit CYP3A4.
- Monitor: Monitor for phosphodiesterase inhibitor toxicity including visual disturbances, hypotension, and syncope. Reduced dose of the phosphodiesterase inhibitor may be required.