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.