Tran Diane, Howes Laurence Guy
Department of Clinical Pharmacology, St George Hospital, University of New South Wales, Kogarah, New South Wales, Australia.
Drug Saf. 2003;26(7):453-60. doi: 10.2165/00002018-200326070-00002.
Initial reports of myocardial infarction and sudden death in men with erectile dysfunction who had taken sildenafil (sometimes in conjunction with nitrates) raised concerns that sildenafil may increase the risk of cardiovascular events in men with erectile dysfunction and vascular disease. A significant body of evidence now indicates that sildenafil generally has a good safety profile in men with erectile dysfunction and cardiovascular disease. Sildenafil therapy does not appear to be associated with ischaemic events either at the time of introduction of therapy or during longer-term use. Rates of discontinuation from sildenafil therapy due to adverse events are similar to placebo in men with cardiovascular disease. Sildenafil does not interact in a potentially hazardous way with antihypertensive or antianginal therapy, with the exception of nitrates. Nitrates should not be administered within 24 hours of sildenafil therapy, and care should be taken to determine whether sildenafil may have been used before nitrates are administered to patients. Sildenafil appears to be generally well tolerated in most patients with chronic, stable cardiovascular disease.
最初有报道称，服用西地那非（有时与硝酸盐类药物联用）的勃起功能障碍男性出现心肌梗死和猝死，这引发了人们对西地那非可能增加勃起功能障碍和血管疾病男性发生心血管事件风险的担忧。现在大量证据表明，西地那非在勃起功能障碍和心血管疾病男性中总体具有良好的安全性。西地那非治疗在开始治疗时或长期使用期间似乎均与缺血性事件无关。在心血管疾病男性中，因不良事件而停用西地那非治疗的发生率与安慰剂相似。除硝酸盐类药物外，西地那非与抗高血压或抗心绞痛治疗不存在潜在有害的相互作用。在西地那非治疗后24小时内不应使用硝酸盐类药物，在给患者使用硝酸盐类药物前应注意确定患者此前是否使用过西地那非。在大多数慢性稳定心血管疾病患者中，西地那非似乎总体耐受性良好。
