43 Oral Sildenafil in the Treatment of Erectile Dysfunction

Anecdotal reports of oral

• Sildenafil is not a cure for erectile dysfunction but helps improve function.
• Use sildenafil only as prescribed to ensure safety and efficacy.
• It is not intended for recreational use and can be harmful.

sildenafil in cardiac surgery patients

include both the successful

pulmonary vasodilation in a child

Authors' objectives

In addition, withdrawal of inhaled NO therapy can lead to dangerous rebound pulmonary hypertension. Oral sildenafil, a phosphodiesterase type V (PDE-V) inhibitor, prevents the degradation of cGMP and has been shown to be as effective as inhaled NO in the setting of primary pulmonary hypertension and pulmonary fibrosis. However, sildenafil does not require an inhaled delivery system and does not cause rebound pulmonary hypertension [2–4]. Furthermore, its effects have been noted to last for at least three hours without affecting systemic arterial pressure [5]. In the laboratory we have demonstrated an intravenous formulation of a sildenafil analogue, UK 343 to 664, shows sustained reduction of pulmonary hypertension in a porcine model of pulmonary hypertension [6].

Usual Adult Dose for:

Increasing evidence has shown that sildenafil is an effective pulmonary vasodilator for both children and adults with primary pulmonary hypertension [7–10]. We report our initial experience with the use of sildenafil as adjunctive therapy for the postoperative pulmonary hypertension following cardiac surgery. After Institutional Review Board approval, we conducted a retrospective review of the initial eight consecutive patients that received sildenafil to treat persistent pulmonary hypertension after mitral valve surgery (n = 6) or left ventricular assist device (LVAD) placement (n = 2) at our institution. In each case, sildenafil was administered only if the patient had persistently elevated pulmonary artery pressures despite multiple, conventional pulmonary vasodilators (Table 1). Oral sildenafil was initiated in an intensive care setting, hemodynamics were closely monitored, and the dose was readministered based on pulmonary hemodynamics.

Revatio for Oral Suspension

Conventional agents were typically weaned 24 hours after administration of the first dose of sildenafil. The dose of sildenafil was recorded along with the hemodynamic factors. Pulmonary artery and systemic arterial vascular resistance indices were calculated according to standard formulas: PVRI = MPAP − LAP/CI and SVRI = MAP − CVP/CI, where PVRI = Pulmonary vascular resistance index MAP = mean arterial pressure, CVP = central venous pressure, MPAP = mean PAP, LAP = left atrial pressure, CI = cardiac index, and SVRI = systemic vascular resistance index. Hemodynamic measurements were recorded before the administration of the initial dose of sildenafil and 30 and 60 minutes later. Statistical analysis was performed with SAS software (Cary, NC) using analysis of variance with repeated measures. with mitral stenosis and

in an adult patient who

Warnings & Precautions

Their effectiveness correlates with the level of PDE-V inhibition and the increase in pulmonary vascular smooth muscle cGMP [15]. This report has significant limitations, as it is a retrospective review of a small number of patients with no controls. However, the findings are consistent with the few isolated case reports describing the use of PDE-V inhibitors as pulmonary vasodilators in patients undergoing cardiac surgery. Intravenous dipyridamole was used successfully in a small series of pediatric heart surgery patients [16]. However, dipyridamole has antiplatelet effects that are undesirable in the perioperative period. underwent placement of a

What other information should I know?

Because experience with sildenafil and postoperative pulmonary hypertension is limited, the optimal dose has not been established. Initial doses were similar to that described in previous case reports, with intervals determined by observation of pulmonary hemodynamics. Preexisting pulmonary hypertension and postoperative acute pulmonary hypertension complicate the management of patients with mitral valve disease. Our experience showed that in six different patients undergoing mitral valve surgery, PAP and PVR decreased following sildenafil administration. Furthermore, conventional therapies for pulmonary hypertension were successfully weaned with no rebound pulmonary hypertension.

Sildenafil Tablets or Oral Suspension for PAH

Severe pulmonary hypertension can also lead to right ventricular failure in patients with LVADs. In order to assure delivery of preload to the LVAD, right ventricular function must be preserved. Sildenafil reduced pulmonary hypertension in both our patients with LVADs, improving LVAD filling and obviating the need for RVAD placement. Consequently both LVAD patients progressed to heart transplantation without difficulty. The ability of PDE-V inhibitors, including sildenafil, zaprinast, and dipyridamole to decrease MPAP and PVR has been previously demonstrated in experimental models of pulmonary hypertension [11–14]. biventricular assist device [17, 18].

• Sildenafil should not be used with certain medications like alpha-blockers.
• Avoid alcohol consumption when taking sildenafil to reduce side effects.
• Discuss all medications with your doctor to prevent interactions.