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Nitrate and sildenafil — GPhC CRA MCQ

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HardCardiovascular TherapeuticsNitrate and sildenafilGPhC CRA

A man who took sildenafil 50 mg two hours ago develops central chest pressure and sweating during sexual activity. He normally uses sublingual glyceryl trinitrate for angina and asks whether to take it now. What is the best immediate advice?

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Correct answer: B — Call 999, avoid glyceryl trinitrate and tell the ambulance team when sildenafil was taken

Chest pain with autonomic symptoms may be an acute coronary syndrome and needs emergency assessment. Nitrates must not be taken after recent sildenafil because combined vasodilation can cause profound hypotension; the ambulance team needs the timing so that treatment can be selected safely. Aspirin may form part of emergency advice in some circumstances, but it must not delay calling 999 and does not make nitrate use safe. Dose reduction of glyceryl trinitrate is not an acceptable workaround.

Reference: NHS: Side effects of sildenafil: https://www.nhs.uk/medicines/sildenafil-viagra/side-effects-of-sildenafil/