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Erectile dysfunction with nitrate use — ABIM Board MCQ

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HardWomen's Health/Men's HealthErectile dysfunction with nitrate useABIM Board

A 58-year-old man with stable angina controlled by sublingual nitroglycerin has erectile dysfunction. He asks for sildenafil. Blood pressure is 118/70 mm Hg and he used nitroglycerin twice last week. Morning testosterone is normal. Which of the following would you recommend?

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Correct answer: D — Avoid PDE5 inhibitors while nitrate therapy is required and discuss alternative angina or erectile dysfunction strategies

Phosphodiesterase-5 inhibitors are contraindicated with nitrate therapy because of risk of profound hypotension. Management should address whether nitrates can be safely discontinued or alternative erectile dysfunction therapies used.

Reference: AUA Erectile Dysfunction Guideline; ACC/AHA Stable Ischemic Heart Disease Guidance