Cardiovascular safety of sildenafil citrate (Viagra®): An updated perspective
Section snippets
General cardiovascular effects of sildenafil
The cardiovascular effects of sildenafil are mediated primarily by means of its relaxant effect on vascular smooth muscle, which causes vasodilation. Sildenafil was originally developed as an antianginal therapy but proved to be no more effective than nitrates.8 PDE5, which is plentiful in vascular smooth muscle,9 is inhibited by sildenafil, thereby increasing levels of cyclic guanosine monophosphate (cGMP).10, 11 Intracellular levels of cGMP affect numerous cellular functions, with protein
Cardiovascular safety of sildenafil during treatment of patients with erectile dysfunction
The cardiovascular safety of sildenafil in the treatment of patients with ED has been assessed in tens of thousands of individuals worldwide. Data were pooled from up to 37 phase 2, 3, and 4 clinical trials of men with ED who received sildenafil (N = 4405) or placebo (N = 3945). These data enabled calculation of the adverse event profile, including cardiovascular adverse events, in the sildenafil clinical trial population of men with ED1, 37 and in subpopulations with concomitant CVD1 or CAD,38
Conclusions
Men with ED tend to be at increased risk for cardiovascular events because of shared risk factors with CVD. In the 2 hours after sexual activity, the relative risk of MI is increased 2.5-fold in men without a history of cardiac disease and 2.9-fold in those with a history of cardiac disease, although the absolute risk is low (0.9%).51 However, no evidence suggests that the use of sildenafil is associated with an increased risk for cardiovascular events. The sildenafil adverse event profile,
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Viagra (Sildenafil Citrate): The Remarkable Story of the Discovery and Launch
Cited by (56)
Case report: Non-occlusive mesenteric ischemia in the setting of sildenafil use
2022, American Journal of Emergency Medicinep38 mitogen activated protein kinase mediates cardiac Na<sup>+</sup>/H<sup>+</sup> exchanger inhibition induced by Sildenafil
2019, European Journal of PharmacologyChronical treatment with sildenafil causes Achilles tendinopathy in rats
2018, Life SciencesCitation Excerpt :Sildenafil acts as a phosphodiesterase-5 selective inhibitor, leading to extended GMPc lifetime and consequent longer erections [2,4]. Sildenafil revolutionized erectile dysfunction (ED) treatment due to its advantageous pharmacokinetics characteristics and is also indicated to treat other conditions, such as neuroinflammation, rheumatoid arthritis, pulmonary hypertension, hepatic fibrosis, benign prostate hyperplasia, chronic cardiac diseases, ischemia, hypertension and chronic kidney diseases [5–11]. Despite the benefits, sildenafil adverse effects listed in the literature include headaches, redness, small blood pressure falls, visual alterations, dyspepsia, nasal congestion, urinary tract infections, priapism, melanoma, recurrence of prostate cancer, light sensitivity and dizziness [1,12,13].
Cardiovascular Safety of Phosphodiesterase Type 5 Inhibitors After Nearly 2 Decades on the Market
2018, Sexual Medicine ReviewsCardiovascular Outcomes Among Sildenafil Users: Results of the International Men's Health Study
2014, Journal of Sexual Medicine
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Graham Jackson and Melvin D. Cheitlin are consultants to, and meeting participants and lecturers for, Pfizer Inc.