Sildenafil super active

The risk of developing myocardial ischemia during coitus is low if a load of 5 to 6 METs can be reached without triggering ischemia or arrhythmia induced by exercise 11 .

Effects of sildenafil in patients with coronary artery disease. In double-blind controlled randomized studies,

70%

The medication was well tolerated, with the incidence of collateral cardiovascular effects in 5% of the patients in the sildenafil group and in 3% of the patients in the placebo group.

More severe problems, such as acute myocardial infarction and unstable angina, occurred in 3% and 2% of the patients in the sildenafil and placebo groups, respectively. On the other hand, in patients without coronary artery disease, the incidence of these more severe events was lower than 1% for both the sildenafil and placebo groups 12 .

Between April and November 1998, the United States Food and Drug Administration (FDA) confirmed that 130 patients died after taking sildenafil. Of these patients, 80 (61.5%) had a cardiovascular event (acute myocardial infarction in 41, cardiac arrest in 27, stroke in 3, cardiac symptoms in 6, and coronary artery disease in 3 others); 2 patients

died

In 106 patients with a known age, the mean age was 64 years (29 to 87 years). Sildenafil dosage varied from 25 to 100 mg and one patient had an overdose.

Sixteen patients took nitrate and one used medication with a nitrate base, but its use was not confirmed. Forty (sildenafil super active 34%) patients died in the first 4 to 5 hours after using sildenafil; 27 of them died during or right after the coitus.

In the remaining, the periods of time in relation to coitus were increasingly high: 6 patients died after 6 hours, 8 patients died on the day after, 5 died 2 days after the coitus, and 4 patients died 3 to 4 days after the coitus.

Considering this temporal relation with the use of sildenafil, this mortality is markedly lower than that expected for the American male population with a similar mean age.

Therefore, considering that the deaths occurred in a period of 8 months, coinciding with 6.4 million prescriptions of sildenafil, 4 deaths occurred per week. This mortality is markedly lower than the total cardiovascular mortality expected, which is 150 deaths per week per each million men 12 .

Recommendations for the use of sildenafil in patients with cardiovascular disease.

1) Sildenafil is contraindicated in patients using long- and short-acting nitrates due to the possibility of developing potentially fatal severe hypotension. 2) In patients with stable coronary artery disease treated with long-acting nitrates, one may consider the possibility of suspending the nitrate in accordance with the patient, so that sildenafil can be used. 3) Patients not using long-acting nitrates but requiring nitrates sublingual for

treatment

4) Any use of nitrate is contraindicated in the 24 hours following the use of sildenafil. Sildenafil is also contraindicated if any nitrate has been used in the preceding 24 hours.

5) High-risk cardiovascular patients, including patients with atherosclerotic disease, NYHA functional classes II and III patients individuals above 65 years of age, hypertensive and, diabetic patients, smokers, patients with moderate to severe dyslipidemia, and obese individuals, even if not having asked for sildenafil, should be informed about the potential severe risk of sildenafil-nitrate interaction. This should be done because patients may obtain sildenafil by other means without the recommendations necessary for its use. 6) High-risk cardiovascular patients should sildenafil teva 25 be previously assessed through a treadmill stress test.

The risk of ischemia during coitus is low if they do not develop clinical or electrocardiographic signs, of ischemia and or arrhythmia, until a load of 5 to 6 METs is reached.

These load limits are valid for coitus with the usual partner, in a familiar environment, and without additional overload of excessive consumption of food and alcoholic beverages. Patients without sexual activity for a long period should be advised to moderate their physical activity and anxiety during their return to sexual activity. 7) In patients without ischemia and or arrhythmia, or both, on the treadmill stress test with load lower than 5 to 6 METs, the use of sildenafil should be conditioned to the sildenafil super active clinical situation of the patient.

8) It is convenient

that

10) Patients using sildenafil should be instructed to sildenafil super active tell about the use of sildenafil in case of an emergency.

11) An initial dose of 25 mg should be recommended in all situations that may increase the plasma concentration of sildenafil or potentiate its vasodilating effect and that do not constitute a formal contraindication for its use. Treatment of acute ischemic syndromes in patients using sildenafil. Initial treatment of the precordial pain suspicious of angina ? Carefully identify when the last dose of sildenafil was taken.

Do not use any type of nitrate if sildenafil has been taken within the preceding 24 hours.

From 24 to 48 hours after use of sildenafil, nitrate may be administered if no associated conditions increasing

plasma

Patients with acute myocardial infarction ? The same previous precautions should be taken. So far, no restraints regarding the use of heparin, cumarin, and thrombolytic agents exist.

In the case of hypotension, recovery of proper pressure levels can hinder the progression of myocardial lesions.

Unstable angina ? The same guidelines and warnings in relation to the use of nitrates and other medications commonly used in the treatment of this condition apply.

Treatment of the hypotension resulting from the interaction of sildenafil with nitrates.

The following measures should be employed in sequence: 1) place the patient in the Trendelenburg's position; 2) administer intravenous fluids rapidly; 3) use intravenous alpha-adrenergic agonists, such as phenylephrine, ethylephrine, or metaraminol; 4) if necessary, use an alpha or beta agonist, such as norepinephrine to support blood pressure, but one should be aware of the risk of worsening or inducing myocardial ischemia; 5) install auxiliary support through the intra-aortic balloon.

The recommendations here expressed result from a still limited experience in regard to some of the multiple clinical situations of patients with cardiovascular disease, who intend to

use

face