Phosphodiesterase 5 inhibitors (PDE5i) are an effective and well-tolerated first-line treatment for erectile dysfunction. Cardiovascular risk associated with the use of PDE5i appears very low, and there is no convincing evidence that PDE5i increase the risk of myocardial infarction or CV death. However, given that little clinical data exist about the prescription of PDE5i after a recent CV event, it is advised not to prescribe PDE5i during 4 to 6 weeks following the event. Moreover, PDE5i should never be prescribed in patients receiving nitrates. After the intake of sildenafil or vardenafil, at least 24 hours should elapse before using nitrates. For tadalafil, this nitrate-free period is increased to 48 hours.
Key Words
Erectile dysfunction, phosphodiesterase 5 inhibitors, cardiovascular risk, nitrates