Can a man taking isosorbide mononitrate be supplied sildenafil OTC?

Can a man taking isosorbide mononitrate be supplied sildenafil OTC?

• A. Yes
• B. No
• C. Only with physician approval
• D. Not for isosorbide mononitrate use

Answer: (B)

Nitrates and PDE-5 inhibitors have a dangerous interaction that can cause severe hypotension. Isosorbide mononitrate releases nitric oxide to dilate blood vessels, while sildenafil increases levels of cGMP to enhance vasodilation. Together, they can drop blood pressure dramatically, risking fainting, heart attack, or stroke. Because of this, sildenafil should not be supplied over the counter to someone taking isosorbide mononitrate. There isn’t a safe window or physician-led exception that makes this combination acceptable. If ED treatment is needed, it should be discussed with a physician to choose an option that does not interact with nitrates.

Nitrates and PDE-5 inhibitors have a dangerous interaction that can cause severe hypotension. Isosorbide mononitrate releases nitric oxide to dilate blood vessels, while sildenafil increases levels of cGMP to enhance vasodilation. Together, they can drop blood pressure dramatically, risking fainting, heart attack, or stroke. Because of this, sildenafil should not be supplied over the counter to someone taking isosorbide mononitrate. There isn’t a safe window or physician-led exception that makes this combination acceptable. If ED treatment is needed, it should be discussed with a physician to choose an option that does not interact with nitrates.