Sildenafil is available over-the-counter for erectile dysfunction. Which of the following patients can be safely supplied sildenafil OTC?

Sildenafil is available over-the-counter for erectile dysfunction. Which of the following patients can be safely supplied sildenafil OTC?

• A. A man w/ a history of asthma
• B. A man with hypertension controlled with beta-blockers
• C. A man taking nitrates such as isosorbide mononitrate
• D. A man w/ Peyronie's disease

Answer: (A)

The key idea is that sildenafil, a PDE-5 inhibitor, can cause vasodilation and drop blood pressure, so it cannot be given if there are drug interactions or conditions that raise the risk of dangerous hypotension, especially with nitrates. In the scenario, the man with a history of asthma has no known drug interaction with sildenafil and no nitrate use or other contraindications described. He can be supplied sildenafil OTC safely because there’s no red-flag interaction or condition listed. The man taking nitrates (like isosorbide mononitrate) cannot receive sildenafil OTC because combining a PDE-5 inhibitor with nitrates can cause a dangerous, life-threatening drop in blood pressure. Peyronie’s disease itself isn’t a contraindication to sildenafil, but the question asks who can be safely supplied without medical assessment of interactions; the nitrate case is clearly unsafe, and the asthma-only case is the clean, no-interaction scenario. The hypertension controlled with beta-blockers isn’t an absolute disqualifier, but it introduces potential risk and requires medical evaluation beyond OTC supply.

The key idea is that sildenafil, a PDE-5 inhibitor, can cause vasodilation and drop blood pressure, so it cannot be given if there are drug interactions or conditions that raise the risk of dangerous hypotension, especially with nitrates.

In the scenario, the man with a history of asthma has no known drug interaction with sildenafil and no nitrate use or other contraindications described. He can be supplied sildenafil OTC safely because there’s no red-flag interaction or condition listed.

The man taking nitrates (like isosorbide mononitrate) cannot receive sildenafil OTC because combining a PDE-5 inhibitor with nitrates can cause a dangerous, life-threatening drop in blood pressure.

Peyronie’s disease itself isn’t a contraindication to sildenafil, but the question asks who can be safely supplied without medical assessment of interactions; the nitrate case is clearly unsafe, and the asthma-only case is the clean, no-interaction scenario. The hypertension controlled with beta-blockers isn’t an absolute disqualifier, but it introduces potential risk and requires medical evaluation beyond OTC supply.