Both the Second Princeton Consensus Panel and a consensus statement from the American College of Cardiology/American Heart Association concluded that a Viagra-like drug is safe for men with stable coronary artery disease who are not taking nitrates.
There are no clinical differences among the Viagra-like drugs with the exception of a prolonged duration of action with tadalafil.
The Viagra-like drugs are contraindicated as co-prescription with any nitrate preparation and they should also not be taken with alpha-blocking agents. Cardiac patients should be counselled about the interaction with nitrates, even if a Viagra- like drug is not currently prescribed.
If a man who has taken a Viagra-like drug develops chest pain, nitrates should not be administered within 24 hours (or longer in patients with renal or hepatic dysfunction) of sildenafil, 24 hours of vardenafil, or up to 48 hours of tadalafil.
Viagra like drugs can be dangerous in folllowing cases:
- In patients with active coronary ischemia, even in those who are not taking nitrates (e.g., positive exercise stress test for ischemi
- Patients with heart failure and borderline low blood pressure and/or low volume status
- Patients on a complicated multidrug antihypertensive drug regimen. Drugs like rifampin (TB) and phenytoin (epilepsy), can be expected to reduce the effectiveness of these drugs.