Joel Phillips
Journal of Paramedic Practice, Vol. 9, Iss. 11, 03 Nov 2017, pp 490 - 494

Rapid drug-induced vasodilation is essential in treating coronary medical
emergencies. Through oral or sublingual administration of glyceryl trinitrate
(GTN), changes occur in cyclic guanosine monophosphate (cGMP) levels, as
well as a reduction in blood pressure. Patients who require GTN treatment
may also take vasodilatory medication for other medical conditions, including
erectile dysfunction (ED). Current guidance in the UK contraindicates GTN use
alongside sildenafil (commercially known as Viagra) and other related drugs,
owing to the likelihood of life-threatening hypotension. Therefore, it is essential
that paramedics and emergency responders establish whether patients have
taken sildenafil within the past 24 hours before administering GTN. This article
identifies the action mechanisms of both drugs, and provides an evidence-based
explanation for co-administration outcomes; a dramatic drop in blood pressure
which can potentially be fatal. This article also reflects on the challenges faced
by paramedics when considering administration of GTN to determine whether
sildenafil has been taken within the past 24 hours.

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