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medication
patient care
patient safety

‘Have you had Viagra within the past 24 hours?’

02 November 2017
Features
02 November 2017
Volume 9 · Issue 11

Abstract

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.

Sildenafil, commercially known as Viagra, is the most effective first-line treatment for erectile disfunction (ED) in the UK (Chamsi-Pasha, 2001; National Institute for Health and Care Excellence (NICE), 2014a). ED is estimated to affect more than 100 million men worldwide (Chamsi-Pasha, 2001), with one in four patients seeking help for the onset of ED being younger than 40 years (Capogrosso et al, 2013). However, its prevalence varies greatly. It is estimated to affect more than 30% of the population subgroup of men aged between 30 and 70 years worldwide (Feldman, 1994). A German study identified 19.2% of men aged between 30 and 80 years with this condition (Braun et al, 2000). This data should be treated with caution however, as it could potentially be an underestimation. For example, there are men who, for various reasons (e.g. embarrassment), do not report ED issues.

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NO-cGMP pathway
Sildenafil
GTN
Paramedic
Pre-hospital
Contraindication