27th June 2023

Pharmacological Management

For most men, phosphodiesterase-5 (PD5) inhibitors, as required, are appropriate – these can now be bought over the counter in the UK, as well as prescribed. They should be avoided in men with severe coronary artery disease, those who have had a stroke in the last six months or myocardial infarction in the last three months. They are not suitable for men who have severe hepatic impairment, and the dose should be reduced for those with significant renal impairment. There are many drug interactions, including with cytochrome p450 inhibitors, as clearance of PD5-inhibitors relies on this pathway. Concurrent use of nitrates is an absolute contraindication due to the risks of unpredictable hypotensive episodes. If a man develops chest pain after taking a PD5 inhibitor organic nitrates cannot be given for at least 12 hours (depending on PD5 inhibitor taken).