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Angina - stable - Management
What key drug interactions should I be aware of?
- The concurrent use of phosphodiesterase inhibitors (sildenafil, tadalafil, and vardenafil) with nitrates is contraindicated. This combination can produce excessive hypotension and possibly precipitate myocardial infarction.
- A nitrate should not be given for at least 24 hours after the last dose of sildenafil or vardenafil, and for at least 48 hours after the last dose of tadalafil.
- Sildenafil and vardenafil should not be used for at least 24 hours after the last dose of a nitrate, and tadalafil should not be used for at least 48 hours after the last dose of a nitrate.
- Advise people with angina who are taking a phosphodiesterase inhibitor that they must not use glyceryl trinitrate if they have an episode of angina during sexual intercourse. Advise them to stop sexual activity and, if their pain does not resolve, they should call for an ambulance.
[ABPI Medicines Compendium, 2008a; Baxter, 2008; ABPI Medicines Compendium, 2009b; ABPI Medicines Compendium, 2009f]
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