Drug interactions
Nitroglycerin sublingual + Sildenafil
Severity: Contraindicated
Nitroglycerin sublingual and Sildenafil: contraindicated interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Taking sublingual nitroglycerin after sildenafil can cause abrupt and severe hypotension. This is dangerous in patients with chest pain who may reach for a nitrate.
What this interaction means in plain words
Nitroglycerin sublingual and Sildenafil are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Why it happens
Sildenafil blocks PDE5, preventing cGMP breakdown, which markedly amplifies nitrate-induced vasodilation.
What to do
Do not use within 24 hours of sildenafil, and warn patients to seek emergency care rather than self-treat chest pain with nitroglycerin after sildenafil. Use non-nitrate anti-anginal options where needed.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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Other interactions of Sildenafil
- Amyl nitrite + Sildenafil Contraindicated
- Atazanavir + Sildenafil Contraindicated
- Cobicistat + Sildenafil Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Sildenafil Contraindicated
- Glyceryl trinitrate pr + Sildenafil Contraindicated
- Isosorbide dinitrate + Sildenafil Contraindicated
Frequently asked questions
Can I take Nitroglycerin sublingual with Sildenafil?
MediHelp rates the interaction as contraindicated. Nitroglycerin sublingual and Sildenafil are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Taking sublingual nitroglycerin after sildenafil can cause abrupt and severe hypotension. This is dangerous in patients with chest pain who may reach for a nitrate.
How serious is the interaction between Nitroglycerin sublingual and Sildenafil?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Do not use within 24 hours of sildenafil, and warn patients to seek emergency care rather than self-treat chest pain with nitroglycerin after sildenafil. Use non-nitrate anti-anginal options where needed.
What other medicines interact with Sildenafil?
MediHelp also lists interactions of Sildenafil with, for example, Amyl nitrite, Atazanavir, Cobicistat. The full list is on the Sildenafil page.
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