Is oxandrolone (anabolic steroid) safe to use with sildenafil (phosphodiesterase type 5 inhibitor)?

Safety of Oxandrolone Use with Sildenafil

The concurrent use of oxandrolone (an anabolic steroid) with sildenafil (a PDE5 inhibitor) should be approached with caution due to potential cardiovascular risks, though no absolute contraindication exists between these specific medications.

Pharmacological Considerations

Sildenafil Safety Profile

• Sildenafil is a selective phosphodiesterase type-5 inhibitor that causes vasodilation through the NO/cGMP pathway 1
• Common side effects include headache, flushing, epistaxis, and dyspepsia, which are generally mild to moderate and transient 1, 2
• Sildenafil produces modest, transient reductions in blood pressure with negligible effects on heart rate in most patients 3

Known Drug Interactions with Sildenafil

• Absolute contraindications: Sildenafil must not be used with nitrates in any form or with riociguat due to potentially life-threatening hypotension 2
• Medications that inhibit CYP3A4 (ketoconazole, itraconazole, ritonavir, erythromycin, fluconazole) can significantly increase sildenafil levels, requiring dose adjustment 2
• Sildenafil is generally safe with most antihypertensive medications, including beta-blockers, alpha-blockers, diuretics, ACE inhibitors, and calcium antagonists 4

Oxandrolone and PDE5 Inhibitor Considerations

While there is no specific evidence in the guidelines addressing the interaction between oxandrolone and sildenafil directly, several important factors should be considered:

1. Cardiovascular Effects:

   • Anabolic steroids like oxandrolone can affect cardiovascular health, potentially causing hypertension, altered lipid profiles, and increased risk of cardiovascular events
   • The vasodilatory effects of sildenafil combined with potential cardiovascular effects of oxandrolone warrant careful monitoring

2. Risk Assessment Approach:

   • The Princeton Consensus recommendations suggest integrating multiple aspects of cardiometabolic health when assessing risk for sexual activity and PDE5 inhibitor use 1
   • Patients should be evaluated for cardiovascular risk factors before combining these medications

3. Monitoring Recommendations:

   • Blood pressure should be monitored regularly when initiating this combination
   • Patients should be educated about potential signs of adverse cardiovascular effects

Clinical Approach

For patients considering combined use of oxandrolone and sildenafil:

1. Initial Assessment:

   • Evaluate baseline cardiovascular status and risk factors
   • Consider starting with lower doses of sildenafil (25mg) when used with oxandrolone 5

2. Ongoing Monitoring:

   • Regular monitoring of blood pressure and cardiovascular symptoms
   • Periodic assessment of liver function, as both medications may affect hepatic function

3. Patient Education:

   • Inform patients about potential side effects and when to seek medical attention
   • Explain that sexual activity itself carries a small but real cardiovascular risk (equivalent to 3-5 METs of exercise) 6

Conclusion

While no absolute contraindication exists between oxandrolone and sildenafil based on available evidence, their combination should be approached with caution due to potential cardiovascular effects. Careful cardiovascular risk assessment, appropriate dosing, and regular monitoring are essential when these medications are used concurrently.