From the FDA Drug Label
CONTRAINDICATIONS Sildenafil citrate is contraindicated in patients with: Concomitant use of organic nitrates in any form, either regularly or intermittently, because of the greater risk of hypotension [see Warnings and Precautions (5.2)] .Known hypersensitivity to sildenafil or any component of the tablet. The FDA drug label does not answer the question.
From the Research
Sildenafil Contraindications
- Sildenafil is contraindicated in patients who are using organic nitrates in any form, either regularly or intermittently, as it potentiates the hypotensive effects of nitrates 1.
- Sildenafil should be used with caution in patients who take alpha-blockers because coadministration may lead to symptomatic hypotension in some individuals 1.
- Safety has not been established in patients with recent serious cardiovascular events, hypotension or uncontrolled hypertension, or retinitis pigmentosa, and physicians should consult their current local prescribing information before prescribing sildenafil for these patients 1.
Atrial Fibrillation and Non-Alcoholic Fatty Liver Disease
- Non-alcoholic fatty liver disease (NAFLD) is associated with an increased prevalence of atrial fibrillation (AF) in hospitalized patients with type 2 diabetes 2.
- The relationship between NAFLD and AF is thought to be linked by common risk factors such as dyslipidemia, insulin resistance, inflammatory milieu, and activation of the renin-angiotensin system 3.
- A systematic review and meta-analysis found that patients with NAFLD had a 2.5 times significantly higher chance of developing new-onset atrial fibrillation compared to those without NAFLD 4.
- A nationwide population-based cohort study found that NAFLD was positively correlated with the risk of incident atrial fibrillation in young adults 5.
Sildenafil Use in Patients with Atrial Fibrillation and Non-Alcoholic Fatty Liver Disease
- There is no direct evidence to suggest that sildenafil is contraindicated in patients with atrial fibrillation (AF) and non-alcoholic fatty liver disease (NAFLD) 1, 2, 3, 4, 5.
- However, patients with AF and NAFLD may have underlying cardiovascular disease, and sildenafil should be used with caution in these patients, as safety has not been established in patients with recent serious cardiovascular events 1.