From the Guidelines
Imdur (isosorbide mononitrate) can cause erectile dysfunction as a side effect, and patients taking this medication should not combine it with erectile dysfunction medications like sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) due to the risk of a dangerous and potentially fatal drop in blood pressure. This medication belongs to the nitrate class of drugs commonly used to treat angina and heart conditions by dilating blood vessels. Erectile dysfunction occurs in approximately 1-5% of men taking nitrates like Imdur because these medications affect blood vessel tone and nitric oxide pathways throughout the body, including those involved in achieving erections.
If you experience erectile dysfunction while taking Imdur, do not stop the medication on your own, but consult your healthcare provider. They may adjust your dosage, switch you to an alternative medication, or prescribe an erectile dysfunction treatment that is safe to use with your heart condition. According to the American College of Physicians, clinicians should initiate therapy with a PDE-5 inhibitor in men who seek treatment for erectile dysfunction and who do not have a contraindication to PDE-5 inhibitor use 1. However, the most recent study from 2021 suggests that vascular erectile dysfunction is a strong predictor of IHD, and cardiovascular evaluation of patients presenting with erectile dysfunction is now recommended 1.
Some key points to consider:
- Imdur can cause erectile dysfunction as a side effect
- Do not combine Imdur with erectile dysfunction medications like sildenafil, tadalafil, or vardenafil
- Consult your healthcare provider if you experience erectile dysfunction while taking Imdur
- The American College of Physicians recommends initiating therapy with a PDE-5 inhibitor in men who seek treatment for erectile dysfunction and who do not have a contraindication to PDE-5 inhibitor use
- Vascular erectile dysfunction is a strong predictor of IHD, and cardiovascular evaluation of patients presenting with erectile dysfunction is now recommended.
From the Research
Imdur and Erectile Dysfunction
- Imdur, a sustained-release isosorbide 5-mononitrate preparation, is used to treat chronic stable angina pectoris 2.
- There is no direct evidence that Imdur is used to treat erectile dysfunction.
- However, studies have shown that sildenafil, a phosphodiesterase type 5 inhibitor used to treat erectile dysfunction, can interact with nitric oxide donor drugs like isosorbide mononitrate 3, 4.
- The combination of sildenafil and isosorbide mononitrate can produce significant reductions in blood pressure, which may be beneficial for patients with treatment-resistant hypertension 5.
- In patients with coronary artery disease and erectile dysfunction, sildenafil has been shown to have mild hemodynamic effects, increasing cardiac index and stroke volume index, while isosorbide mononitrate reduced mean arterial pressure more than sildenafil 4.
Interaction between Imdur and Sildenafil
- The coadministration of sildenafil with isosorbide mononitrate or glyceryl trinitrate can produce significantly greater reductions in blood pressure than isosorbide mononitrate or glyceryl trinitrate alone 3.
- Based on these data, sildenafil should not be administered to patients taking nitrates, including Imdur 3.
- However, the combination of an NO donor drug and a phosphodiesterase 5 inhibitor may represent an effective treatment for patients with treatment-resistant hypertension, and longer studies in larger numbers of patients are now justified 5.