How do PDE5 inhibitors and protease inhibitors (PIs) interact?

Updated: Jan 15, 2019
  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: Michelle R Salvaggio, MD, FACP  more...
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Answer

Answer

For PIs in combination with sildenafil for the treatment of erectile dysfunction (ED), it is recommended to start with sildenafil 25 mg q48h; for sildenafil for treatment of pulmonary arterial hypertension (PAH), combination therapy is contraindicated.

For PIs in combination with tadalafil for the treatment of ED, it is recommended to start with tadalafil 5 mg (do not exceed a single dose of 10 mg q72h); for treatment of PAH (patients on a PI >7 days), start with tadalafil 20 mg/day and increase to 40 mg/day, based on tolerability; patients on tadalafil who require a PI, stop tadalafil >24 hours before PI initiation, restart 7 days after PI initiation at 20 mg/day, and increase to 40 mg/day, based on tolerability.

For PIs in combination with vardenafil, start with vardenafil 2.5 mg q72h and monitor for adverse effects of vardenafil.

Avanafil coadministration is not recommended with ATV +/- RTV, DRV/RTV, FPV/RTV, SQV/RTV, or LPV/RTV.


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