Sildenafil for the Treatment of Preeclampsia, an Update

Should We Still Be Enthusiastic?

Noémie Simon-Tillaux; Edouard Lecarpentier; Vassilis Tsatsaris; Alexandre Hertig


Nephrol Dial Transplant. 2019;34(11):1819-1826. 

In This Article


Preeclampsia is a frequent, potentially fatal syndrome and has long-term consequences for both the mother and her child. Until recently, SC was found to have a satisfactory safety and efficacy profile as an antihypertensive agent in preeclamptic women. However, the Dutch arm of the STRIDER trial, where SC was given early and for up to 4 weeks, rang an alarming warning bell regarding the potential increase in the risk of pulmonary hypertension in neonates, which might be fatal even though a causal link to SC has not yet been proven. Any enthusiasm regarding SC must be tempered by these findings and we must assume a degree of pessimism regarding the future of SC as a drug that improves IUGR and its use before delivery. Whether tadalafil, which does not cross the placental barrier, has similar antihypertensive efficacy and safety in preeclamptic women is uncertain at this time. Very recently, a Phase 2 trial studying the use of tadalafil in IUGR in Japan (UMIN000023778) was stopped prematurely due to the results from the STRIDER trial, but its partial results may give some answers regarding the safety of this other PDE5 inhibitor. However, in our opinion and looking at it from a pathophysiological angle, postpartum use of SC as an antihypertensive drug deserves further investigation.