Nitrate cessation profiles in men wishing to use sildenafil citrate

To define the likelihood of nitrate users wishing to use sildenafil citrate being permitted by their nitrate-prescribing physicians to cease nitrate use, and to attempt to derive predictors of a "no" response to this request.

A total of 248 patients with erectile dysfunction were included in this study. All patients using or in possession of nitrates who opted to be treated with sildenafil had letters sent to the nitrate-prescribing physician, asking whether the nitrate could be ceased so as to facilitate sildenafil use.

Of 248 letters, 236 (95.7%) were answered by the nitrate-prescribing physicians. The types of nitrate use included oral (72 patients), sublingual (150 patients), and transdermal (14 patients); mean patient age was 64 years. To the question, "Would you permit the patient to cease use or possession of nitrate, to facilitate the use of sildenafil," 42% of the physicians (99 of 236) responded "yes." For men who were using oral, transdermal, and as-required sublingual nitrates, 28%, 0, and 53% of letters had a "yes" response. In a multivariable analysis we found five predictors of a "no" response: patient age greater than 65 years, duration of nitrate possession less than 6 months, oral/transdermal nitrate use, sublingual nitrate use more than once per year, and nitrate medication prescribed by a non-cardiology physician.

We demonstrated that 42% of men with erectile dysfunction who were using nitrates were permitted to discard their nitrates to facilitate sildenafil use, and we identified factors predicting a "no" response to such a request.