Cardiovascular Risks Associated with THC and Sildenafil Combination

Introduction to Cardiovascular Risks

• The American Urological Association recommends evaluating the baseline cardiovascular risk in patients using cannabis, especially before prescribing sildenafil 2

Mechanism of Potential Interaction

• The European Heart Journal reports that THC is a known inhibitor of cytochrome P450 3A4, which metabolizes sildenafil, potentially increasing sildenafil plasma concentrations and enhancing vasodilatory effects 1

Established Interactions with Sildenafil

• The Journal of Urology states that sildenafil has well-established interactions with nitrates, which are absolutely contraindicated due to the risk of potentially fatal hypotension 3
• The European Heart Journal notes that potent CYP3A4 inhibitors, such as ketoconazol and ritonavir, significantly increase sildenafil levels and require dose adjustment 4

Recommendations for Patient Care

• The American Urological Association guidelines suggest that healthcare providers should explicitly ask about cannabis use and warn patients about the risk of cardiovascular events when combining cannabis and sildenafil 2