Sildenafil and Calcium Channel Blocker Interactions

Clinical Recommendations

• The American College of Cardiology recommends that dihydropyridine CCBs, such as amlodipine, are preferred over non-dihydropyridine CCBs when concurrent sildenafil therapy is needed, due to the higher risk of symptomatic hypotension and bradycardia with non-dihydropyridine CCBs 1
• Patients taking sildenafil with amlodipine should be monitored for hypotension, and patients should be informed about potential symptoms of hypotension, such as dizziness and lightheadedness, and advised to seek medical attention if these occur 1
• The European Society of Cardiology suggests using extreme caution in elderly patients or those with pre-existing cardiovascular disease when combining sildenafil with CCBs, such as amlodipine 1
• Dihydropyridines, such as amlodipine, have high selectivity for vascular L-type calcium channels with less effect on cardiac conduction, resulting in an additive but not synergistic effect on blood pressure when combined with sildenafil 2