Safety of Sildenafil in Chronic Kidney Disease

Medication Management

Medication review should be performed periodically in CKD patients to assess for potential drug interactions, as polypharmacy is common in this population, according to Kidney International 1, 2

The American College of Cardiology states that sildenafil must not be used concomitantly with nitrate medications due to risk of severe hypotension 3
Patients on sildenafil should avoid taking nitroglycerin for at least 24 hours after sildenafil use (48 hours for tadalafil), as recommended by the American College of Cardiology 3

Sexual activity represents moderate physical activity (3-5 metabolic equivalents), so patients should be assessed for ability to perform this level of activity, according to the American College of Cardiology 3

The Kidney International guideline recommends monitoring eGFR, electrolytes, and therapeutic medication levels in CKD patients receiving medications with narrow therapeutic windows or potential adverse effects 2
Consider GFR when dosing medications cleared by the kidneys, as suggested by Kidney International 2
For most clinical settings, validated eGFR equations using serum creatinine are appropriate for drug dosing, according to Kidney International 2

People with CKD may be more susceptible to nephrotoxic effects of medications, so always consider benefits versus potential harms, as stated by Kidney International 2

Review and limit use of over-the-counter medicines and dietary/herbal remedies that may be harmful for people with CKD, as recommended by Kidney International 2
When prescribing to CKD patients of child-bearing potential, review teratogenicity potential and provide reproductive counseling, according to Kidney International 2
In patients with extremes of body weight, eGFR non-indexed for body surface area may be indicated, especially for medications with narrow therapeutic ranges, as suggested by Kidney International 2