PDE5 Inhibitors (Sildenafil) for Labile Hypertension

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I am a physician S/P resection of Pituitary Macroadenoma (Stroke Risk) and keep BP tightly controlled using multiple Meds. I have found serendipitously PDE5 Inhibitors, such as Sildenafil (Viagra), Vardenafil...to be best tolerated PRNs for acutely incr. BP, especially with reflex Bradycardia. As a physician, I am aware of potential interactions (Don't try this if you are not).  Who else knows about this, has tried it?  Why not?  Who is studying this. These are, of course, already used for Pulmonary Hypertension. Please respond if you have ideas or info. Thank you. 

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5 Replies

  • Posted

    I suffer from labile hypertension, frequent and unpredictable acutely increased BP (from <120 0="" to="">170/110), which occurs randomly and is thus in need of PRN treatment, My doctor, at a loss about this changeability, is flexible and surprisingly lenient in my "experimentation" and trusts my judgement in dosage (which I don't even trust).

    So far, I have relied on extra benazepril and xanax (quick-acting) to stop rapidly ascending BP, but it has very unfortunately increased my tolerance for and physical (mostly BP) dependence on xanax considerably. Benazepril also causes me generalized body aching at high doses and thus makes sleep fitful and unrestorative.

    It has been interesting to see that my BP spikes correspond with brachycardia, rather than tachycardia (which surprisingly occurs when my BP drops below "normal" BP, 120/80, due to excess benazepril, xanax, or alcohol). I'm relieved to read "acutely incr. BP, especially with reflex Bradycardia" - which is exactly what often happens to me without medication.

    By the way, amlodipine caused  me hypotension, serious tachycardia, and non-sexual priapism, as well as very poor sleep, generalized aching, and severe hot flashes that woke me in the middle of the night. The drug from hell.

    I have a small supply of sildenafil that I haven't used, and I'm willing to experiment, as my doctor trusts me to do. Your recommendation as to dosage would be most welcome.


    • Posted

      Calibri and Derek76:  It would be best to discuss your dose issues with your physician, who has information about your history, other DX, medications,..  As you know, PDE5's may cause severe hypotension w nitrates, alpha blockers...  Also, Dr/pharmacist may assist you w interactions. A time-honored caveat in medicine is "Start low, Go slow."

      Medical wisdom is not to sail in uncharted waters.  That's why I probe this community for experience, serendipitous findings, research,  hazards and successes in this approach. That said, I am not beyond trying this with best physiological indications.  Will share.  Colibri, your Bradycardia may be reflex response to HTN, but can be associated w beta blockers, Ca Channel Blockers, intracranial disturbances...Be sure your Dr knows.


    • Posted

      My bradycardia is most likely a reflex to HTN. It is not a response to beta blockers, and certainly not to a calcium channel blocker.

      My previous post describes my experience with amlodipine - one of the most used Ca channel blockers - it caused significant tachycardia - up to 80+ beats per minute. I had to take a beta blockers to bring my HR back to my more normal 60ish while taking a Ca Channel blocker!

      If you mean by "intracranial disturbance" that I'm "nuts" then that is certainly a possibility.

  • Posted

    very interesting . i found taking 5 mg of cialis helped me to achieve better bp values than other bp drugs . I am thinking of reducing the dose of other bp meds (amlor cozaar).

    hope to hear from you.

    best wishes


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