Webster et al1 found that the PDE5 inhibitor sildenafil citrate can be safely used in the treatment of ED in men with NYHA classes II and III heart failure. The study by Webster and colleagues1 may include additional data of further clinical importance. It is generally recognized that the concomitant use of nitrates and PDE5 inhibitors is strictly contraindicated. Caution in using PDE5 inhibitors in patients receiving treatment with α-blockers has also been warranted, and combination therapy cannot be recommended. In the product summary of the most recent commercial available PDE5 inhibitor vardenafil hydrochloride (launched in 2003), it is emphasized that clinical data addressing the safety of combination therapy with vardenafil and α-blockers are insufficient. Similar conclusions can most likely be drawn for therapy with sildenafil or tadalafil.
Mickley H, Poulsen TS. Use of Sildenafil Is Safe in Men With Congestive Heart Failure. Arch Intern Med. 2004;164(18):. doi:10.1001/archinte.164.18.2068