22.Uluslararası yoğun bakım sempozyumu, İstanbul, Turkey, 3 - 04 May 2019, pp.1
INTRODUCTION/ PURPOSE Sildenafil is used in the treatment of erectile dysfunction and pulmonary hypertension. The use of sildenafil with nitrates is well known to cause myocardial ischemia. A few cases have been reported in the literature related to ischemic stroke and transient ischemic attack due to sildenafil use. Aim of this case report is to underline the importance of caution needed when prescribing sildenafil to patients with risk factors of ischemic stroke like smoking or alcohol. FACT: A 57-year-old, right-handed male patient came to the emergency room with a speech disorder, dropping of mouth, and inability to recognize his relatives for 2 days. The patient had smoked 15 packs / year and used alcohol rarely. The patient received sildenafil tablets with alcohol 2 days ago. Since the patient did not improve his consciousness, his relatives brought him to the emergency room. In the physical examination, the patient was lethargic, did not have orientation and cooperation, or nuchal stiffness, his pupils were anisochoric, and myosis on his left eye was present. He had motor and sensory aphasia. The patient had hemiplegia on the right side.The patient was not given a TPA and thrombectomy could not be performed because the patient admitted 24 hours later. Enoxaparin, aspirin, clopidogrel, treatments were started. Cranial MRI are shown in figure 1.
DISCUSSION: Sildenafil is a widely used drug for men with erectile dysfunction, but little is known about stroke risk in patients who take sildenafil. Sildenafil should be prescribed with caution to patients with persistent hypotension, previous myocardial infarction, stroke or arrhythmias. Few ischemic strokes associated with the use of sildenafil have been described. Alcohol may enhance the hypotensive effect of Phosphodiesterase 5 Inhibitors. Clinicins should be aware that alcohol may exacerbate hipotensive effects of fosfodiesteraz 5inhibitors which may lead to ischemic stroke