Transient ischemic attack and stroke associated with sildenafil (Viagra) use

Morgan, John C.; Alhatou, Mohammed; Oberlies, Jennifer; Johnston, Karen C.

doi:10.1212/wnl.57.9.1730

Cited by 64 publications

(40 citation statements)

References 8 publications

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“…Some authors have suggested that there is an increased risk of cerebrovascular events in association with sildenafil. [2][3][4] Others reported two cases of tonic-clonic seizures after sildenafil. 5 Transient global amnesia (TGA), which occurred soon after the intake of sildenafil, has been published previously in three patients.…”

Section: Introductionmentioning

confidence: 99%

Transient global amnesia after intake of tadalafil, a PDE-5 inhibitor: a possible association?

Schiefer¹,

Sparing²

2005

Int J Impot Res

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Inhibitors of phosphodiesterase type 5 (PDE-5) are well established as an oral treatment for the majority of patients with erectile dysfunction (ED). PDE-5 is found in high concentration in smooth muscle cells of the corpora cavernosa. However, enzymes of the PDE family are also expressed in various other tissues, including the brain. Little is known about its effects on the central nervous system (CNS), although it has been suggested that PDE-5 inhibitors might cross the blood-brain barrier. Side effects, such as headache, nasal congestion, flushing, nausea, are much more common. We describe a patient who had a transient global amnesia (TGA) after his first-ever use of tadalafil, a potent PDE-5 inhibitor. Despite the fact that the aetiology of TGA has not entirely been clarified at present, we consider the hypothesis of a causal relationship as tempting with respect to the current hypotheses of TGA pathophysiology. This case, together with others, suggests that PDE-5 inhibitors might be capable of exerting adverse effects in the CNS. Physicians should be aware of the possibility of neurological disturbances when prescribing PDE-5 inhibitors for ED.

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Section: Introductionmentioning

confidence: 99%

Transient global amnesia after intake of tadalafil, a PDE-5 inhibitor: a possible association?

Schiefer¹,

Sparing²

2005

Int J Impot Res

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“…Although there have been several reports of ischemic stroke associated with sildenafil use [1][2][3][4] , this adverse effect is not widely…”

Section: Discussionmentioning

confidence: 99%

“…Although there have been several reports of ischemic stroke associated with sildenafil use [1][2][3][4] , this adverse effect is not widely appreciated, the drug is generally considered extremely safe [5][6][7] , and there have been no prior reports of aversion of threatened stroke with alteplace treatment. The underlying pathophysiologic mechanisms contributing to ischemic cerebral events have not been elucidated and have been postulated to reflect hypoperfusion distal to critical artery stenosis [8] , unrecognized transient arrhythmia [2,4] , cardioembolism or a hypercoagulable state [8][9][10] .…”

Section: Discussionmentioning

confidence: 99%

Sildenafil Associated Threatened Ischemic Stroke Reversed with Alteplase

Simons¹,

Rosengart²,

Schlick³

et al. 2017

IJNBD

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A 68-year-old male presented with a threatened ischemic stroke after ingesting sildenafil. Signs and symptoms promptly reversed with alteplase administration, and subsequent studies disclosed no other likely etiology for stroke. Although ischemic stroke owing to sildenafil has been reported, to our knowledge this is the first demonstration of reversal by alteplase. Case ReportA 68-year-old male with no prior history of hypertension, cardiac disease or stroke was transported to the emergency department after developing lower extremity weakness and slurred speech 30 minutes after ingesting of 40 mg of sildenafil. He was noted to be normotensive, in sinus rhythm, and to have dysarthria and a right facial droop, suggestive of left hemispheric ischemia. A non contrast CT scan of the head disclosed no evidence of hemorrhage, 6.7 mg of alteplace (TPA) was administered followed by infusion of 60.3 mg, during which all neurologic signs and symptoms abated, and he returned to his normal baseline. EKG showed normal sinus rhythm, CT angiogram of the head and neck, echocardiogram with bubble study, transcranial Doppler with micro-embolus detection and laboratory studies were all normal. His only risk factor for stroke was mild hyperlipidemia, controlled on 5 mg of rosuvastatin daily. There was no family history of stroke. DiscussionSildenafil is a competitive inhibitor of the cyclic guanosine monophosphate degrading enzyme phosphodiesterase type 5 and has been used for the treatment of both erectile dysfunction and pulmonary hypertension for approximately 15 years. Although there have been several reports of ischemic stroke associated with sildenafil use [1][2][3][4] , this adverse effect is not widelyCopyrights:

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“…Some authors have suggested that there is increased risk of cerebrovascular events in association with sildenafil [5][6]. Mehdizahed et.…”

Section: Discussionmentioning

confidence: 99%

Sildenafil: Can Cause Acute Ischaemic Stroke? A Case Report

Sunumu¹,

Ayas²,

Bölük³

2015

Türk Beyin Damar Hast Derg

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Sildenafil is an inhibitor of phosphodiesterase type-5 (PDE-5), is used for erectile dysfunction. There is not enough information about its effects on the central nervous system Headache, nasal congestion, facial flushing, nausea are the most common side effects. However, neurological complications such as third cranial nerve palsy, transient global amnesia, seizures, cerebral hemorrhage, and infarction are less commonly observed. We present a case of a 60-year-old man with acute ischaemic stroke, which we considered to be interrelated to sildenafil intake. Clinicians must be aware of the possibility of neurological side effects when the patient use sildenafil.

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Transient ischemic attack and stroke associated with sildenafil (Viagra) use

Cited by 64 publications

References 8 publications

Transient global amnesia after intake of tadalafil, a PDE-5 inhibitor: a possible association?

Transient global amnesia after intake of tadalafil, a PDE-5 inhibitor: a possible association?

Sildenafil Associated Threatened Ischemic Stroke Reversed with Alteplase

Sildenafil: Can Cause Acute Ischaemic Stroke? A Case Report

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