Sildenafil Citrate Administration Resulting in Death

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Sildenafil citrate is a phosphodiesterase (PDE) 5 inhibitor. Many case reports have described associated with acute coronary syndrome of Sildenafil citrate ingestion. However, mortality due to ventricular arrhythmias has not been reported for Sildenafil yet. We described a case of a patient with no cardiac history, resulting in death due to ventricular tachycardia (VT) occurring after ingestion sildanafil citrate.

A -56- year old man was brought to the emergency department (ED) with palpitation. After he had taken orally 100 milligram sildenafil citrate tablet (Viagra, Pfizer, New York) because of his erectile dysfunction, the patient experienced palpitation in approximately 6 hours. There were no any cardiopulmonary symptom and disease in the patient’s past medical history. A physical examination revealed a body temperature of 36.7°C (axillary), arterial blood pressure of 110/50 mm/Hg, and a pulse rate of 185 beats/min. Sustained monomorphic ventricular tachycardia was determined in 12-lead electrocardiogram (ECG) recorded when the patient was admitted to the ED (Figure 1).

Three hundred milligrams of Amiodarone was administered for treatment of VT intravenously. But, VT cannot be returned to sinus rhythm. He was transferred to coronary care unit (CCU) and simultaneously, the patient went into hemodynamic instability there. Electrical cardioversion was performed. Asystole appeared after electrical cardioversion and cardiopulmonary resuscitation was performed. However, asystole did not respond to performed cardiopulmonary resuscitation and he patient was dead.

PDE 5 inhibitors were developed as cardiovascular drugs and were incidentally found to enhance erections. Sildenafil citrate, is widely used to treat male erectile dysfunction, is a PDE 5 inhibitor. Since the introduction of the first sildenafil citrate, in 1998, there has been concern about the effects of these agents on the heart and its safety in patients with cardiovascular disease. These concerns can be collected to three subjects: effects on blood pressure and heart rate, effects on cardiac electrophysiology, and the number of cardiovascular adverse events.