Viagra™ and the emergency physician

News

CJEM 1999;1(2):133

Emergency physicians are far too virile and studly to worry about Viagra^TM. Or so I thought. Like many others, my first response to Viagra^TM was a chuckle. Then I noticed an explosion of seminars, conferences, articles and lectures on erectile dysfunction (it's amazing how a new drug spawns CME events). My amusement turned to dismay when the new ED Viagra^TM Policy was rolled out at a recent group meeting. The policy states that emergency physicians should not ingest Viagra^TM within 12 hours of working a shift, and that . . .

"Any patient who has taken Viagra^TM within 24 hours of their ED visit must not be given nitroglycerine."

Okay, I'm lying. The new Viagra^TM policy says, and I quote: "There are several reported deaths from refractory hypotension with concomitant use of Viagra^TM and nitroglycerine. Effective immediately, every patient must be asked whether they are taking Viagra^TM before they are given nitroglycerine or nitroprusside. Any patient who has taken Viagra^TM within 24 hours of their ED visit must not be given nitroglycerine. This policy will be in effect until further data is available on the safety and timing of nitrate use in patients who are on Viagra^TM."

I found this extremely upsetting. Now I'll have to remember 2 questions: "When was your last Viagra^TM?" and "Have you had a tetanus shot within 10 years?" Moreover, it will mean a significant change in the way we treat patients with chest pain (I wonder if it's more harmful or less harmful to just give the nitroglycerine). I hope Pfizer is doing some research on this topic, or else Viagra^TM will turn into a major long-term headache for ED physicians and cardiac patients alike.

Have you instituted your Viagra^TM policy yet?

Grant Innes, MD
St. Paul's Hospital
Vancouver, BC
ginnes@interchange.ubc.ca