A large proportion of patients who have erectile dysfunction also have coronary artery disease(CAD). In these patients, nitrate therapy is a contraindication to the use of sildenafil. To assess whether the metabolic anti-ischemic agent, trimetazidine, is effective in controlling episodes ofmyocardial ischemia during sexual activity in patients who have CAD and use longterm nitrate therapy, we studied 38 men(57±6 years of age) who had proved CAD. Patients underwent 24-hour ambulatory electrocardiographic monitoring at baseline, after 1 week of oral nitrate therapy(20 mg 3 times a day), and after 1 week of trimetazidine(20 mg 3 times a day). Patients were asked to engage in< 1 session of sexual intercourse during each session of ambulatory electrocardiographic monitoring. They were instructed to take sildenafil(100 mg) 1 hour before sexual intercourse performed at baseline and during therapy with trimetazidine and sildenafil or placebo(blinded) during therapy with nitrates. A decrease in total ischemic burden was observed with nitrates and trimetazidine compared with baseline(-3±1.2 episodes/patient/24 hours vs-5±1.3 episodes/patient/24 hours and-6±5 min/patient/24 hours vs-8±3 min/patient/ 24 hours, p< 0.01 for nitrates and trimetazidine vs baseline). Trimetazidine plus sildenafil was more effective in controlling episodes of myocardial ischemia during sexual activity than nitrates alone(-45±11%vs-18±7%, p< 0.04). In conclusion, in patients who have CAD, combination therapy with sildenafil and trimetazidine is more effective than nitrate therapy in the control of ischemic episodes during sexual activity, suggesting that long-term nitrate therapy may be safely switched to trimetazidine therapy when therapy for erectile dysfunction is required.
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