ModerateAngiotensin II receptor blockers (sartans)×Phosphodiesterase type 5 inhibitors (PDE5)
Updated · Methodology
Mechanism
Both lower blood pressure by different routes: losartan blocks the angiotensin II receptor, sildenafil relaxes vascular smooth muscle through the nitric oxide/cGMP pathway. The effect is additive and quantified in the label for a comparable antihypertensive: with amlodipine, sildenafil 100 mg lowered supine systolic pressure by a further 8 mmHg and diastolic by 7 mmHg.
Symptoms
Dizziness on standing, vision darkening for a few seconds, facial flushing, headache, palpitations. In older or dehydrated people the drop can reach syncope. The nitrate combination is contraindicated and should not be confused with this one.
Management
The pair is acceptable with controlled blood pressure. Start at the lowest sildenafil dose, avoid alcohol, and stand up slowly for the first hours. Skip it on the day the antihypertensive dose is adjusted or a diuretic is added, and always check for nitrates, where the combination is no longer possible.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- AEMPS: Ficha técnica Sildenafilo Cinfa 100 mg comprimidos masticables EFG (2022)– AEMPS, CIMA, nº registro 80115, sección 4.5
- AEMPS: Ficha técnica Losartán Cinfa 50 mg comprimidos recubiertos con película EFG (2025)– AEMPS, CIMA, nº registro 67729, secciones 4.4 y 4.5