title: Prehospital consideration of sildenafil-nitrate interactions.
abstract: OBJECTIVE
  To determine whether paramedics and on-line physicians screen patients for use of sildenafil citrate (Viagra) prior to prehospital administration of nitrates.
  
  
  METHODS
  A prospective, observational study was performed over a one-month period in three EMS systems. Consecutive radio communications between on-line physicians and paramedics concerning male patients with cardiac complaints were monitored. Investigators observed the frequency with which on-line physicians screened for sildenafil use prior to ordering nitrates. After observation of the radio communications was completed, a written survey was distributed to all paramedics in the three EMS systems.
  
  
  RESULTS
  Seventy-six physician-paramedic interactions were monitored. Nitrates were ordered by on-line physicians in 56 cases. No paramedic reported sildenafil use/nonuse, and no on-line physician inquired about the patient's potential use of the drug. Only half of the surveyed paramedics reported that they routinely screen for sildenafil use, and approximately a fourth reported that its use would not alter their management of chest pain patients.
  
  
  CONCLUSIONS
  In this study, on-line physicians in three EMS settings did not screen for sildenafil use prior to ordering nitrates. While some paramedics do screen for sildenafil use, practice patterns among paramedics in these three systems were inconsistent.
authors.affiliation: Department of Emergency Medicine, State University of New York Health Science Center at Syracuse, 13210, USA. reedd@mailbox.hscsyr.edu
authors.forename: D B
authors.initials: DB
authors.lastname: Reed
authors.forename: J E
authors.initials: JE
authors.lastname: Gough
authors.forename: J D
authors.initials: JD
authors.lastname: Ho
authors.forename: L H
authors.initials: LH
authors.lastname: Brown
mesh_terms: D000368:Aged; D000488:Allied Health Personnel / Q000193:education / Q000706:statistics & numerical data*; D000075202:Contraindications; D003625:Data Collection; D004347:Drug Interactions; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006323:Heart Arrest / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009573:Nitrites / Q000009:adverse effects; D010819:Physician's Role; D010879:Piperazines / Q000009:adverse effects*; D011446:Prospective Studies; D011687:Purines; D000068677:Sildenafil Citrate; D013450:Sulfones; D014481:United States
chemical_list: D009573:Nitrites; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate