Sildenafil Beta blockers

Drugs that may interact with nitrates include alcohol, alteplase, aspirin, beta-blockers, calcium channel blockers, dihydroergotamine, heparin, nondepolarizing muscle relaxants, phenothiazines, phosphodiesterase inhibitors (eg, sildenafil, tadalafil, vardenafil), and vasodilators. 

The manufacturers report that in population pharmacokinetic analysis, there was no effect on sildenafil pharmacokinetics in those taking ACE inhibitors, calcium-channel blockers and tMazide and related diuretics whereas the AUC of the less potent active metabolite of sildenafil is increased by 62% by loop and potassium-sparing diuretics and by 102% by non-selective beta blockers, although these changes were not considered clinically relevant. ... 

The manufacturer notes that in population pharmacokinetic analysis of patients with pulmonary hypertension, there appeared to be an increase in sildenafil exposure when it was taken with beta blockers (none named) in combination with CYP3A4 substrates (none named). " The clinical relevance of this is uncertain, and fiuther study is needed. 

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