Sildenafil 4- Sodium nitroprusside

Smaller doses of sodium nitroprusside might be required in patients receiving antihypertensive drugs. There is a risk of severe hypotension if phosphodiesterase inhibitors (e.g. sildenafil, tadaiafil and vardenafil) are used with sodium nitroprusside. 

The use of phosphodiesterase inhibitors (e.g. sildenafil, tadaiafil and var-denafil) with sodium nitroprusside is contraindicated by the manufacturers, due to the risk of severe hypotension. See also Phosphodiesterase type-5 inhihitors +Nitrates , p.l272. A case report describes the therapeutic use of sildenafil to enhance the hypotensive effect of sodium nitroprusside and other antihypertensives in a patient with a hypertensive crisis. ... 

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