Heart rate at 1, 4, and 8 hours
Heart-rate increases were potentiated when NTG was taken at 1, 4, and 8 hours after the 20 mg swallow.
Those clocks are healthy-volunteer pharmacology. They are not a home schedule for chest pain.
What happened at 1 hour and 4 hours?
Sublingual NTG 0.4 mg at those hours after vardenafil 20 mg potentiated the blood-pressure lowering effects in healthy middle-aged subjects.
That is why a 'just in case' spray in a golf bag closes this tablet. Access to nitrates is the issue.
Leaflet language warns that nitrates could drop pressure to an unsafe level, with dizziness, syncope, or even heart attack or stroke.
Poppers count
Amyl nitrate and butyl nitrate recreational 'poppers' are named on the patient leaflet next to prescription nitrates.
A club night does not open a 10 mg tablet. The path is the same nitric-oxide stack.
Is any nitrate interval labelled safe for IHD?
No. The file says a suitable time interval for safe nitrate use after vardenafil has not been determined.
Potentiation in men who already need nitrates for ischemia was not evaluated. The combination stays contraindicated.
Twenty-four hours in healthy men is not a home rule
The extra effects were not observed when vardenafil 20 mg was taken 24 hours before NTG in that sitting.
The IHD interval is still 'not determined.' Do not turn 24 hours into a kitchen timer.
Riociguat is the other NO-path stop
Guanylate-cyclase stimulators such as riociguat (Adempas) are contraindicated. PDE5 inhibition can potentiate their hypotensive effect.
QT screening does not open riociguat. Read the QT tag as a separate job.