Impact of Priligy on Patients with Aortic Regurgitation: A Clinical Inquiry

What is the effect of Priligy on patients with aortic regurgitation?

Hello Dr.
Lee,
I have moderate to severe aortic regurgitation, with a history of 30 years.
I also have left bundle branch block, but the physician seems to consider this less significant.
I have not undergone surgery yet, and my medication (Valsartan) is managing my condition reasonably well.
My left ventricular internal diameter in diastole (LVIDD) is approximately 51 mm, and my left ventricular ejection fraction (LVEF) is about 75%.
I can perform normal activities without issues, including climbing six flights of stairs daily and engaging in sexual activity.
The doctor mentioned that I am approximately at Stage II heart failure.
However, I am troubled by premature ejaculation and recently learned about the medication Priligy.
The information leaflet states that it should not be used in patients with significant heart disease, but it seems that it is not as strictly contraindicated as Viagra and nitrates.
Could you please advise on the effects of this medication on patients with aortic regurgitation? Given my situation, would it be safe for me to take it? Thank you!

Yang Zhe, 50~59 year old female. Ask Date: 2021/07/07

Dr. Li Han reply Cardiology

Hello, regarding your inquiry about "moderate-severe aortic regurgitation with a 30-year history, along with left bundle branch block, long-term medication (Valsartan) for control, LVIDD approximately 51, LVEF approximately 75%, and no issues with normal activities, including climbing six flights of stairs daily," is it safe to take Priligy? The warnings in the medication insert indicate that it should be avoided in patients with orthostatic hypotension or heart conditions classified as New York Heart Association (NYHA) functional class II-IV or those with coronary artery disease.
Based on functional classification, you may not have issues with either heart failure or angina; however, the concern regarding orthostatic hypotension can be assessed with a simple orthostatic test.
Best wishes from Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2021/07/07

More Info

When considering the use of Priligy (dapoxetine) in patients with moderate to severe aortic regurgitation, it is essential to evaluate both the pharmacological effects of the medication and the underlying cardiac condition of the patient. Aortic regurgitation is a condition where the aortic valve does not close properly, allowing blood to flow back into the left ventricle from the aorta during diastole. This can lead to volume overload of the left ventricle, potentially resulting in heart failure if left untreated.

Priligy is a selective serotonin reuptake inhibitor (SSRI) that is primarily used to treat premature ejaculation. While it is not a traditional treatment for cardiac conditions, it is important to understand its cardiovascular implications. The prescribing information for Priligy indicates that it should be used with caution in patients with significant cardiovascular conditions, particularly those with a history of heart disease, due to the potential for side effects such as orthostatic hypotension, syncope, and other cardiovascular events.

In your case, you have a history of moderate to severe aortic regurgitation and left bundle branch block, with a left ventricular internal diameter in diastole (LVIDD) of 51 mm and a left ventricular ejection fraction (LVEF) of 75%. These parameters suggest that your left ventricle is still functioning well, and you are asymptomatic during normal activities, including climbing stairs and engaging in sexual activity. However, the presence of early heart failure symptoms (class II) indicates that your heart is under some strain.

Given that Priligy is contraindicated in patients with significant heart disease, it is crucial to weigh the risks and benefits in your specific situation. While you are currently stable and managing your condition with Valsartan, the potential effects of Priligy on your cardiovascular system must be considered. The medication can cause changes in blood pressure and heart rate, which may exacerbate your existing condition or lead to complications.

Before considering the use of Priligy, it is advisable to consult with your cardiologist or healthcare provider. They can assess your overall cardiac function, review your current medications, and determine if the potential benefits of using Priligy outweigh the risks associated with your aortic regurgitation. Additionally, they may suggest alternative treatments for premature ejaculation that do not carry the same cardiovascular risks.

In summary, while Priligy may not be as strictly contraindicated as some other medications for patients with aortic regurgitation, caution is warranted. A thorough evaluation by your healthcare provider is essential to ensure your safety and well-being while managing both your cardiac condition and any concerns related to premature ejaculation.

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