Safety of Sildenafil for Antidepressant-Related Sexual Dysfunction

Letter to the Editor

Sir: I wish to call your attention to a possible safety issue in the report on the use of sildenafil for antidepressant-related sexual dysfunction. Although the authors screened their patients for medical illness and reported no serious adverse reactions to sildenafil in these antidepressant-treated subjects, the use of this agent in patients taking nefazodone (as in cases 1 and 3) may pose some risk. Nefazodone is a substantial inhibitor of the cytochrome P450 3A4 (CYP3A4) enzyme system, which also metabolizes sildenafil.