Association between sexual activity-related death and non-prescription use of phosphodiesterase type 5 inhibitors. (February 2021)

• Record Type: Journal Article
• Authors: Nagasawa, Sayaka; Saka, Kanju; Yamagishi, Yoshikazu; Yajima, Daisuke; Chiba, Fumiko; Yamaguchi, Rutsuko; Torimitsu, Suguru; Iwase, Hirotaro
• Is Part Of: Legal medicine. Volume 48(2021)
• Publication Date: 2021-02
• Subjects: Erectile dysfunction -- Phosphodiesterase type 5 inhibitor -- Cardiovascular disorder -- Nonprescription -- Postmortem redistribution; Medical jurisprudence -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Medical jurisprudence; Periodicals; 614.1
• DOI: 10.1016/j.legalmed.2020.101815
• Languages: English
• ISSNs: 1344-6223

Abstract

Highlights: Non-prescription use of phosphodiesterase type inhibitors can lead to death. PDE5i contribute to death in various ways in high-risk individuals regardless of blood levels. With appropriate care, death from PDE5i might be avoided. Awareness-raising of the risks associated with the imported PDE5i use by individuals is necessary. C/P ratios of sildenafil and tadalafil suggest postmortem redistribution. Abstract: In recent years, there has been an increase in the use of phosphodiesterase type 5 inhibitors (PDE5i) that are purchased from abroad without a doctor's diagnosis via the Internet or other means. We report six cases in which nonprescription use of PDE5i may have led to death. Among the four deceased individuals who were believed to have experienced sudden cardiac death, three (cases 1–3) had a history of cardiovascular disease, which is a contraindication, and the remaining case (case 4) involved combined use of multiple PDE5i. Sildenafil (0.063 µg/mL, 0.087 µg/mL) was detected in two of the four cases of sudden cardiac death. Tadalafil (0.096 µg/mL) was detected in one of the remaining two cases, and tadalafil (0.197 µg/mL) and vardenafil (0.011 µg/mL) were detected in the other case. Sildenafil (0.032 µg/mL), tadalafil (0.062 µg/mL), and ethanol were detected in a traffic accident case with a history of contraindications. In a case of asphyxiation by vomit aspiration, autopsy showed 90% stenosis in the anterior descending branch of the coronary artery, and sildenafil (0.063 µg/mL) was detected. To the best of our knowledge, this is the first report of postmortem blood levels of tadalafil and vardenafil likely contributing to the cause of death. Despite all the warnings about the dangers of using PDE5 inhibitors, cases of PDE5i contributing to death are still identified during autopsies. Therefore, raising public awareness of the risks of the risks associated with the imported drug use by individuals is necessary.