We had a complicated patient with very severe Raynaud’s disease who was experiencing ischemia in her fingers. She had used lots of medications in the past, and these were re-ordered by the physician. In an attempt to create some vasodilation, the internist also ordered pentoxiphylline orally, nitroglycerin 2% ointment applied to the finger, and iloprost through the special access programme.
We have a great pharmacist here in Prince Albert named Toni Sommerfeld, and she realized that the patient was already on sildenafil orally as off-label use for her Raynaud’s. The drug interaction between sildenafil and nitroglycerin is well-documented, but no one else had it on their radar for this young lady who didn’t fit the stereotypical picture of that reaction.
Well done, Toni.