Rare fatal effect of combined use of sildenafil and alcohol leading to Cerebrovascular Accident |
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| Institution: | 1. Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India;2. Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India;1. Forensic Science SA, School of Biomedicine, Australia;2. The University of Adelaide, Adelaide, South Australia, Australia;1. Centre of Forensic and Legal Medicine and Dentistry, School of Dentistry, University of Dundee, United Kingdom;2. Department of Dentistry, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia;3. Division of Forensic Dentistry, Faculdade São Leopoldo Mandic, Campinas, Brazil;1. Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa;2. Burden of Disease Research Unit, South African Medical Research Council. Visiting Research Fellow, Institute for Lifecourse Development, University of Greenwich, London, UK;1. Department of Orthopaedic Surgery, Indiana University School of Medicine, Riley Children''s Hospital, Indianapolis, IN, USA;2. Research and Instructional Services Librarian, Ruth Lilly Law Library, Indiana University, Robert H. McKinney School of Law, USA;3. Indiana University, Robert H. McKinney School of Law, Office of the General Counsel, Columbus Regional Health, Columbus, IN, USA |
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| Abstract: | Sildenafil is the first internationally approved drug for erectile dysfunction. Unsupervised and non-prescribed use of sildenafil among young Indian population has increased in last few years. Sildenafil helps in erection of penis by inhibiting the action of Phosphodiesterase-5 (PDE-5) enzyme, present in the vasculature of corpus cavernosum muscle and lengthens the duration of erection. Documented adverse effects of sildenafil are headache, flushing, nasal congestion, dyspepsia, and slight decrease in systolic and diastolic blood pressure.We present a rare case of sudden death due to cerebrovascular hemorrhage after sildenafil use and concomitant alcohol intake. The history is that a 41-year-old male with no significant past medical and surgical history was staying at a hotel room with a female friend; he had consumed 2 tablets of sildenafil (50 mg each) and alcohol at night. Next morning, he developed uneasiness following which he was taken to the Hospital where he was declared dead on arrival. The important autopsy findings include edematous brain with about 300 g of clotted blood in the right basal ganglia extending to bilateral ventricles, and in pons region. Other significant findings on microscopic examination were hypertrophic ventricular wall of heart, fatty changes in liver and acute tubular necrosis and hypertensive changes in the kidney.The findings are discussed in the light of the literature about the lethal complications of combined use of sildenafil and alcohol including cerebrovascular accidents. As a forensic pathologist it is the duty of the doctor to execute meticulous autopsy along with ancillary investigations including toxicological analysis and to correlate all these findings to determine the possible effects of drugs when present, so as to gather knowledge about potentially fatal drugs and further create public awareness regarding the same. |
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| Keywords: | Sudden death Sildenafil Alcohol Cerebrovascular accident Acute tubular necrosis |
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