Which medication is contraindicated with sildenafil due to potential drug interaction leading to severe hypotension?

Sildenafil, a phosphodiesterase type 5 inhibitor, is used primarily for the treatment of erectile dysfunction and pulmonary hypertension. One of its main mechanisms is to enhance the effects of nitric oxide, promoting vasodilation and thereby lowering blood pressure. When combined with other medications that also cause vasodilation, particularly nitrates like nitroglycerin, there is a heightened risk of severe hypotension, potentially leading to dizziness, syncope, or even more serious cardiovascular complications.

The contraindication with nitrates is well-documented; patients taking sildenafil should refrain from using nitrates in any form for the same day to avoid this dangerous interaction. The interaction can lead to a significant drop in blood pressure that can be life-threatening.

Other medications listed, such as enalapril, albuterol, and finasteride, do not carry the same risk of severe hypotension when taken with sildenafil and therefore are not specifically contraindicated. Enalapril is an ACE inhibitor that does lower blood pressure, but the risk of interaction is not significant compared to the well-established risks associated with nitrates. Albuterol is a bronchodilator that typically raises blood pressure or has minimal impact on it and does not interact with sildenafil in a harmful way. Fin