Sildenafil and furosemide associated ototoxicity: consideration of drug-drug interactions, synergy, and broader clinical relevance.
Bibliographic record
Abstract
Drug-induced ototoxicity, particularly those involving phosphodiesterase type 5 (PDE-5) inhibitors, is considered to be rare and to our knowledge such an adverse effect has not been reported in Canada. Here we present a case of a 77-year old man initiated on a sildenfil regimen for the treatment of pulmonary hypertension, who developed sudden bilateral hearing loss after taking sildenafil, in the setting of high dose furosemide and diltiazem. We outline the likely interplay of patient characteristics, drug synergy and drug-drug interactions in the development of his ototoxicity. Importantly, given the extent and popularity of PDE-5 inhibitors for erectile dysfunction as well as a newer therapeutic option for pulmonary hypertension, clinicians should be aware of the risk for drug-induced ototoxicity, particularly in the setting of concomitant loop diuretics and CYP3A4 inhibiting medications.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".