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available through 503A compounding Sildenafil metabolism / CYP3A4 (major), CYP2C9 (minor) Key risk / additive vasodilation leading to symptomatic hypotension Sildenafil BP effect alone / mean reduction of 8.4/5.5 mmHg at 100 mg dose Nitrate contraindication / sildenafil plus any nitrate source can drop systolic BP by an additional 25 mmHg or more Monitoring / orthostatic vitals before and 1 hour after first combined dose Patient population of concern / men over 60, those on alpha-blockers or antihypertensives Why This Interaction Matters BPC-157 and sildenafil both act on the nitric oxide (NO) signaling cascade, raising a plausible concern for additive blood pressure reduction when used together

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