Which of the following should not be taken with nitroglycerin?

Taking sildenafil (Viagra) with nitroglycerin should be avoided due to the potential for a dangerously low blood pressure interaction. Both drugs act as vasodilators; nitroglycerin is commonly used to relieve angina by dilating blood vessels, and sildenafil enhances blood flow to the penis by relaxing blood vessels. When taken together, they can cause a cumulative effect, leading to significant hypotension, dizziness, fainting, or even heart problems. This is why it's crucial to wait a specific period after taking sildenafil before administering nitroglycerin.

The other options, such as ibuprofen, aspirin, and metoprolol, do not have the same type of interaction with nitroglycerin. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that generally has a different mechanism of action and is not known to cause serious interactions with nitroglycerin. Aspirin is frequently recommended in patients with angina for its antiplatelet effects, which can help prevent heart attacks. Metoprolol, a beta-blocker, is often prescribed alongside nitroglycerin to manage heart rate and reduce myocardial oxygen demand, making these combinations safe and beneficial for most patients.