Is it safe to take Viagra with my heart medications?


sex, drugs and rock and roll

By Julian Booker, MD

Sexual activity plays a crucial role in the psychological health and quality of life scores in patients with cardiovascular disease. Unfortunately, intimacy is frequently an issue in patient with cardiovascular disease. The causes of sexual dysfunction following myocardial infarction are multiple and include anxiety, depression, medication effect and vascular insufficiency. Regardless of the cause, the results can be devastating to relationships and the psyche.

There are three phosphodiesterase-5 inhibitors currently available in the United States: sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). For simplicity and because of its name recognition, I will use the trade name Viagra to represent all phosphodiesterase-5 (PDE5) inhibitors even if the studies were completed using one of the other drugs.  I do not endorse Viagra above any of the others. Viagra has been shown to be effective in the treatment of erectile dysfunction. Viagra works by increasing the amount of nitric oxide available which enhances erectile function.

Viagra has been shown to be safe in stable cardiovascular diseases including heart failure, hypertension, and coronary artery disease. Although many have looked, there has been no clear evidence that Viagra is associated with increased rate of heart attacks or cardiovascular events. When Viagra is combined with most blood pressure medicines, there is a small but real additive effect but no change in cardiovascular events. However, when Viagra is combined with doxazosin and tamsulosin, two alpha-blocking medications often used to treat BPH (benign prostate hypertrophy) some patients develop low blood pressures. It is recommended that if these prostate medications are required, the smallest doses of each respective medication should be used.  Patients already receiving Viagra and other PDE5 inhibitors for pulmonary hypertension should not receive a second PDE5 for the treatment of erectile dysfunction.

On the whole, Viagra can be considered safe with almost all of your cardiac medications. Unfortunately, the combination of Viagra with nitrates should never be considered safe. Together they can cause life threatening hypotension, also known as low blood pressure.  Nitrates should not be taken within 24 hours of sildenafil or vardenafil and within 48 hours of tadalafil. I have included a short list of commonly prescribed nitrates to help you avoid them.

  1. Nitroglycerin
    1. Sublingual nitroglycerin tablets (Nitrostat)
    2. Sublingual nitroglycerin spray
    3. Nitro patch
    4. Nitro paste
    5. Isosorbide mononitrate (Imdur, ISMO)
    6. Isosorbide dinitrate (Isordil)

About Julian Booker, MD

I am a noninvasive cardiologist at the University of Alabama at Birmingham specializing in multi-modality cardiovascular imaging and preventative medicine. My training was primarily at Baylor College of Medicine in Houston TX and the National Institutes of Health in Bethesda MD.
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2 Responses to Is it safe to take Viagra with my heart medications?

  1. Pingback: High Cholesterol – Part 1 – Do you really need a statin? | MyHeartBlog

  2. Pingback: When can I have sex after a heart attack? | MyHeartBlog

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