The FDA (U.S. Food and Drug Administration) has issued warnings about using sildenafil and nitrates. It is not just Viagra actually since it is only one of several other medications that contain Sildenafil.
Sildenafil is the generic name of several branded medications, including Viagra (1). Another drug that also contains Sildenafil is Revatio, which is another brand name.
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Why Sildenafil and Nitrates Don’t Mix
The warning issued by the FDA was made in conjunction with the manufacturer of Viagra, Prizer. The slogan “Viagra and Nitrates don’t mix” was made in hopes that the effort would save lives.
So, what is the reason why you can’t take both of these drugs together? It is because both of these medications control the size of the blood vessels. They both cause the muscles controlling blood vessel size to relax.
When these muscles relax, the blood vessels themselves tend to enlarge and, of course, increase in diameter. This allows more blood to flow to that part of the body, and the overall effect is that the person’s blood pressure drops.
Taking either just Viagra or any nitrate alone can produce such a dramatic effect. Thus either of these two drugs can cause one’s blood pressure to go down.
Now imagine taking both of them together at the same time. If you do, you will experience a massive drop in blood pressure. In many instances, this can cause a critical and hazardous condition (2).
Details on Viagra (Sildenafil)
Sildenafil, such as Viagra, is a drug that is used as a treatment for erectile dysfunction. Initial studies reported by the Baylor College of Medicine in Houston Texas show that it is a well-tolerated drug (3).
The same study says that there is a very low incidence of adverse reactions when people use this drug. However, it does come with a few side effects.
That is why the reported number of side effects may be higher than what is initially reported. Here are some of the reported sildenafil side effects:
- Heartburn – 10.5% of cases reported
- Nasal congestion – 18.7% of cases reported
- Headache – 25.4% of all cases
- Flushing – 30.8% of cases
It should be noted that in the study above, all of these side effects were only short-lived. Patients may experience one or more of the symptoms mentioned above.
Can you use sildenafil for long term treatment of erectile dysfunction? The short answer is yes. However, there are precautions, according to a multicenter study (4, 5).
Remember that sildenafil is only a treatment for erectile dysfunction. It is not a cure for the said condition.
In the said studies, men who used sildenafil for four years were evaluated as to the efficacy of their treatment. They were also tested surveyed and observed for adverse side effects.
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28% of study participants had hypertension. 3.8% of participants experienced adverse side effects. Thus they either had to discontinue their use of sildenafil or had their dosage changed.
Some of the participants discontinued use because they failed to respond to the survey (6.3%). All in all, 94% of participants responded affirmatively.
Details on Nitrates
Nitrates are medications prescribed for patients with angina (6). They either reduce the intensity of or prevent heart attacks altogether. They act by widening blood vessels.
However, nitrates aren’t the only medications that are prescribed to angina patients (7). Other types of medications used to achieve the same effect include the following:
- Anticoagulants
- Oral antiplatelet medicines
- Angiotensin-covering enzyme (ACE) inhibitors
- Calcium channel blockers
- Beta-blockers
Examples of Nitrates Sold Today
The following are brand names of nitrates sold in the market today:
- Transderm-Nitro
- Nitro-Time
- Nitro-Par Nitrostat
- Nitrong
- Nitrol ointment (APPLI-KIT)
- Nitrolingual (spray)
- Nitroglyn
- Nitrogard
- Nitro-DUR
- Nitrodisc
- Nitro-BID ointment
- Nitrek
- Minitran
- Deponit
- Nitroglycerin
Note that this is not an exhaustive list. Please check with your doctor or pharmacist if the medication you are using or purchasing is indeed a nitrate brand.
What Is Angina?
Angina is simply described as a tightness, discomfort, or even chest pain that one may experience. Any type of discomfort that one may experience in the chest from 1 to 15 minutes may be classified as angina (8).
Note that angina is often described as a pain in the chest that is most likely heart related. This condition has different classifications. Some are stable, while others are referred to as unstable angina variants.
Here are a few facts that you should remember:
- It’s a symptom of heart disease
- Angina is not a disease
- Treatments may include medication and lifestyle changes
- Most common symptoms include chest pain, difficulty breathing, and tightness
If you have angina, you may also experience the following symptoms (9):
- Unexplained fatigue
- Dizziness
- Shortness of breath
- Sweating
- Anxiety
- Nausea
- Pain that can radiate to upper extremities
- Chest pains that feel like sharp, squeezing, pressure like someone crushing your chest
Note that stable angina may develop into unstable angina. Taking nitrates and Viagra can worsen conditions for angina patients.
Effect of Sildenafil on Angina Pectoris Patients
Experiencing a massive drop in one’s blood pressure is a condition that is quite dangerous to patients with angina pectoris. This condition is also called heart pain. That is why taking Viagra and nitrates isn’t a good idea.
Those with angina pectoris interestingly need a higher blood pressure to supply enough blood to the heart. When their blood pressure drops, the supply of blood to the heart drops as well.
When that happens, such a patient may experience a heart attack. That is why people with angina pectoris should never take sildenafil after taking nitrates.
Back in November 1998, there were a number of deaths recorded that was due to the use of Viagra in the United States (10). Some of those men who took Viagra also took nitrates, which triggered the concern.
It should be noted that either exercise or sexual activity can lead to a heart attack in people with angina pectoris. These can be aggravated when nitrates and sildenafil are taken together.
Final Note
Both male and female patients with angina who experience any of the symptoms mentioned above during intercourse should seek immediate medical help. Dizziness, nausea, and chest pain are key symptoms.
Remember that sildenafil and nitrates don’t go together. We voice out the same concern with the FDA to remind others that if you take one of these drugs, you shouldn’t take the other.
