Can I take Viagra if I’m on nitrates? Is it safe?

Nitrates, a medication for heart disease and high blood pressure, lower blood pressure. So does Viagra. Taking nitrates and Viagra together can cause a dangerous drop in blood pressure that can be fatal.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Viagra (sildenafil) is an oral medication that treats erectile dysfunction (ED).

Like Cialis (tadalafil), Levitra (vardenafil), and Stendra (avanafil), Viagra is a type of drug known as a PDE-5 inhibitor. PDE-5 (phosphodiesterase type 5) is basically the “off” switch for an erection: It’s an enzyme that causes blood vessels to narrow (through a series of reactions), particularly in the penis and the lungs. Viagra works by blocking PDE-5. This keeps the tissues of the penis relaxed. The net effect is that blood flows more freely to the penis, resulting in an erection.

Because Viagra keeps blood vessels widened, it also lowers blood pressure.

Vitals

No!
Nitrates, a medication for heart disease and high blood pressure, lower blood pressure.
So does Viagra. Taking nitrates and Viagra together can cause a dangerous drop in blood pressure that can be fatal.

Viagra and nitrates

Nitrates, an oral medication for high blood pressure and heart disease, also lower your blood pressure by expanding blood vessels.

That’s why nitrates and Viagra do not mix. In fact, using nitrates and Viagra together can be fatal. Viagra changes how you break down cGMP, which is a molecule that is controlled by nitric oxide. So adding even more nitric oxide to your system can make your blood pressure plummet. It’s a deadly one-two punch.

Never take Viagra while taking nitrates. Period.

If you have problems with your blood pressure (if it is too high or too low) or if you’re on blood pressure medication, talk to a doctor to make sure you’re healthy enough for sex and that Viagra is a safe treatment option for you.

Viagra can interact with blood pressure medications like nitrates, alpha-blockers, riociguat, and other antihypertensives. If you’re on these medications, or if you have a heart condition, Viagra may not be safe for you. (These are not all of the risks and contraindications for Viagra. Check out more important safety information for Viagra here.)

ED treatments, prescribed online

A real, U.S.-licensed physician will review your information and get back to you within 24 hours.

Other medication options for ED

If you can’t take Viagra, there are other medication options for ED. They include Caverject and MUSE (alprostadil). Caverject is injected into the penis and works within five to 20 minutes and produces an erection that lasts for about an hour. MUSE (for Medicated Urethral System for Erections—snazzy!) is a small pellet suppository inserted into the urethra. It works within 15 to 30 minutes. Caverject is considered more effective than MUSE.

Alprostadil works as a vasodilator. It relaxes smooth muscle within blood vessels of the penis. But alprostadil works more directly on the penis, without lowering blood pressure throughout the body (Cuzin, 2016).

(Alprostadil is available as a topical cream in several countries—including Canada, Mexico, and some countries in Europe, Latin America, and the Middle East—under the brand name Vitaros. But the FDA has rejected it for prescription in the United States, citing safety concerns.)

It’s important to talk with a healthcare provider—particularly if you’re currently taking medication or have a health condition such as cardiovascular disease or high or low blood pressure—before starting any new supplement or health regimen.

References

Cuzin, B. (2016). Alprostadil cream in the treatment of erectile dysfunction: clinical evidence and experience. Therapeutic Advances in Urology, 8(4), 249–256. doi: 10.1177/1756287216644116, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5131739/