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Viagra (sildenafil) and nitrates: can you mix them?

Reviewed by Chimene Richa, MD, 

Written by Michael Martin 

Reviewed by Chimene Richa, MD, 

Written by Michael Martin 

last updated: Dec 20, 2022

3 min read

Here's what we'll cover

Here's what we'll cover

Erectile dysfunction (ED) is a common condition that impacts approximately 30–50 million men in the United States each year. Given that about 50% of adults in the U.S. have some form of heart disease, it’s no surprise that there’s some overlap between populations who take medications for heart disease and medications to treat erectile dysfunction (Sooriyamoorthy, 2022; Virani, 2021). 

However, you should never take Viagra and nitrates together. Nitrates are medications prescribed to treat heart attacks, chest pain, and some types of heart disease. Like Viagra, nitrates lower blood pressure. Combining the two medications can result in dangerously low or even fatal blood pressure. Continue reading to learn more about Viagra (sildenafil) and nitrates. 

Viagra Important Safety Information: Read more about serious warnings and safety info.

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Viagra (sildenafil) and nitrates: are they safe to take together?

Can you take Viagra and nitrates? The short and concrete answer is no. You should never take Viagra if you’re taking nitrates. The combination is dangerous and can be deadly.

Nitrates, like nitroglycerin, are oral medications used to treat chest pain and other cardiovascular diseases. Your body uses nitrates to make nitric oxide, a substance that opens up blood vessels, making the blood flow more easily. Imagine your blood vessels are like highways. Nitrates work by adding lanes. More lanes means less traffic, and when it comes to blood, that translates to lower blood pressure (Lee, 2022).

This process can make it easier for the heart to pump blood, which is important for people with heart disease. But even though heart disease and erectile dysfunction are conditions many people experience in tandem, Viagra and nitrates aren’t medications you want to mix. 

Prescription ED drugs like Viagra (active ingredient, sildenafil) make your blood vessels more sensitive to nitric oxide. If you take ED medications at the same time as nitrates, your system will contain more nitric oxide than usual. The end result is a dangerous and potentially fatal combination that can make your blood pressure plummet (Dishy, 2001). 

Signs that you may have low blood pressure include: 

  • Dizziness or lightheadedness

  • Nausea 

  • Weakness and fatigue

  • Passing out/fainting

  • Feeling confused or having trouble focusing

  • Changes in your eyesight like blurred vision

  • Cold or clammy skin

In addition to nitrates, Viagra can interact with other blood pressure medications, including alpha-blockers. If you have high or low blood pressure or take heart medication, Viagra (and similar medications like Levitra and Cialis) may not be safe for you. Tell your healthcare provider about any medications you are taking or any underlying medical conditions you have so they can help you find a safe erectile dysfunction treatment.

Cialis Important Safety Information: Read more about serious warnings and safety info.

How to treat ED without Viagra

If you can't take Viagra, there are other treatment options for ED. 

Caverject (alprostadil), for example, is a drug injected into the penis that relaxes smooth muscle and blood vessels inside. Unlike drugs taken by mouth, alprostadil works directly on the penis––without affecting blood pressure throughout your body. It’s usually used 5-20 minutes before sexual activity and produces an erection that lasts about an hour (MedlinePlus, 2018). 

Alprostadil also comes as a small pellet suppository that’s inserted into the urethra. It usually works within 5-10 minutes (MedlinePlus, 2018). Alprostadil is also available as a topical cream, which may also be an option for some (Cuzin, 2016).

Before you begin taking medication for erectile dysfunction, tell your doctor about any additional medications you take or any underlying medical conditions you have. If ED medication isn’t for you, many other treatment options and tools exist to help you achieve an erection strong enough for satisfying sex. No matter your circumstances, your healthcare provider will help you create an ED treatment plan that’s right for you. 

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.

Sildenafil (Generic of Viagra)
Erectile Dysfunction

How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

December 20, 2022

Written by

Michael Martin

Fact checked by

Chimene Richa, MD

About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.

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