Viagra and nitrates: can you mix them? No, here’s why

The fact of the matter is, you should never take Viagra (sildenafil) and nitrates together. Period.  

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 and nitrates. 

No, you should never take Viagra if you’re already taking nitrates. The combination is dangerous and can be deadly.

Nitrates, such as nitroglycerin and isosorbide mononitrate, are oral medications used to treat chest pain and other heart 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 mean less traffic, and when it comes to blood, that translates to lower blood pressure.

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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 (ED) are conditions many people experience in tandem, Viagra and nitrates aren’t medications you should mix. 

Prescription ED drugs like Viagra 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. 

Since Viagra relaxes blood vessels and nitrates do the same, taking them together results in an additive effect. The end result is a dangerous drop in blood pressure. 

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, such as 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 Cialis (tadalafil) and vardenafil) may not be safe for you. 

Important note: You should also not take Viagra with recreational nitrates, aka “poppers.” This can also be dangerous and fatal.

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 ED treatment.

Taking Viagra and nitrates together poses major and even life-threatening risks — particularly sudden and dangerously low blood pressure, or hypotension. When you have extremely low blood pressure, this can lead to serious complications, such as fainting, abnormal heartbeat, organ damage, stroke, or coma. 

This is why you should not take Viagra and nitrates together. The serious risk of death should not be ignored.

If you can't take Viagra, there are other treatment options (drug and non-drug 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 significantly affecting blood pressure throughout your body, though it can still cause a small drop in blood pressure. 

It’s usually used 5-20 minutes before sexual activity and produces an erection that lasts up to an hour.

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

Before you begin taking medication for ED, tell your healthcare provider 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. 

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You cannot take Viagra if you’re on nitrates — it’s really that simple. Combining the two can lead to a serious drug interaction. Here are the highlights to remember:  

• Since both Viagra and nitrates both relax your blood vessels, there is an additive effect when combining the two medications.

• The combination of medications can result in a sudden and dangerous drop in blood pressure. Severe low blood pressure can even lead to death.

• If you have ED and take nitrates, ask your healthcare provider about safer Viagra alternatives, such as localized medications applied directly to the penis or non-drug options.