Start your free visit for ED treatment. Learn more

Dec 16, 2021
3 min read

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

Do not take Viagra when taking nitrates. Nitrates are medications used to treat heart attacks, chest pain, heart disease, and high blood pressure. Since both nitrates and Viagra lower blood pressure, taking them together can have a combined effect, resulting in dangerously low blood pressure that can be dangerous and even 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.

Erectile dysfunction (ED) is a common condition, impacting about 30 million men in the United States. Since almost 50% of men in the U.S. have some form of heart disease, it’s no surprise that there’s going to be some overlap between the people taking medications for heart disease and those taking medications to treat ED (Nunes, 2012; Virani, 2021). 

But that doesn’t mean you should take Viagra for ED and nitrates for heart disease at the same time. Let’s discuss why mixing nitrates and ED medication is a bad idea. 

Get $15 off your first month of ED treatment

If prescribed, get ED treatment delivered discreetly directly to your door.

Learn more

Viagra and nitrates: are they safe to take together?

You should never take Viagra if you’re taking nitrates. It’s dangerous and can even be deadly.

Nitrates like nitroglycerin are oral medications used to treat high blood pressure 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 like highways: this drug works by adding lanes. More lanes means less traffic, and when it comes to blood, that translates to lower blood pressure.

This can make it easier for your heart to pump your blood, which is important for people with heart disease and high blood pressure. But nitrates and Viagra aren’t medications you want to mix. 

Prescription ED drugs like Viagra (generic name sildenafil; see Important Safety Information) make your blood vessels more sensitive to nitric oxide. If you take it at the same time as nitrates, your system will have way 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

Besides 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 [generic name tadalafil; see Important Safety Information]) 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 find the best treatment option for you.

Other medication options for ED

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 15–30 minutes before sexual activity and produces an erection that lasts 2–4 hours (Abdallah, 1998). 

Alprostadil also comes as a small pellet suppository called MUSE (Medicated Urethral System for Erections—snazzy!) that’s inserted into the urethra. It usually works within 15–30 minutes. Alprostadil is also available as a topical cream, which may be more effective and have fewer side effects (Cuzin, 2016).

If you’re taking medication for erectile dysfunction, it’s important to find out whether any of your other medications may interact with it. It’s a good idea to talk with your healthcare provider—particularly if you have another health condition—before starting any new treatment for ED.

References

  1. Abdallah, H. M. (1998). Comparison of Alprostadil (Caverject) and a combination of vasoactive drugs as local injections for the treatment of erectile dysfunction. International Urology and Nephrology, 30(5), 617–620. doi:10.1007/BF02550556. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9934808/
  2. 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. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5131739/
  3. Dishy, V., Sofowora, G., Harris, P. A., Kandcer, M., Zhan, F., Wood, A. J., et al. (2001). The effect of sildenafil on nitric oxide-mediated vasodilation in healthy men. Clinical Pharmacology and Therapeutics, 70(3), 270–279. doi:10.1067/mcp.2001.117995. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11557915/
  4. Nunes, K. P., Labazi, H., & Webb, R. C. (2012). New insights into hypertension-associated erectile dysfunction. Current Opinion in Nephrology and Hypertension, 21(2), 163–170. doi:10.1097/MNH.0b013e32835021bd. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004343/
  5. Padma-Nathan, H., Hellstrom, W. J., Kaiser, F. E., Labasky, R. F., Lue, T. F., Nolten, W. E., et al. (1997). Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. The New England Journal of Medicine, 336(1), 1–7. doi:10.1056/NEJM199701023360101. Retrieved from https://www.nejm.org/doi/full/10.1056/nejm199701023360101 
  6. U.S. Food and Drug Administration (FDA). (2010). Viagra (Sildenafil Citrate). Retrieved on Nov. 10, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020895s033lbl.pdf 
  7. Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., et al. (2021). Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation, 143(8), e254–e743. doi:10.1161/CIR.0000000000000950. Retrieved from https://www.ahajournals.org/doi/10.1161/CIR.0000000000000950