One of the most popular questions we get from our customers is whether Viagra and nitrates work well together. Unfortunately, the answer is, for the most part, no — they should be avoided at all costs.
Sildenafil, the active ingredient in Viagra®, is a generally safe and effective medication for treating erectile dysfunction (ED).
Most of its side effects, such as nasal congestion and headaches, are minor and unlikely to cause any health issues or significant discomfort.
However, Viagra (and other medications used to treat ED) can interact with nitrates, potentially causing serious side effects.
Below, we’ve explained how this interaction occurs and why it’s a potential risk to your health and wellbeing if you use any nitrate-based medications while taking Viagra.
How Viagra Affects Blood Pressure
Sildenafil (generic Viagra), the active ingredient in Viagra, is a PDE5 inhibitor. It works by inhibiting the enzyme that’s responsible for regulating blood flow to the soft tissue of your penis. This makes it easier to get an erection and stay hard during sexual activity.
As part of this process, Viagra affects the muscle tissue that controls the diameter of your blood vessels. When you take Viagra, your blood vessels dilate. This increases blood flow not only to the erectile tissue in your penis, but also to other parts of your body.
This dilation of blood vessels affects your blood pressure. When you use Viagra on its own, your blood pressure decreases by a small amount. On average, blood pressure decreases by 8.4/5.5 mmHg shortly after taking a normal dose of Viagra.
This drop in blood pressure also occurs with other medications used to treat ED, such as Ciails® (tadalafil) and Levitra® (vardenafil). Other medications that use sildenafil as an active ingredient, such as Revatio®, can also trigger a similar decrease in blood pressure.
On its own, this drop in blood pressure generally isn’t something to worry about. If you’re a healthy person without any cardiovascular health issues, the small decrease in blood pressure that’s caused by Viagra won’t affect your health or wellbeing.
However, when you use Viagra or any other ED medication in combination with a nitrate, it can trigger a more severe drop in your blood pressure levels. This could potentially result in loss of consciousness or worse, full-on cardiac arrest.
How Viagra and Nitrates Interact
The FDA has warned against the use of nitrates with Viagra, as well as other ED medications such as Cialis® and Levitra®.
PDE5 inhibitors such as Viagra and nitrates both have the same effects on the diameter of your blood vessels. When used together, the interaction between these medications can cause your blood pressure to drop too low, affecting your consciousness and heart health.
This can precipitate a heart attack, especially if you use nitrates to treat angina or another heart condition that requires a certain minimum blood pressure level.
Commonly used nitrates that can interact with Viagra include nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, erythrityl tetranitrate, pentaerythritol tetranitrate, sodium nitroprusside and amyl nitrate. These medications are primarily used to treat systemic hypertension.
Many of these medications are sold under specific brand names, rather than under their generic names. Make sure you read the packaging of your medication to check if it contains any active ingredients that could interact with Viagra.
Other cardiovascular medications, such as riociguat, alpha-blockers and other medications used to treat hypertension also have the potential to interact with Viagra to cause hypotension.
Recreational drugs containing nitrates, such as amyl nitrate and butyl nitrate “poppers,” can also interact with Viagra, Cialis and Levitra. These drugs are not safe to use with ED medication and should not be taken before using Viagra or any other PDE5 inhibitor.
ED treatments, delivered
Do You Use Nitrates?
If you use nitrates to treat hypertension or any other health condition and want to use Viagra or other medication to treat erectile dysfunction, you’ll need to discuss this with your healthcare provider.
Currently, none of the PDE5 inhibitor medications used to treat ED are safe to use at the same time as nitrates.
This means that your healthcare provider will likely not prescribe a medication like Viagra if you use a nitrate-based medication.
Luckily, there are options for improving sexual performance beyond medication. Eating healthy, getting more exercise and quitting unhealthy habits like cigarette smoking and drinking alcohol can all help to protect your erection and improve your sexual performance.
Other options include limiting your consumption of porn (which is closely linked to ED in some men) and investigating some of the root causes of erectile dysfunction, such as a testosterone deficiency.
It’s also possible that you could benefit from other treatments for erectile dysfunction, such as psychotherapy. There are also several other medications available for treating ED in men with cardiovascular issues, such as alprostadil.
Our guide to erectile dysfunction treatment options lists several of these treatments, with more information on how they work. While they aren’t as convenient as taking a Viagra tablet, they can and often do produce results, all without affecting your health and wellbeing.
Long Story Short: Viagra and Nitrates Don’t Mix
It’s not safe to use erectile dysfunction medications such as Viagra (sildenafil), Cialis (tadalafil) or Levitra (vardenafil) if you also use nitrates to treat hypertension or chest pain. Used together, these drugs could cause a severe, potentially fatal drop in your blood pressure.
Other antihypertensive drugs, such as alpha-blockers and riociguat, can also potentially cause health issues when used with Viagra and other ED medications.
Because of this, it’s important to inform your healthcare provider that you’re using these before considering Viagra, Cialis or Levitra.
If you have hypertension, angina or any other cardiovascular condition and want to treat ED or improve your sexual performance, talk with your healthcare provider. They’ll be able to tell you more about effective, heart-safe treatment options that are suitable for you.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.