For men living with erectile dysfunction, oral phosphodiesterase-5 inhibitors (PDE5Is) — like Viagra — are likely to be the first treatment suggestion from your doctor. Since Viagra first arrived on the scene in the late ’90s, over 23 million patients have been prescribed the medication.
If you are among these 23 million+ men, you’ll want to exercise caution if you’re also taking nitrate vasodilators for coronary artery disease (CAD).
More men have coronary artery disease than any other type of heart disease. When plaque begins to take over our artery walls, blood has less space in which to flow freely which can lead to blockages in the long run.
While symptoms of CAD can include lightheadedness, nausea, or shortness of breath, chest pain (known as angina) is the most common symptom experienced by patients.
Nitrates are prescription medications that can help alleviate this chest pain by dilating the arteries and boosting circulation. People with heart disease sometimes take these drugs before having sex to ward off angina symptoms. However, combined use of nitrates with PDE5Is could potentially be life-threatening.
PDE5Is taken with nitrates can induce hypotension
In the study, researchers looked at patient data from 2006 to 2013 of men diagnosed with stable coronary artery disease. Out of 61,487 men who had been treated with nitrates, 5,710 of these patients were taking nitrates along with PDE5I medications. Over the course of a nearly six-year average follow-up period, the results showed that taking nitrates and PDE5Is increased the risk of patient death, including cardiovascular death and non cardiovascular mortality. The greatest number of deaths were seen in relation to circulatory diseases.
The researchers explained that one of the risks associated with the combined use of nitrates and PDE5Is is hypotension, as both drugs cause decreases in patient blood pressure. Researchers from a 2001 article published outline how hypotension can result in death if a patient’s blood pressure gets too low too fast.
For this reason, the researchers advised against giving ED drugs like Viagra to patients taking nitrates, particularly if a person has just taken a PDE5I. This doesn’t mean that men diagnosed with coronary artery disease are left to deal with erectile dysfunction on their own, however.
Some research alternatively suggests that while hypotension is a potential risk associated with the simultaneous use of nitrates and PDE5Is, the timing of the drugs may make a difference.