Combining nitrates with erectile dysfunction (ED) drugs poses a serious risk of dangerously lowering blood pressure, caution doctors. It’s essential for men, especially those with coronary artery disease, to take heed of this warning and take proper precautions.
A recent study in the Journal of the American College of Cardiology underscores this concern. Men with coronary artery disease who use ED drugs alongside nitrates, commonly prescribed for chest pain, face a significantly elevated risk of premature death. Beyond the heightened mortality risk, the concurrent use of nitrates and phosphodiesterase type 5 (PDE5) inhibitors like Viagra, Levitra, and Cialis is associated with an increased likelihood of heart failure, heart attack, and the need for revascularization procedures aimed at enhancing blood flow to the heart. Thus, it’s crucial for individuals to be aware of these risks and to consult with their healthcare providers before combining these medications.
“Physicians are seeing an increase of requests for erectile dysfunction drugs from men with cardiovascular diseases,” said Daniel Peter Andersson, MD, the senior study author, in a recent statement. He is also an associate professor of physiology at Karolinska Institutet in Stockholm. “While there is a positive association of ED medication for men with cardiovascular disease, patients taking nitrates may experience an increased risk of negative health outcomes.”
The recent study encompassed a substantial cohort of over 61,000 Swedish men with a medical history involving heart attacks or percutaneous coronary intervention (a procedure aimed at alleviating blocked arteries) who had been prescribed nitrate medications on two occasions within a six-month period. Among them, 55,777 individuals received only nitrates, while 5,710 men were prescribed both nitrates and drugs for erectile dysfunction (ED).
Over an average monitoring duration of 5.7 years for those solely on nitrates and 3.4 years for those on the combined therapy, notable differences emerged. Notably, the cohort receiving nitrates alongside ED medications exhibited a younger average age of 61.2 years compared to the nitrate-only group’s average age of 70.3 years.
The findings underscored significant disparities in health outcomes. Those concurrently using nitrates and ED drugs faced considerable risks compared to their counterparts solely on nitrates. Specifically, this group had a 39 percent higher likelihood of mortality, a 72 percent elevated risk of experiencing a heart attack, a 67 percent increased probability of heart failure, and a staggering 95 percent higher odds of necessitating revascularization procedures.
A Combination That Can Bring About a Steep Blood Pressure Drop
It’s not unexpected that combining nitrates with medications for erectile dysfunction could pose health risks. The FDAhas cautioned about potential interactions between Viagra and nitrates present in certain prescription drugs like nitroglycerin, which can lead to a significant drop in blood pressure. Nitrates are commonly used by individuals dealing with conditions like diabetes, high blood pressure, high cholesterol, or heart disease, as they work by dilating the blood vessels. This dilation, combined with the effects of erectile dysfunction medications, can exacerbate the lowering of blood pressure, potentially reaching dangerous levels. Therefore, it’s crucial for individuals with these health conditions to consult their healthcare providers before using erectile dysfunction medications to avoid adverse effects.
“This study just emphasizes the fact that PDE5 inhibitors remain a contraindication when a person is also taking nitrates,” said Robert Kloner, MD, PhD. He is the director of the Cardiovascular Research Institute at Huntington Medical Research Institutes in Pasadena, California, as well as a professor of medicine in the cardiovascular division at the Keck School of Medicine of USC.
A contraindication arises when a specific medication could pose risks to a patient and should therefore be avoided.
While a recent study flagged PDE5 inhibitor drugs as contraindicated for men on nitrates, Dr. Kloner highlights earlier research indicating that certain individuals on this combination might not necessarily encounter elevated cardiac events.
“The current study shows contrary effects and there are some potential reasons for it,” he explained. “This new study is already in a high-risk population of men who have either had myocardial infarctions [heart attacks] or percutaneous coronary interventions.”
Be Cautious and Mindful When Combining Meds
Kloner also suggests that patients in earlier studies might have received more guidance from their healthcare providers, advising against the concurrent use of the two drug types.
“If a man takes a PDE5 inhibitor, has sexual activity and gets angina [chest pain], he should not pop a sublingual nitroglycerin tablet within 24 hours of using a short-acting PDE5 inhibitor or within 48 hours if it is a long-acting PDE5 inhibitor,” he said.
The research findings underscored a noteworthy observation: there were notably few instances of heart-related events within the 28-day period following the administration of PDE5 inhibitors, with incidence rates being lower compared to individuals solely using nitrates.
Kloner advises that if a man is currently taking nitrates but is interested in exploring PDE5 inhibitors as a treatment for erectile dysfunction (ED), it’s crucial for him to engage in a conversation with his healthcare provider. He emphasizes that there are alternative medications available for managing angina besides nitrates, and some patients who have previously experienced heart issues may no longer require nitrate therapy.
In an accompanying editorial, Dr. Glenn N. Levine, affiliated with Baylor College of Medicine and the Michael E. DeBakey VA Medical Center in Houston, suggests that erectile dysfunction medications could be reasonably safe for individuals with ischemic heart disease, mild angina, and a reasonable capacity for exercise — provided they are not undergoing chronic nitrate therapy.
However, for those undergoing chronic oral nitrate therapy, the use of medications like Viagra and Cialis is at best inadvisable and generally contraindicated, he emphasizes.
“Erectile dysfunction and coronary artery disease are unfortunate, and all too common, bedfellows,” Dr. Levine had written. “But, as with most relationships, assuming proper precautions and care, they can coexist together for many years, perhaps even a lifetime.”
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