Is Viagra (Sildenafil) Safe for Men With Heart Disease?

Viagra (sildenafil) has been life-changing for many people with erectile dysfunction (ED), making it possible to have a robust and satisfying sex life. However, this drug and others belonging to a class of medications called phosphodiesterase type 5 inhibitors (PDE5 inhibitors), may not be safe for people with certain types of heart disease.

There are two reasons for this:

  • The way these drugs affect blood pressure
  • Their potential for interacting with nitrates, a class of drugs sometimes prescribed to treat angina (chest pain)

Other PDE5 Inhibitors for ED

Besides Viagra, there are four PDE5 inhibitors FDA-approved to treat ED:

  • Cialis (tadalafil)
  • Levitra (vardenafil)
  • Staxyn (vardenafil)
  • Stendra (avanafil)
A blister pack of Viagra pills.
Christopher Furlong / Getty Images

Heart Disease and ED

Erectile dysfunction and heart disease are inextricably linked. People who have ED have an increased risk of also having heart disease and vice-versa. This is because both can be associated with vascular disease, conditions that affect blood vessels and blood flow.

In fact, vascular conditions account for 70% of erectile dysfunction. These conditions include atherosclerosis (hardening of the arteries), hypertension (high blood pressure), and high cholesterol.

Atherosclerosis, a predictor for coronary artery disease (CAD) and cardiac events, accounts for 50% to 60% of ED cases in people over 60.

Heart Disease and Viagra

Viagra and other PDE5 inhibitors prescribed for treating ED drugs are vasodilators, meaning they work by dilating (widening) blood vessels to allow for the free flow of blood to the penis, which is essential to a robust erection.

In so doing, Viagra lowers the systolic blood pressure (the "top" number in blood pressure measurements) by an average of 8 mmHg. For most people with heart disease, including those taking medication to treat high blood pressure, this isn't a problem.

However, according to the Food and Drug Administration (FDA), there have been reports of myocardial infarction (heart attack), stroke, irregular heartbeat (arrhythmias), and even death in people taking Viagra.

Most, but not all, of these men had heart problems before taking this medicine. The FDA notes that it's not possible to determine whether these events were directly related to Viagra.

There also are some heart conditions in which a modest drop in systolic blood pressure caused by Viagra may be dangerous:

  • Severe heart failure accompanied by borderline low blood pressure (hypotension) defined as resting hypotension (blood pressure less than 90/50) or resting hypertension (blood pressure greater than 170/100)
  • Significant aortic stenosis accompanied by low blood pressure which may worsen in response to the drug
  • Hypertrophic cardiomyopathy (a genetic disorder in which the walls of the heart become thick). People with this condition may develop symptoms if their systolic blood pressure drops.
  • Ischemia (periods of time during which the heart muscle is not getting ample blood flow, most often manifested by chest pain)

Additionally, people with pulmonary veno-occlusive disease (PVOD) (a rare form of pulmonary hypertension) should not take Viagra.

Drug Interactions

At one time, medications called nitrates, such as nitroglycerin, were a mainstay of CAD treatment. For the most part, this is no longer the case, thanks to procedures such as angioplasty and stenting.

However, for people who do take nitrates, Viagra is unsafe, according to the American College of Cardiology and the American Heart Association. This is because, like Viagra, nitrates work by widening blood vessels.

Taking both medications creates a significant risk of severe hypotension, which has the potential to lead to shock by depriving the brain and other organs of oxygen.

Nitrates of Concern

These nitrates should not be taken with Viagra:

  • Nitroglycerine
  • Amyl nitrate
  • Alkyl nitrites ("poppers")
  • Isosorbide mononitrate
  • Isosorbide dinitrate
  • Sodium nitroprusside

There are also other heart disease medications that can interact with Viagra and ED drugs, including certain medicines for blood pressure and Tracleer (bosentan), which is a drug used to treat pulmonary artery hypertension (PAH).

Non-Drug Treatment Options for ED

If you're dealing with erectile dysfunction but have a heart condition or are taking a medication that can interact with Viagra and other ED medications, there are other options—namely lifestyle modifications that have been shown to help improve the ability to achieve and maintain an erection:

  • Exercise. Both moderate to vigorous aerobic exercise and weight training may be beneficial.
  • Weight loss can lessen the stress excess pounds put on the cardiovascular system.
  • A heart-healthy diet places the focus is on fresh produce, whole grains, lean proteins, and healthy fats, with limited consumption of red meat, full-fat dairy, and added sugar and salt.
  • Quit habits that can interfere with blood flow—particularly smoking, which is a known cause of erectile dysfunction. If you drink a lot, cut back on alcohol. Illegal drug use can be an underlying factor in ED (as well as an overall health risk).
  • Sex therapy can address psychological problems are a common barrier to achieving an erection. Working with a professional therapist can help to assuage anxiety or emotional issues that contribute to ED.

If you're new to exercise or it's been some time since you were regularly physically active, talk to your doctor before starting a fitness regimen. They can make sure you're healthy enough to work out as well as determine how much and what type of exercise is safe for you to begin with.

A Word From Verywell

Severe cardiovascular complications caused by Viagra and other medications for treating erectile dysfunction are rare. But if are dealing with ED, you and your doctor should carefully consider the risk of such problems before you take a PDE5 inhibitor.

But even if it's determined Viagra is safe for you, consider also taking non-pharmaceutical measures to deal with ED: You may find you can solve the problem without medication and you will certainly improve your overall health and well-being.

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