Why you can't take Viagra and nitrates

There have been popular interests in why Viagra can’t be taken with nitrates. It is important to repeat the warning that Viagra and nitrates don’t work well together and should be avoided at all costs by anyone who’s taking the two types of drugs or may consider doing so in the future.

The US Food and Drug Administration (FDA) has warned against the use of Viagra with medications that contain nitrates. The FDA's warning was issued in conjunction with Pfizer, the manufacturer of branded Viagra (generic or non-branded name: Sildenafil).

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Viagra is one of the most popular drugs for the treatment of erectile dysfunction (ED), a condition relating to the inability to get or keep an erection firm enough to have sexual intercourse. It works by boosting the effects of a chemical the body makes called nitric oxide which relaxes the muscles in certain parts of the body, including the penis. The relaxation of the muscles result in the opening of blood vessels, increase in blood flow to the penis and helps you get an erection during sexual stimulation.

So, Viagra and nitrates both cause the muscles that control the size of blood vessels to relax, making the vessels to enlarge in diameter and blood pressure to drop. When Viagra and nitrates are taken together, the side effects of the drugs and decrease in blood pressure are greater than when either one is used alone. There may be a marked relaxation of the muscles that control the vessels with a great drop in blood pressure.

A drastic drop in blood pressure is especially harmful to patients who have angina pectoris (heart pain), a condition in which a higher blood pressure is necessary to supply the heart with blood. Lowering the blood pressure decreases the flow of blood to the heart and can hasten a heart attack.

People who are using medications containing nitrates should therefore NOT take Viagra. As of November 1998, 130 deaths had been associated with the use of Viagra in the US. Sixteen of the men who died had also taken a nitrate.

Since sexual activity or exercise can hasten a heart attack in patients with angina pectoris, it may not have been the use of Viagra and nitrates that was responsible for all of the deaths. However, it would seem better to be safe than sorry and NOT mix Viagra with nitrates.