Are erectile dysfunction pills safe for
men with heart disease?
In men without cardiovascular disease, erectile dysfunction pills
are very safe. The three rivals -- Viagra, Cialis, and Levitra -- have
similar side effects, including headache, facial flushing, nasal congestion,
diarrhea, backache, and, in a few Viagra or Levitra users, temporary
impaired color vision (men with retinitis pigmentosa, a rare
eye disease, should check with their ophthalmologists before using
Headaches and blue vision are one thing, cardiac abnormalities, quite
another. Are ED pills safe for the heart?
These drugs are safe for healthy hearts, but all men with cardiovascular
disease should take special precautions, and some cannot use them under
any circumstances. The problem is their effect on arteries. All arteries,
not just those in the penis, generate nitric oxide, so any artery can
widen in response to Viagra, Levitra, or Cialis, causing blood pressure
to drop temporarily by 5-8 mmHg, even in healthy men.
Organic nitrates are drugs that widen arteries by increasing
their supply of nitric oxide; that’s how they open the partially
blocked coronary arteries in patients with angina. But because nitrates
and ED pills both act on nitric oxide, the drugs don’t mix; healthy
volunteers given Viagra followed an hour later by nitroglycerin see their
blood pressures drop by 25–51 mm Hg, a potentially dangerous amount.
All experts agree that men who are taking nitrates cannot use ED pills;
this includes all preparations of nitroglycerin (short-acting,
under-the-tongue tablets or sprays), long-acting nitrates (isosorbide
dinitrate or Isordil, Sorbitrate, and others, and isosorbide
mononitrate, Imdur, ISMO, and others), nitroglycerin patches and
pastes, and amyl nitrite or amyl nitrate (so-called
poppers, which some men use for sexual stimulation). Men who have taken
Viagra or Levitra must not take nitrates for 24 hours; for Cialis, the
ban extends to 48 hours, a disadvantage for men at risk for heart disease.
Faced with concern about ED pills and the heart, the FDA has urged caution
in patients who have suffered heart attacks, strokes, or serious disturbances
of the heart’s pumping rhythm in the previous six months, in men
with a history of congestive heart failure or unstable angina, and in
men with low blood pressure or uncontrolled high blood pressure (above
170/110 mm Hg). Because certain medications can boost the blood levels
of these drugs, men taking erythromycin or certain antifungal or anti-HIV
medications should use only low-dose PDE-5 inhibitors. Reduced dosage
is also important for men with advanced age and for those with significant
kidney or liver disease.
Faced with all these warnings, should any man use Viagra, Levitra, or
Cialis? Indeed, no one should use them needlessly or recklessly, but
20 million American men are plagued by impotence, and most can use them
If nothing can be done to correct the cause of a man’s erectile
dysfunction and if he has no problems that make oral medications risky,
then a drug is worth a try. Each comes in several strengths; most doctors
prescribe a middle dose initially, lowering it if it works well or increasing
it if it does not. Men with potential problems should always start with
the lowest dose. Every man should avoid consuming alcohol before taking
these drugs. Men who do not respond to a full dose on two or three different
occasions should try other treatments.
July 2005 Update
Back to Previous Page