On call: Viagra, sex, and the heart

On call

Viagra, sex, and the heart

Q. I am 66 years old and have had angina for nearly 5 years. I take aspirin and Zocor, but I haven't needed nitroglycerin for at least 3 years, even though I ride my bike quite hard at least 4 days a week. I've started having trouble with my erections, and now I want to try Viagra. My doctor gave me a prescription, but my wife won't let me fill it. Is Viagra safe for me?

A. If your wife is worried about your heart, she can be reassured about Viagra (sildenafil). The medication is not safe for men who use nitrates in any form, including nitroglycerin tablets and spray, long-acting nitrate tablets, nitrate patches, and amyl nitrate. But the drug is quite safe for men who do not take these medications, even if they have stable coronary artery disease or well-controlled hypertension. For example, a study from the Mayo Clinic agrees with lots of earlier research and demonstrates that Viagra is safe. More than 100 men with coronary artery disease participated in the trial. Each man underwent two detailed stress tests that used a bike for exercise and used echocardiograms as well as EKGs to monitor the result. Before one of their tests, the volunteers took Viagra (50 or 100 mg, the top dose), and before the other they took a placebo. Compared to the placebo, Viagra did produce a slight drop in systolic blood pressure (the higher number, recorded while the heart is pumping blood), but there were no changes in diastolic blood pressure (the lower number, recorded when the heart is refilling between beats), exercise capacity, symptoms, or echocardiograms and EKGs.

As everyone who watches TV knows, Viagra has two newer rivals. Although neither has been studied as extensively as Viagra as of mid-2005, Levitra (vardenafil) appears to be as safe as Viagra for cardiac patients. But Cialis (tadalafil) is not a good choice. Its longer duration may be an advantage for some healthy men, but it is a disadvantage for gents with heart disease or major risk factors. Men can take nitroglycerin 24 hours after a dose of Viagra or Levitra, but they must avoid nitrates for 48 hours after taking Cialis.

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