Erectile dysfunction (ED) medications like sildenafil and tadalafil have been around for decades, with millions of users and proven safety records. For healthy men without cardiovascular conditions, ED medication is thoroughly tested and widely regarded as completely safe.
However, if you have heart disease, you should consult with your doctor immediately. Don't even think about taking ED medicine with a heart condition if you haven't talked to your doctor first.
ED medication works by increasing your body’s production of nitric oxide, which studies show helps men achieve erections. The downside is nitric oxide can also cause arteries throughout the body to dilate. This can lead to a drop in blood pressure that can cause issues for men with cardiovascular disease.
In this guide, we’ll explain the link between heart disease and erectile dysfunction, how widely used ED medications such as sildenafil and tadalafil can affect the heart, as well as the interactions and effects you should be aware of if you suffer from heart disease.
ED Medication and the Heart
ED drugs such as sildenafil, tadalafil and vardenafil have a variety of side effects, most of which are relatively minor. Our guide to what you should expect from ED medication goes into greater detail on the most commonly reported side effects of ED medication.
Beyond these side effects, most ED medications can also affect the cardiovascular system through an increase in nitric oxide production.
Nitric oxide is a signaling molecule released by arteries to dilate blood vessels. ED medications work by increasing the body’s production of nitric oxide, which boosts blood flow to areas of the body like the soft tissue of the penis.
The end result is an improved erection, but with some cardiovascular side effects. Because all arteries of the body produce nitric oxide, the effects of drugs like sildenafil and vardenafil aren’t limited to the penis. Instead, all of the body’s blood arteries can dilate.
This results in a drop in blood pressure while the drug is active—for most men, around five to eight mmHg.
In healthy men without heart disease, this drop in blood pressure is rarely an issue. However, if you take nitrates to treat high blood pressure or another cardiovascular condition, the combined effects of these drugs and ED medication can be dangerous.
Erectile Dysfunction Medication and Nitrates
If you take nitrates to treat heart disease, using ED medication can result in a significant, dangerous drop in blood pressure.
This is because ED medications and nitrates both increase nitric oxide levels and widen arteries to improve blood flow. Combined, the medications can interact and result in dangerous drops in blood pressure of as much as 25–51 mmHG, according to the Harvard study linked above.
Medications that can interact with ED drugs include nitroglycerin, as well as other nitrates such as isosorbide dinitrate and isosorbide mononitrate.
Nitrates that are used recreationally, such as amyl nitrate and amyl nitrite, can also mean trouble for anyone contemplating taking ED medicine with a heart condition, because they too can interact and cause dangerous drops in blood pressure.
In short, if you use nitrates to treat angina, high blood pressure or other cardiovascular health issues, you cannot and should not take ED medication. If you suffer from heart disease and erectile dysfunction and wish to learn more about treatment options, you should speak to your doctor about safe treatments.
Is ED Medication Safe if You Don’t Use Nitrates?
Even if you don’t use nitrates, you should be extremely cautious about taking ED medication if you’re affected by heart disease.
The FDA has recommended that men who’ve suffered from strokes, heart attacks and all other heart disturbances exercise caution regarding ED drugs. This includes common conditions such as high blood pressure, which affects almost one in every three American adults.
If you suffer from high blood pressure, heart disease and erectile dysfunction, the best course of action is to talk to your doctor to learn more about treatment options. Your doctor might be able to offer an alternative treatment or reduced dosage medication that’s safe for you to use.
Important Safety Information
IMPORTANT SAFETY INFORMATION
Do not take Sildenafil (sildenafil citrate) if you:
- take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
are allergic to sildenafil, as contained in Sildenafil and REVATIO, or any of the ingredients in Sildenafil
Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or
nausea during sex, seek immediate medical help
Sildenafil can cause serious side effects. Rarely reported side effects include:
- an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, get medical help right away.
If it is not treated right away, priapism can permanently damage your penis
- sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called
non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking Sildenafil and call your healthcare provider right away if you
have any sudden vision loss
sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have
these symptoms, stop taking Sildenafil and contact a doctor right away
Before you take Sildenafil, tell your healthcare provider if you:
- have or have had heart problems such as a heart attack,
irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
- have had heart surgery within the last 6 months
- have pulmonary hypertension
- have had a stroke
- have low blood pressure, or high blood pressure that
is not controlled
- have a deformed penis shape
- have had an erection that lasted for more than 4 hours
- have problems with your blood cells such as sickle cell
anemia, multiple myeloma, or leukemia
- have retinitis pigmentosa, a rare genetic (runs in families)
eye disease
- have ever had severe vision loss, including an eye problem
called NAION
- have bleeding problems
- have or have had stomach ulcers
- have liver problems
have kidney problems or are having kidney dialysis have any other medical conditions
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins,
and herbal supplements.
Sildenafil may affect the way other medicines work, and other medicines may affect the way Sildenafil works, causing side effects.
Especially tell your healthcare provider if you take any of the following:
- medicines called nitrates
- medicines called guanylate cyclase stimulators such as Adempas (riociguat)
- medicines called alpha-blockers such as Hytrin (terazosin
HCl), Flomax (tamsulosin HCl), Cardura (doxazosin
mesylate), Minipress (prazosin HCl), Uroxatral (alfuzosin HCl),
 Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin).
Alpha-blockers are sometimes prescribed for prostate
problems or high blood pressure. In some patients, the use
of Sildenafil with alpha-blockers can lead to a drop in blood pressure or to fainting
- medicines called HIV protease inhibitors, such as ritonavir (Norvir), indinavir sulfate (Crixivan), saquinavir (Fortovase or Invirase), or atazanavir sulfate (Reyataz)
- some types of oral antifungal medicines, such as
 ketoconazole (Nizoral) and itraconazole (Sporanox)
- some types of antibiotics, such as clarithromycin (Biaxin),
telithromycin (Ketek), or erythromycin
- other medicines that treat high blood pressure
- other medicines or treatments for ED
Sildenafil contains sildenafil, which is the same medicine found
in another drug called REVATIO. REVATIO is used to treat a
rare disease called pulmonary arterial hypertension (PAH).
 Sildenafil should not be used with REVATIO or with other PAH
treatments containing sildenafil or any other PDE5 inhibitors
(such as Adcirca tadalafil)
Sildenafil does not protect against sexually transmitted diseases, including HIV.
The most common side effects of Sildenafil: headache; flushing; upset stomach; abnormal vision, such as changes in color vision
(such as having a blue color tinge) and blurred vision; stuffy or runny nose; back pain; muscle pain; nausea; dizziness; rash.
Sildenafil (sildenafil citrate) is prescription medicine used to treat erectile dysfunction (ED).
Sildenafil is not for women or children.