One of the most popular questions we get from our customers is whether Viagra and nitrates work well together. Unfortunately, the answer is, for the most part, no — they should be avoided at all costs.
Sildenafil, the active ingredient in Viagra, is a generally safe and effective medication for treating erectile dysfunction (ED). Most of its side effects, such as nasal congestion and headaches, are minor and unlikely to cause any health issues or significant discomfort.
However, Viagra (and other medications used to treat ED) can interact with nitrates, potentially causing serious side effects. Below, we’ve explained how this interaction occurs and why it’s a potential risk to your health and wellbeing if you use any nitrate-based medications while taking Viagra.
How Viagra Affects Blood Pressure
Sildenafil, the active ingredient in Viagra, is a PDE5 inhibitor. It works by inhibiting the enzyme that’s responsible for regulating blood flow to the soft tissue of your penis. This makes it easier to get an erection and stay hard during sexual activity.
As part of this process, Viagra affects the muscle tissue that controls the diameter of your blood vessels. When you take Viagra, your blood vessels dilate. This increases blood flow not only to the erectile tissue in your penis, but also to other parts of your body.
This dilation of blood vessels affects your blood pressure. When you use Viagra on its own, your blood pressure decreases by a small amount. On average, blood pressure decreases by 8.4/5.5 mmHg shortly after taking a normal dose of Viagra.
This drop in blood pressure also occurs with other medications used to treat ED, such as Ciails (tadalafil) and Levitra (vardenafil). Other medications that use sildenafil as an active ingredient, such as Revatio, can also trigger a similar decrease in blood pressure.
On its own, this drop in blood pressure generally isn’t something to worry about. If you’re a healthy person without any cardiovascular health issues, the small decrease in blood pressure that’s caused by Viagra won’t affect your health or wellbeing.
However, when you use Viagra or any other ED medication in combination with a nitrate, it can trigger a more severe drop in your blood pressure levels. This could potentially result in loss of consciousness or worse, full-on cardiac arrest.
How Viagra and Nitrates Interact
The FDA warns against the use of nitrates with Viagra, as well as other ED medications such as Cialis and Levitra.
PDE5 inhibitors such as Viagra and nitrates both have the same effects on the diameter of your blood vessels. When used together, the interaction between these medications can cause your blood pressure to drop too low, affecting your consciousness and heart health.
This can precipitate a heart attack, especially if you use nitrates to treat angina or another heart condition that requires a certain minimum blood pressure level.
Commonly used nitrates that can interact with Viagra include nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, erythrityl tetranitrate, pentaerythritol tetranitrate, sodium nitroprusside and amyl nitrate. These medications are primarily used to treat systemic hypertension.
Many of these medications are sold under specific brand names, rather than under their generic names. Make sure you read the packaging of your medication to check if it contains any active ingredients that could interact with Viagra.
Other cardiovascular medications, such as riociguat, alpha-blockers and other medications used to treat hypertension also have the potential to interact with Viagra to cause hypotension.
Recreational drugs containing nitrates, such as amyl nitrate and butyl nitrate “poppers,” can also interact with Viagra, Cialis and Levitra. These drugs are not safe to use with ED medication and should not be taken before using Viagra or any other PDE5 inhibitor.
Do You Use Nitrates?
If you use nitrates to treat hypertension or any other health condition and want to use Viagra or other medication to treat erectile dysfunction, you’ll need to discuss this with your doctor.
Currently, none of the PDE5 inhibitor medications used to treat ED are safe to use at the same time as nitrates. This means that your doctor will likely not prescribe a medication like Viagra if you use a nitrate-based medication.
Luckily, there are options for improving sexual performance beyond medication. Eating healthy, getting more exercise and quitting unhealthy habits like cigarette smoking and drinking alcohol can all help to protect your erection and improve your sexual performance.
Other options include limiting your consumption of porn (which is closely linked to ED in some men) and investigating some of the root causes of erectile dysfunction, such as a testosterone deficiency.
It’s also possible that you could benefit from other treatments for erectile dysfunction, such as psychotherapy. There are also several other medications available for treating ED in men with cardiovascular issues, such as alprostadil.
Our guide to erectile dysfunction treatment options lists several of these treatments, with more information on how they work. While they aren’t as convenient as taking a Viagra tablet, they can and often do produce results, all without affecting your health and wellbeing.
Long Story Short: Viagra and Nitrates Don’t Mix
It’s not safe to use erectile dysfunction medications such as Viagra (sildenafil), Cialis (tadalafil) or Levitra (vardenafil) if you also use nitrates to treat hypertension or chest pain. Used together, these drugs could cause a severe, potentially fatal drop in your blood pressure.
Other antihypertensive drugs, such as alpha-blockers and riociguat, can also potentially cause health issues when used with Viagra and other ED medications. Because of this, it’s important to inform your doctor that you’re using these before considering Viagra, Cialis or Levitra.
If you have hypertension, angina or any other cardiovascular condition and want to treat ED or improve your sexual performance, talk with your doctor. They’ll be able to tell you more about effective, heart-safe treatment options that are suitable for you.
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.