Men taking erectile dysfunction drugs like Viagra combined with nitrate medications used to treat chest pain are at heightened risk of premature death, according to a new study. Researchers are urging medical professionals to exercise caution when prescribing these drugs together.
New Research Shows Potentially Fatal Interactions
A study published January 16 in the Journal of Sexual Medicine analyzed health data on over 1.6 million adults. It found men taking both nitrate drugs and erectile dysfunction drugs like Viagra (sildenafil), Cialis (tadalafil), or Levitra (vardenafil) were twice as likely to die early compared to patients only taking nitrates (Source 1).
Researchers say these erectile dysfunction (ED) medications can interact with the nitrates, causing severely low blood pressure. This reduces blood flow and oxygen to key organs, heightening the risk of heart attack, stroke, or even death.
Dr. Nivetha Murugesan, lead researcher, stated: “Men should not be prescribed nitrate drugs along with these erectile dysfunction medications. If the patient has chest pain due to coronary disease, there are many other classes of drugs that can be used instead without this level of risk.” (Source 2)
Widespread Use of Both Medication Types
Nitrate medications like nitroglycerin are frequently prescribed to treat angina. Angina causes recurring chest pain due to inadequate blood flow and oxygen to the heart. Up to 9.4 million adults are estimated to experience angina throughout each year in the U.S. (Source 3).
Meanwhile, prescriptions for erectile dysfunction drugs have skyrocketed over the past two decades. Viagra alone racked up 2.7 million prescriptions in 2022 (Source 4). With so many people taking both types of medications, researchers emphasize understanding the risks this new study highlights.
Breakdown of Key Statistics
- Men taking both nitrates and ED drugs were 2x more likely to die early than those only taking nitrates
- They were 80% more likely to be hospitalized for heart failure
- Risk of death rose along with ED prescription dose
- Greatest risk shown in the first 30 days after starting combination
- Highest death rates among those who recently began nitrates or had severe chest pain
(Source 5)
What Should Patients Do?
Doctors advise patients already taking nitrates alongside ED drugs to schedule an appointment to discuss alternative treatment options. Suddenly stopping nitrate use without medical guidance could also pose cardiovascular risks. Patients currently experiencing angina or ED issues should inform their provider about any medications they are taking.
For men seeking ED treatment, experts suggest considering alternatives to drug options that are known to interact with nitrates. Some lifestyle changes like quitting smoking, losing weight, reducing alcohol consumption and increasing exercise have shown promise in relieving ED. Non-drug therapies like penile pumps, implants or counseling are other avenues doctors may now explore more readily with patients needing nitrates (Source 6).
Looking Ahead
Researchers believe the results underline the importance of thoroughly analyzing how pervasive medications interact, especially widely used drugs like Viagra and nitrate heart medications.
Dr. Murugesan’s team wants to build on their findings by investigating outcomes among patients taking drugs like Viagra for pulmonary hypertension and women taking ED medications for sexual dysfunction (Source 7). They hope increased awareness within the medical community and improved electronic health records can help prevent dangerous combinations being prescribed inadvertently.
While this study sheds new light on the risks, experts concede further research is still required to fully understand the biological mechanisms causing these poor outcomes and confirm the findings. However, they advise doctors to exercise extreme caution in prescribing erectile dysfunction medications alongside nitrate drugs for chest pain until more evidence emerges. Patients affected are also urged to speak to their provider as soon as possible.
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