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Viagra and Nitrates: Why These Medications Don't Mix

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD

Written by Geoffrey C. Whittaker

Published 07/10/2019

Updated 04/15/2024

If you’re a guy who struggles with chest pain, you may have noticed another part of your body is struggling too — your penis.

Cardiovascular disease is one of many potential causes of erectile dysfunction (ED). When guys use medications like sildenafil (the active ingredient in Viagra) to treat ED, it’s generally safe and effective — unless they’re already being treated with certain medications for heart disease.

You’ve seen the commercials — medications like Viagra, Cialis and Stendra can put a smile back on your face. But you have to be careful if you’re taking them with various other medications, including nitrates.

Chances are, you didn’t have to look far to learn that Viagra and nitrates don’t mix — but many guys wonder what exactly could go wrong. Some even consider shrugging off the warnings and getting both medications.

That’s a really bad idea, and we’ll explain why. To understand fully, you’ll need to know the following information (which we’ll go over below):

  • What nitrates are

  • Why mixing nitrates and Viagra is dangerous

  • How long after taking Viagra you can take nitrates

Read on to learn just how bad this combo could be and how to avoid the worst-case scenario.

Nitrates are a group of medications that cause dilation of blood vessels — a process called vasodilation.

Nitrates are a large group of meds. They include nitric oxide compounds, nitroglycerin and several other formats used primarily for treating heart failure, angina pectoris and acute coronary syndrome.

In other words, these medications increase blood flow to treat chronic and deadly heart conditions that might otherwise lead to your heart just, ya know…stopping.

Nitrates that can interact with Viagra include nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, erythrityl tetranitrate and pentaerythritol tetranitrate.

Many of these medications are sold under specific brand names rather than generic versions. Make sure you read the packaging of your medication to check if it contains any active ingredients that could interact with Viagra.

These medications are super effective and have helped save lives for decades.

Nitrites are also dangerous to combine with Viagra. Nitrites include the recreational drug known as “poppers.”

Nitrates do what they do by widening blood vessels throughout your body — which is why erectile dysfunction medications can be so dangerous.

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The problem with mixing nitrates with Viagra is that they both widen blood vessels and can droop blood pressure.

Sildenafil (generic Viagra) is a PDE5 inhibitor. This type of medication inhibits phosphodiesterase type 5 — the enzyme responsible for regulating blood flow to the soft tissues of your penis, making erections easier. As part of this process, what Viagra does is affect the muscle tissue that controls the diameter of your blood vessels — dilating them.

When you use Viagra on its own, your blood pressure decreases by a small amount. Medications used to treat ED — such as tadalafil (generic for Cialis), Stendra and Levitra® (vardenafil) — and medications that use sildenafil as an active ingredient, such as Revatio®, can also trigger a similar decrease in blood pressure.

On average, blood pressure decreases by a maximum of 8.4/5.5 mmHg (millimeters of mercury) shortly after taking a normal dose of Viagra — which, we’re told by the smart people on our team here, is not a big deal.

Most of its side effects, such as nasal congestion and headaches, are minor and unlikely to cause any health issues or significant discomfort.

However, when you use Viagra or any other ED medication in combination with a nitrate, it can trigger a more severe drop in blood pressure levels. Other things do this, too, including alpha blockers and even some things you eat and drink — which is why you may want to read up on foods to avoid when taking Viagra and other things to do when taking Viagra for best results.

Combining Viagra and nitrates could cause your blood pressure to drop too low, affecting your consciousness and heart health. This could potentially result in loss of consciousness or worse: full-on cardiac arrest.

Choose your chew

If you use nitrates to treat any health condition and want to use Viagra or another medication to treat erectile dysfunction, you’ll need to discuss this with your healthcare provider.

Currently, none of the PDE5 inhibitor medications used to treat ED are safe to use at the same time as nitrates. This means your healthcare provider will likely not prescribe a medication like Viagra if you use a nitrate-based heart disease medication because of the drug interactions.

PDE5 inhibitors, such as Viagra, and nitrates have similar effects on the diameter of your blood vessels. When used together, the sildenafil interactions lead to sudden and severe blood pressure drops (called hypotension), which can lead to chest pain and an abrupt end to living.

In other words, it can precipitate a heart attack, especially if you use nitrates to treat angina or another heart condition.

Simply put, you probably can’t use either of these medications until you’ve stopped using the other one long enough to have it leave your system. So if you have ED, you can’t address it with medication until your heart health gets better — better enough to drop the pills.

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 potentially linked to ED in some men) and investigating some of the root causes of erectile dysfunction, such as testosterone deficiency.

It’s also possible you could benefit from other treatments for erectile dysfunction, like psychotherapy. Beyond that, other medications are 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, these alternative medications can (and often do) produce results, all without affecting your health and well-being.

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Nitro and Viagra: Long Story Short

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Certain health problems can be surprisingly connected. When you’re a kid, keeping weight off a broken leg makes the other sore. When you’re in college, you learn that putting too much alcohol in your bloodstream can make your head sore.

As many men age, they start to learn that bad heart health habits — smoking, not exercising, using hard drugs — can affect their heart and, eventually, their boners.

Sadly, treating these issues with medication is an either/or issue today — at least when it comes to nitrates and PDE5 inhibitors.

In short:

  • Certain heart medications and ED medications don’t mix — you can’t take Viagra and nitrates at the same time.

  • Because of this, it’s important to inform your healthcare provider that you’re using nitrates before considering Viagra, Cialis or Levitra for ED.

  • Effective, heart-safe treatment options are available, including therapy and lifestyle changes. If you have hypertension, angina or any other cardiovascular condition and want to treat ED or improve your sexual performance, talk with your healthcare provider.

Viagra warnings shouldn’t be ignored, especially those that could lead to death — and unfortunately, this is one of them. If you have heart issues, get those taken care of before looking into ED meds. Priorities, dude.

We know it’s a bummer to wait to get back into bedroom activities. But taking a cautious approach will ensure you’ll be here for future erections — hopefully, many to come.

Need more guidance? Explore the sexual health resources from Hims today.

11 Sources

  1. U.S. Department of Health and Human Services. (n.d.-h). Treatment for erectile dysfunction - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment.
  2. HIGHLIGHTS OF PRESCRIBING INFORMATION : VIAGRA® (sildenafil citrate) tablets, for oral use . (n.d.-h). https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/20895s039s042lbl.pdf.
  3. Chamsi-Pasha H. (2001). Sildenafil (viagra) and the heart. Journal of family & community medicine, 8(2), 63–66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437061/.
  4. van Amsterdam, J., Nabben, T., & van den Brink, W. (2015). Recreational nitrous oxide use: Prevalence and risks. Regulatory toxicology and pharmacology : RTP, 73(3), 790–796. https://www.sciencedirect.com/science/article/abs/pii/S027323001530101X?via%3Dihub.
  5. Lee PM, Gerriets V. Nitrates. [Updated 2022 Jul 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545149/.
  6. Rewbury, R., Hughes, E., Purbrick, R., Prior, S., & Baron, M. (2017). Poppers: legal highs with questionable contents? A case series of poppers maculopathy. The British journal of ophthalmology, 101(11), 1530–1534. https://pubmed.ncbi.nlm.nih.gov/28396339/. [abstract only, for general info]
  7. HIGHLIGHTS OF PRESCRIBING INFORMATION: REVATIO (sildenafil) tablets, for oral use. (n.d.-d). https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021845s011%2C022473s004%2C0203109s002lbl.pdf.
  8. Dragoni S, et al. (2007). Pentaerythrityl Tetranitrate and Nitroglycerin, but not Isosorbide Mononitrate, Prevent Endothelial Dysfunction Induced by Ischemia and Reperfusion. Arteriosclerosis, Thrombosis, and Vascular Biology. https://www.ahajournals.org/doi/10.1161/ATVBAHA.107.149278.
  9. U.S. Food & Drug Administration (FDA). Ingesting or Inhaling Nitrite "Poppers" Can Cause Severe Injury or Death. (2021). https://www.fda.gov/consumers/consumer-updates/ingesting-or-inhaling-nitrite-poppers-can-cause-severe-injury-or-death.
  10. Tasker, NR and Wipf, P. (2021). Chapter One - Biosynthesis, total synthesis, and biological profiles of Ergot alkaloids. The Alkaloids: Chemistry and Biology. https://www.sciencedirect.com/science/article/abs/pii/S1099483120300298.
  11. Kaar SJ, et al. (2016). Up: The rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use. Journal of Psychopharmacology. https://www.researchgate.net/publication/295861832_Up_The_rise_of_nitrous_oxide_abuse_An_international_survey_of_contemporary_nitrous_oxide_use.
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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