From the Guidelines
Viagra (sildenafil) should not be used by individuals taking nitrate medications, as this combination can cause a dangerous drop in blood pressure, and other contraindications include severe cardiovascular disease, recent stroke or heart attack, severe liver disease, hypotension, uncontrolled hypertension, retinitis pigmentosa, and known hypersensitivity to sildenafil. The American College of Physicians recommends that clinicians initiate therapy with a PDE-5 inhibitor in men who seek treatment for erectile dysfunction and who do not have a contraindication to PDE-5 inhibitor use 1. According to the evidence, nitrate therapy is a contraindication for treatment with oral PDE-5 inhibitors 1.
Key Contraindications
- Nitrate medications (like nitroglycerin, isosorbide mononitrate, or isosorbide dinitrate)
- Severe cardiovascular disease
- Recent stroke or heart attack (within 6 months)
- Severe liver disease
- Hypotension (blood pressure below 90/50)
- Uncontrolled hypertension (blood pressure above 170/110)
- Retinitis pigmentosa
- Known hypersensitivity to sildenafil
Precautions
- Caution is needed when using Viagra with alpha-blockers, as this combination may cause symptomatic hypotension
- Patients with anatomical deformation of the penis (such as Peyronie's disease) or conditions that predispose to priapism (sickle cell anemia, multiple myeloma, leukemia) should use Viagra cautiously
- Always consult with a healthcare provider before starting Viagra, especially if you have any pre-existing medical conditions or take other medications.
From the FDA Drug Label
Sildenafil citrate is contraindicated in patients with: Concomitant use of organic nitrates in any form, either regularly or intermittently, because of the greater risk of hypotension [see Warnings and Precautions (5.2)] .Known hypersensitivity to sildenafil or any component of the tablet. Do not take sildenafil tablets if you: take nitrate medicines are allergic to sildenafil or any other ingredient in sildenafil tablets. Concomitant use of sildenafil citrate with nitrates in any form is contraindicated [see Contraindications (4)].
The contraindications for Viagra (sildenafil) are:
- Concomitant use of organic nitrates in any form
- Known hypersensitivity to sildenafil or any component of the tablet
- Allergy to sildenafil or any other ingredient in sildenafil tablets 2, 2, 2
From the Research
Viagra Contraindications
- The concomitant use of sildenafil and organic nitrates is contraindicated because it may lead to a potentiation of the decreases in blood pressure and thus cause life-threatening hypotension 3, 4, 5, 6.
- Uncontrolled hypertension and impaired cardiac reserve are relative contraindications to Viagra in cardiovascular disease 4.
- The use of Viagra necessitates caution in cardiac failure and when used within six months of acute myocardial infarction and stroke 4.
- It is inadvisable in patients with unstable angina pectoris 4.
- Patients with heart disease, suspected heart disease, and risk factors for heart disease should discuss with their physicians the safety of resuming sexual activity 6.
Special Considerations
- A cardiac work-up, including exercise treadmill testing, should be considered in appropriate patients 5, 6.
- Physicians should discuss with their cardiac patients the risks of sexual activity before prescribing any treatment for ED 5.
- The potential influence on the metabolism of Viagra by medications that affect the cytochrome-P-450 system does not translate into clinical effects 4.