From the Guidelines
Sildenafil (Viagra) is not typically known to cause gout flares. There is no established direct causal relationship between sildenafil use and gout attacks in medical literature, as supported by the lack of discussion on this topic in recent guidelines such as the 2020 American College of Rheumatology guideline for the management of gout 1. Gout flares are primarily triggered by elevated uric acid levels in the blood, which form crystals in joints causing inflammation and pain. Sildenafil works by inhibiting phosphodiesterase type 5 (PDE5), increasing blood flow to certain tissues, and has no known mechanism for altering uric acid metabolism.
However, if you have gout and are taking sildenafil, it's essential to be aware of potential indirect connections. Some medications commonly taken alongside sildenafil, such as certain diuretics for high blood pressure, can increase uric acid levels and potentially trigger gout, as noted in the 2016 updated EULAR evidence-based recommendations for the management of gout 1. Additionally, lifestyle factors that may coincide with sildenafil use, such as alcohol consumption, could independently trigger gout attacks.
Key considerations for managing gout include:
- Treating acute flares as early as possible with options like colchicine, NSAIDs, or corticosteroids 1
- Implementing urate-lowering therapy (ULT) for patients with recurrent flares, tophi, or radiographic damage, with a goal to maintain serum uric acid levels below 6 mg/dL 1
- Addressing lifestyle factors such as weight loss, diet, and reduced alcohol consumption, especially beer and spirits, as recommended in the 2012 American College of Rheumatology guidelines for management of gout 1
If you experience gout symptoms while taking sildenafil, consult your healthcare provider to evaluate all potential causes rather than assuming the medication is responsible. The management of gout should be tailored to the individual patient, considering factors such as the presence of tophi, radiographic signs, and associated comorbidities, as emphasized in the EULAR evidence-based recommendations 1.
From the Research
Sildenafil and Gout Flares
- There is no direct evidence in the provided studies that sildenafil (Viagra) causes gout flares 2, 3, 4, 5.
- However, a study found that gout is associated with an elevated risk of erectile dysfunction, which may be treated with sildenafil 6.
- The exact relationship between sildenafil and gout flares is not well understood and requires further research.
- Gout flares are often caused by factors such as obesity, high alcohol and purine-rich food consumption, and the use of diuretics 3.
- Sildenafil is generally well-tolerated, with common adverse events including headache, flushing, dyspepsia, nasal congestion, and abnormal vision 2, 4, 5.
Gout Management
- Gout is inflammatory arthritis caused by monosodium urate crystal deposition in articular and non-articular structures 3.
- Acute gout flares are managed with steroids, non-steroidal anti-inflammatory drugs, or colchicine 3.
- Long-term management includes lifestyle modifications, such as weight loss, avoidance of alcohol and purine-rich foods, and diuretics 3.
- Urate-lowering therapies (ULT) are indicated in patients with 2 or more gout flares/year, tophi, or radiographic evidence of gouty arthropathy 3.
Sildenafil and Erectile Dysfunction
- Sildenafil is an effective oral treatment for erectile dysfunction, with a success rate of up to 85% in patients with an organic underlying disease 2, 5.
- Sildenafil has been used by over 20 million men in over 110 countries and is one of the best-studied pharmacological substances available 5.
- The efficacy of sildenafil is not affected by patient age or antihypertensive or antidepressant medications 2.