Is Oxandrolone (oral anabolic steroid) safe to use with Viagra (Sildenafil citrate)?

Safety of Oxandrolone with Viagra (Sildenafil)

Oxandrolone should not be used concurrently with sildenafil (Viagra) due to potential additive cardiovascular effects that could increase risks of adverse events.

Pharmacological Considerations

Oxandrolone

• Oxandrolone is an oral anabolic androgenic steroid (AAS) that is FDA-approved for weight restitution after severe trauma, major surgery, infections, and certain muscular dystrophies 1
• Unlike other C17alpha-alkylated AAS, oxandrolone has a novel chemical configuration that confers resistance to liver metabolism and marked anabolic activity 1
• Common side effects include transient elevations in liver enzymes and reductions in HDL cholesterol 1

Sildenafil (Viagra)

• Sildenafil is a phosphodiesterase type 5 inhibitor (PDE5i) that is first-line pharmacological treatment for erectile dysfunction 2
• It works by enhancing vasodilation in the corpus cavernosum, potentiating erections during sexual stimulation 3
• Common side effects include headache, flushing, dyspepsia, nasal congestion, and visual disturbances 4, 5

Interaction Concerns

Cardiovascular Effects

• Both medications can affect cardiovascular function:
  • Sildenafil causes transient reductions in blood pressure through its vasodilatory properties 5
  • Anabolic steroids like oxandrolone can alter lipid profiles and potentially affect cardiovascular function 1
  • The combination may lead to unpredictable additive hypotensive effects

Specific Contraindications

• Sildenafil is contraindicated with organic nitrates due to dangerous hypotensive effects 5, 6
• While not specifically contraindicated together, the American College of Physicians and American Urological Association recommend using a single medication at a time for erectile dysfunction, optimizing the dose rather than combining agents 2

Risk Assessment

High-Risk Populations

• Patients with:
  • Unstable angina pectoris
  • Recent myocardial infarction or stroke (within 6 months)
  • Cardiac failure
  • Uncontrolled hypertension
  • Impaired cardiac reserve 5, 6

Monitoring Recommendations

If a patient insists on using both medications (not recommended):

• Start with lowest possible doses of both medications
• Monitor blood pressure and cardiovascular symptoms closely
• Discontinue immediately if experiencing significant hypotension, chest pain, or other cardiovascular symptoms

Alternative Approaches

For Erectile Dysfunction

• Optimize the dose of sildenafil alone (25-100mg as needed) 2
• Consider alternative PDE5 inhibitors if sildenafil is ineffective:
  • Tadalafil (5-20mg as needed or 2.5-5mg daily)
  • Vardenafil
  • Avanafil 2

For Anabolic Purposes

• Consider FDA-approved alternatives for the specific condition requiring anabolic support
• Consult with specialists regarding non-steroidal options for muscle wasting or catabolic conditions

Conclusion

The concurrent use of oxandrolone and sildenafil presents potential cardiovascular risks without established benefits. The safest approach is to avoid this combination and instead optimize the dosage of individual medications for their respective indications.