How do erectile dysfunction drugs interact with nitrates?
Although Viagra is an extremely popular drug, used by over 60 million men worldwide since 1998, it is not the answer for everyone. You may already know that if you are taking a nitrate medicine for heart disease, you cannot use viagra or other erectile dysfunction (ED) medicines like Cialis and Levitra because your blood pressure may fall dangerously. But what other options do you have for treating erectile dysfunction? We will talk about it here.
Think about the case of Mr. Jones, a patient he helped at the cardiac clinic. Most of my patients take various medications for heart disease and other complicated conditions, so I often check their medical history to make sure everything is in order. These include lab tests, vital signs, previous reports, and drug interactions. If there is a problem, I will meet with the patient and make recommendations to the medical team.
On his last visit, Jones was prescribed Imdur (isosorbide mononitrate) to treat heart disease. When I read the notes, Imdur seemed to be working. He felt better, even better, that he wanted to have sex with his wife again.
And here’s the problem: Mr. Jones’ doctor has reinstated the prescription for Cialis (tadalafil).
If you really watch TV commercials for erectile dysfunction drugs, ignore jazz viagra or Cialis Sunset, you might hear the phrase “Do not take if you are taking nitrates for chest pain, as they can. cause a dangerous drop in blood pressure ”. Viagra, Cialis, Levitra, and Stendra belong to a class of drugs called phosphodiesterase-5 (PDE-5) inhibitors and all interact with nitrates in the same way.
Many patients ask, “How bad can a ‘drop in blood pressure’ be? The answer, which we learned after the release of Viagra, is that it can lead to heart attacks and potentially kill patients. warning for a whole class of drugs like Viagra.
So Mr. Jones uses nitrates, especially Imdur. Fortunately, he has not yet used Cialis for him. I advised her to avoid this combination, given her extensive cardiac history.
What are my other medication options?
What can patients with erectile dysfunction who take nitrates do to have an active sex life? Another drug can be considered: alprostadil. This drug was released before Viagra and is available under the brand names Caverject and Muse.
Caverject vs. Muse
Although Caverject and Muse share the same active substance, they all have their pros and cons.
How do they work?
Caverject and Muse aid in erection by loosening penile tissue and facilitating blood flow to the penis. On the positive side, they work relatively quickly; The downside is that they are not available in tablet form. And that’s the problem.
How are they served?
Many patients are annoyed when they mention that there is another option for Viagra and other PDE-5 inhibitors. But a nervous look quickly follows when I tell him that Caverject requires injection into the penis and Muse requires small beads to be inserted directly into the urethra. At this point, in order not to completely disconnect the patient, I try to share information that helps them make decisions, especially regarding whether these drugs work and do not have a risky interaction with nitrates.
Which one works best?
You should use Caverject and Muse before engaging in any sexual activity, so you should plan ahead before using them. Caverject tends to work much faster than Muse (in less than 10 minutes) because it enters the bloodstream faster. It may start to work a little longer (15 to 30 minutes) because it must be absorbed by the penis before entering the bloodstream.
What are the side effects?
The main disadvantage of Caverject is that it is an injection that must be given into the lower part of the penis, which can cause irritation to the surrounding tissue. Because a needle is inserted into the penis, it is important to cleanse the penis before each injection to avoid infection. Be sure to talk to your doctor or pharmacist about the proper injection technique to avoid problems or accidents. And let’s be honest, most men don’t want to have sex with an abusive member. Caverject also has a higher risk of priapism compared to Muse. (Priapism is basically an erection that lasts more than 4 hours and is named after the Greek god Priap.)
On the other hand, the mouse can cause a burning sensation in the penis along the urethra (this happens about 20% of the time). But for men who don’t want a needle in their penis, this is an option. For this reason, I generally recommend starting with Muse and if that doesn’t work, try Caverject.
Are there any alternatives?
Unfortunately, while the idea of using Caverject or Muse is not appealing, there are no other approved drugs available in the United States to help treat erectile dysfunction. Instead, the options would likely include talking to your doctor about mechanical devices or surgery. Mechanical solutions include vacuum pumps that can deliver blood to the penis, with surgery involving an inflatable prosthetic device placed over the penis. The urologist will help you think about the pros and cons of the surgery.
In general, men who use nitrates have significant heart problems, so it’s only natural to be concerned about sexual intimacy and how much physical activity can be tolerated. After traumatic events like a heart attack, many men (and their partners) have asked me if it is okay to have sex again or how long they should wait. You should talk to your doctor about these health concerns and see a sex counselor who can help you manage them better if you are really worried. There are currently many clinical guidelines available to help men with such health and sexual problems, so getting the right advice from a healthcare professional can be a positive experience.