Viagra and Nitrates
Viagra (sildenafil) was the first oral medication approved by the Food and Drug Administration for treatment of erectile dysfunction or impotence. It works by dilating the veins that lead to an erection by enhancing the effects of nitric oxide, a substance in the body that causes the blood pressure to decrease.
Erectile dysfunction is common in men with coronary or cardiovascular disease and this combination provides the setting for a dangerous drug interaction. Topical, oral, or sublingual nitrates such as nitroglycerin or isosorbide are taken for angina or chest pain and also cause a drop in blood pressure. When taken together there is usually a marked decrease in systemic blood pressure and the possibility of dangerous heart rhythms. In the surgical vernacular this is described as “a synergistic vasodilation causing profound hypotension and the onset of malignant arrhythmias.”
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