Men with heart disease have asked me whether it is safe for them to use sildenafil (Viagra) for erectile dysfunction (impotence).
A recent study evaluated the results of 80 clinical trials of sildenafil in 9,386 men. Heart attacks occurred in 69 of these men an average of 14 days after their last use of the drug. There was no significant increase in the number of heart attacks within 6 hours or 24 hours after taking sildenafil. The authors of this study concluded that “sildenafil is not associated with an increased risk of cardiovascular events.”
It is important to keep in mind that these men could not be admitted to the studies if they had certain medical conditions, although a substantial number of those admitted had diabetes, high blood pressure, or coronary heart disease. The findings in this study also agree with spontaneous reports to the Food and Drug Administration that showed no evidence of a higher risk for acute coronary events in men taking sildenafil.
I have told my patients that they can safely use sildenafil and other similar drugs for erectile dysfunction. However, men should not take these drugs if any of the following conditions apply to them:
- They are taking nitroglycerin or other nitrates for angina. Nitrates can interact with sildenafil to produce dangerously low blood pressure.
- They have very high or very low blood pressure.
- They have had a heart attack, stroke, or life-threatening abnormal heart rhythm within the past 6 months.
- They have coronary disease with unstable angina.
This caution also applies to men with heart failure or a positive stress test for coronary disease, and those taking multiple drugs for hypertension.
