Increased Risk of Death Linked to Combining Erectile Dysfunction and Chest Pain Medications

A recent study has discovered that the concurrent intake of erectile dysfunction medication and medication for chest pain may heighten the risk of death. Various people suffering from erectile dysfunction (ED) are often prescribed phosphodiesterase-5 inhibitor (PDE5i)—even those with cardiac disease. It has been noted that about 9% of patients have been prescribed both PDE5i and nitrates, a common medicine for chest discomfort.

A new research involving nearly 62,000 men revealed that the combined use of these two drugs could escalate the risk of heart failure and premature death. The researchers pointed out that both medicines cause hypotension or low blood pressure, according to Ylva Trolle Lagerros, MD, PhD, one of the leading authors of the study and a researcher at Karolinska Institutet, and a senior doctor at the Center for Obesity, Stockholm, Sweden. She noted that the medicines employ different methods.

Hence, it might not be advisable to use these two medicines in conjunction.

Lagerros elaborated, “Patients on both PDE5is plus nitrate medication are exposed to an increased risk of cardiovascular morbidity and mortality. This signifies that patients with stable coronary artery disease on nitrate medication for chest pain, who also utilize the most prevalent treatment for erectile dysfunction (PDE5i like Viagra), should weigh the benefits of PDE5i against the likely cardiovascular risk.”

The article goes on to explain how the combined use of these medicines could impact you, the link between erectile dysfunction and chest pain, and how to handle the treatment of both conditions concurrently.

The combined use of ED drugs and nitrates enhances the antihypertensive effect of the drugs. Combined use can lead to serious side effects— death included. Researchers discovered that taking a PDE5i like Viagra along with nitrates for chest pain is accompanied by around a 35% to 40% increased risk of death and a 70% higher risk of heart attack and heart failure.

Scott D. Miller, MD, MBA, a certified urologist and the medical director of Wellstar Urology in Atlanta, Georgia, pointed out that “Several bodily systems assist in maintaining blood pressure when either medicine is consumed alone. However, when two different mechanisms are concurrently blocked, the body’s efforts to maintain normal blood pressure can be overwhelmed.” He added that if a heart attack occurs during this scenario— which is the most likely time chest pain medication would be taken— the heart might not get the blood it requires when it needs it.

The researchers note that people predominantly only use nitrates to provide emergency relief for sudden onset chest pain or angina. When used this way, the body quickly absorbs the drug and then it dissolves just as fast. Similarly, ED drugs are usually only taken when needed.

It could, therefore, be feasible for individuals prescribed both drugs to use one at a time.

The vital factor here is ensuring that patients on these drugs are aware of the risk and that they should not take both drugs concurrently, or consider the use of an entirely different prescription.

According to Lagerros, people using ED medication are often from the same demographic as those taking medication for chest pain. She added, "I believe that what we observe here is that 75 is the new 55; men with stable coronary artery disease are properly cared for, hence retaining an active lifestyle and aspiring for an active sex life as well."

Moreover, being diagnosed with ED could potentially be indicative of future heart health concerns. Lagerros further explained, "ED can be a clinical marker for future heart health issues,” and is often considered a "precursor for cardiovascular incidents."

Indeed, Miller mentioned that a key risk factor for erectile dysfunction is an underlying cardiovascular disease. As such, people with ED may have a higher chance of needing medication for chest pain compared to men without ED. However, due to the well-documented contraindication of combining these medications, men on ED treatment are less likely to be prescribed chest pain medication and vice versa.

Lagerros pointed out that since chest pain could be life-threatening unlike erectile dysfunction, nitrates might need to be given priority over ED medication. Alternative types of medication for erectile dysfunction that can be used instead of PDE5i are available, Miller proposed. Consulting a healthcare professional can help you decide the appropriate treatment option for you.

There are also non-medication strategies to ease chest pain and symptoms of erectile dysfunction. Lagerros proposed the following idea: Remember, whatever benefits the heart is also beneficial for all other bodily functions and ailments.

“Rather than searching for the next best supplement, focus on the pillars of good health—a healthy diet, regular exercise, adequate sleep, stress management, smoking cessation, and monitoring health indicators such as blood pressure, cholesterol, lipids, and blood sugar,” Miller said.

If you are experiencing chest pain, particularly during physical activity, it is important to get immediate medical attention. You also should contact a doctor if you experience difficulties in achieving or maintaining an erection.

“Sometimes the first symptom of underlying cardiovascular disease is erectile dysfunction,” said Miller. “The male organ can serve as a barometer to overall heart health.”

He explained that the blood vessels supplying the penis can be the first to narrow since they are smaller than those feeding the heart. More importantly, this is a body part that readily reveals any vascular deficiency.

“All men who experience a decrease in erectile quality should see their primary care physician to screen for serious underlying health issues such as cardiovascular disease or diabetes,” Miller said.