And PDE5 Inhibitors Don’t Mix
Nitroglycerin, a drug prescribed to treat the discomfort of angina pectoris, is one of the most widely used nitrate-based drugs. The pain of angina is caused when the heart fails to receive adequate amounts of the oxygen-rich blood it needs to function properly. Other nitrate-based drugs also are sometimes prescribed to help bring down high blood pressure that has failed to respond to other forms of treatment.
Like the PDE5 inhibitors, such as Cialis and Viagra, nitrates cause a temporary drop in blood pressure. In the case of nitrates, this drop in blood pressure occurs as arteries dilate so that blood flow to the heart is temporarily expanded, thus relieving the pain of angina.
The PDE5 inhibitors, prescribed to treat erectile dysfunction, work their magic by temporarily optimizing blood flow to the penis. Insufficient blood flow to the penis is the single biggest cause of ED.
Taken together, these two drugs can cause such a sharp drop in blood pressure as to be life-threatening. They should never be taken together. Depending on the severity of a man’s angina symptoms, his doctor may recommend that he refrain from sexual activity, thereby significantly reducing the likelihood of an adverse interaction.
While most nitrate-based drugs are prescribed for the relief of angina’s pain or to bring down intractable hypertension, nitrates are also present in the recreational drugs known as “poppers,” which are often used during sex. If you are taking Viagra or one of the other PDE5 inhibitors, the use of “poppers” can be dangerous, so steer clear of nitrates in any form, including recreational.
- TABLE OF CONTENTS
- Substudy of HOPE-3 Trial
- The Study Population
- Tracking Erectile Function
- The Findings
- Not All Heart Drugs Absolved
- How Statins Work
- Another Study Concurs
- Maybe a PDE5 Inhibitor Could Help
As a number of men have discovered quite by accident, certain medications can make it difficult or even impossible to get and keep an erection suitable for intercourse. The list of offending medications is fairly lengthy and includes such seemingly innocuous drugs as antihistamines and nonsteroidal anti-inflammatory drugs, or NSAIDs.
Men with a higher risk of cardiovascular disease are often treated with statins, drugs designed to lower blood cholesterol levels; antihypertensives designed to lower high blood pressure; or both. For those undergoing treatment with these medications, a recently published study offered some welcome news.
It should be noted that this study, published in the January 2018 issue of the “Canadian Journal of Cardiology,” looked specifically at the effects of two widely used drug therapies but cannot be applied to all medications prescribed to prevent full-blown cardiovascular disease.
Substudy of HOPE-3 Trial
Also, this inquiry into the effects of certain cardiovascular medications on erectile function was conducted as a secondary analysis of data from the Heart Outcomes Prevention Evaluation-3, or HOPE-3, trial. The central thrust of the HOPE-3 trial was to examine both the efficacy and safety of various modes of preventive therapy designed to lower the risk of cardiovascular disease.
As with the substudy, the HOPE-3 trial evaluated the relative merits of daily treatment with rosuvastatin versus placebo, daily treatment with a combination angiotensin receptor blocker/hydrochlorothiazide (ARB/HCTZ) versus placebo, and treatment with both statin and ARB/HCTZ versus double placebo. The researchers conducting the primary HOPE-3 trial found that while daily preventive treatment with rosuvastatin is superior to placebo, the same could not be said of the antihypertensive therapy. They also found that combination treatment was superior to treatment with placebo.
The Study Population
The research team was made up of representatives from the Population Health Research Institute at Canada’s McMaster University and colleagues from other universities around the world. The study cohort consisted of 2,153 men with a mean age of 61.5 years. The mean follow-up period was 5.8 years. All study participants suffered from at least one cardiovascular risk factor.
Some study participants were randomly selected to receive daily doses of 10 milligrams of rosuvastatin (also marketed under the brand name Crestor), while a matching control group received placebo. Yet another subgroup of study participants got daily doses of a pill combining 16 milligrams of candesartan, an angiotensin receptor blocker or ARB, with 12.5 milligrams of hydrochlorothiazide, a diuretic, while a control group got a placebo. Finally, a third group got combination treatment with rosuvastatin and candesartan/HCTZ and was paired with a control group receiving a double placebo.
Tracking Erectile Function
To ascertain what effects the drugs had on erectile function, researchers used the erectile function domain of the International Index of Erectile Function (IIEF-EF) to evaluate study participants from the outset of the study through a years-long follow-up period.
At the outset of the study, baseline IIEF-EF scores indicated that 57.6 percent of all study participants had some degree of erectile dysfunction, although the severity of the ED was not quantified. ED is defined as an IIEF-EF score of less than 26. Over the course of the study and the subsequent follow-up period, the mean IIEF-EF score of study participants declined by only 1.0.
The study’s lead author, Philip Joseph, M.D., noted that ED is common among middle-aged men and is often attributed to the effects of certain medications. However, he said, “the development of ED in men treated with statins, or an angiotensin receptor blocker (ARB) and low-dose thiazide, should not be attributed to the use of these drugs.”
Among men who took rosuvastatin, the decline in IIEF-EF score was 1.4, which is not statistically different from the 1.5 decline reported by those taking placebo. Among men who took the ARB/HCTZ blood pressure-lowering drug, the IIEF-EF score decline was 1.6, compared with a decline of 1.3 among the placebo group.
Study participants who took both a statin and the blood pressure-lowering medication reported a decline in IIEF-EF score of 1.7, compared with a decline of 1.4 in men taking the double placebo.
Not All Heart Drugs Absolved
Statins are the medication of choice for patients with dangerously high levels of low-density lipoprotein (LDL), also known as bad cholesterol, and relatively low levels of high-density lipoprotein (HDL), or good cholesterol. Although rosuvastatin is only one of several statins on the market, its performance in the Canadian study is a hopeful sign for men who are using rosuvastatin or other statins.
However, the range of antihypertensive medications on the market is far more varied than is the case with statins. The specific combination drug therapy used in the study — a low-dose angiotensin receptor blocker (ARB) and a diuretic — seems to have no real adverse effect on erectile function. However, prior studies have found that certain antihypertensives, most notably beta blockers, can make it more difficult to get and keep an erection.
If you have questions about the effects your specific blood pressure medication might have on erectile function, you should talk to your doctor who can best decide whether it’s appropriate to move you to an alternative blood pressure medication.
How Statins Work
As previously noted, statins represent the drug therapy of choice for elevated levels of blood cholesterol, which can lead to atherosclerosis, a buildup of fatty plaques on the inner walls of arteries. The Canadian study found that rosuvastatin (Crestor) had few if any, negative effects on erectile function. Nor does MayoClinic.org cite ED as one of the common or rare side effects of all statins. Because individual reactions to drugs vary from one patient to another, it’s possible that a small number of patients might find one of the statins problematic in terms of erectile function. But, clearly, the problem is not widespread.
Other widely prescribed statins include atorvastain (Lipitor), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), and simvastatin (Zocor). All drugs in this category work by inhibiting production of cholesterol in the liver.
Another Study Concurs
In another study, accepted for publication in “The American Journal of Medicine” but not yet published, University of Florida researchers also found that statin use was not associated with the new onset of ED.
The research team analyzed data from three randomized trials and three observational studies covering a total of 69,448 men, more than a third of whom were statin users.
Maybe a PDE5 Inhibitor Could Help
Unless your doctor has expressly instructed you to refrain from sexual activity or you are taking nitrates or some other drug incompatible with PDE5 inhibitors, one of those oral ED medications may help you to overcome any erection problems you may be experiencing. To get these drugs, you’ll need to have a prescription, which you can get from your doctor and fill at the local pharmacy or use to order the drug from a reliable online supplier, such as AccessRx.com.
If you decide to go the latter route and have a prescription from your doctor, you can fax it or scan and email it along with your order to AccessRx. Alternatively, AccessRx can arrange a complimentary online consultation with one of its team of licensed U.S. physicians who can authorize a prescription if it’s determined that you’re an appropriate candidate for the drug. To learn more about ED, its many causes, and the medications available to treat it, click below to visit AccessRx’s Erectile Dysfunction page.