Caution Urged: Consequences of Combining Erectile Dysfunction Drugs with Chest Pain Medications

A recent study published in the Journal of the American College of Cardiology has sounded a critical warning about the potential dangers of mixing erectile dysfunction (ED) drugs with medications commonly prescribed for chest pain or angina. The research, conducted over a period of three to five years, closely monitored 61,487 men with coronary artery disease, specifically those utilizing nitrate drugs to alleviate chest pain.

Of this cohort, 5,710 men concurrently used ED drugs, such as Pfizer’s Viagra which contains the same active ingredient as Vega 100, Degra or Eli Lilly’s Cialis, both belonging to the phosphodiesterase type 5 (PDE5) inhibitors class. The findings revealed alarming trends, indicating a 67% higher risk of heart failure for those combining nitrates with ED drugs. Additionally, this group was 95% more likely to require procedures to address clogged arteries. Most concerning was the 39% increase in the risk of death from heart disease or other causes, even though this subset was, on average, nine years younger than their counterparts using nitrates alone.

Notably, adverse events tended to manifest more than a month after the initiation of combined drug therapy. Both nitrate drugs and PDE5 inhibitors independently contribute to drops in blood pressure, prompting previous warnings from the U.S. Food and Drug Administration and the American Heart Association against their concurrent usage.

Dr. Daniel Peter Andersson of Karolinska Institutet in Stockholm, the lead researcher, expressed concern over the rising requests for ED drugs among individuals with cardiovascular diseases. Despite the known risks, physicians are facing increasing demand for these medications, highlighting a potential gap in patient awareness.

In an accompanying editorial, Dr. Glenn Levine of Baylor College of Medicine in Houston acknowledged the relative safety of PDE5 drugs in patients with mild coronary artery disease and reasonable exercise ability, provided they are not taking nitrate drugs. However, he strongly cautioned against the combination for those on daily oral nitrate therapy, deeming the use of PDE5 inhibitors as “ill-advised at best and generally contraindicated.”

This study emphasizes the critical need for healthcare professionals to be vigilant and proactive in educating patients about the potential dangers associated with combining these medications. Additionally, it underscores the importance of adherence to existing guidelines and warnings issued by regulatory bodies to ensure patient safety and well-being.


Dr. Oche Otorkpa PG Cert, MPH, PhD

Dr. Oche is a seasoned Public Health specialist who holds a post graduate certificate in Pharmacology and Therapeutics, an MPH, and a PhD both from Texila American University. He is a member of the International Society of Substance Use Professionals and a Fellow of the Royal Society for Public Health in the UK. He authored two books: "The Unseen Terrorist," published by AuthorHouse UK, and "The Night Before I Killed Addiction."
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