Erectile Dysfunction Medication and What You Need to Know

Erectile Dysfunction (ED) is a common condition that affects 12 million men in the United States. A diagnosis of ED can be associated with a two-fold increase in the risk of having a heart attack.

Key takeaways:
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    ED is commonly treated with a medication known as a PDE5 inhibitor. The most common one is Viagra.
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    New studies show that there is an increased risk of cardiovascular disease in people who have ED.
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    PDE5 inhibitors are contraindicated with common medications used to treat heart conditions in an emergency.

Erectile dysfunction medications

Doctors prescribe erectile dysfunction medication to treat erectile dysfunction (ED). However, researchers accidentally discovered its secondary use while developing a medication meant to treat various cardiovascular issues.

For example, sildenafil (Viagra) was originally developed to treat high blood pressure and chest pain due to heart disease. The medication, however, had a bonus side effect of helping men with erectile dysfunction (ED), also referred to as impotence.

Phosphodiesterase type 5 inhibitors (PDE5 inhibitors) are a class of medications used as a vasodilator. This means that they dilate the blood vessels allowing the blood in the body to flow more freely. Since the penis is made up of primarily spongy tissue (corpus cavernosum) and blood vessels, the PDE5 inhibitors also dilate the penis leading to an erection.

PDE5 inhibitors do just that; they inhibit or block the PDE5 enzyme located in the corpus cavernosum allowing nitric oxide to bind to the muscles, allowing the penis to relax, dilate, and increase blood flow.

PDE5 inhibitors medications include:

  • sildenafil (Viagra).
  • tadalafil (Cialis).
  • vardenafil (Levitra and Staxyn).
  • avanafil (Stendra).

Secondary uses for PDE5 inhibitors

While PDE5 inhibitors are most commonly used for ED, some can also be used for other conditions, such as pulmonary artery hypertension (PAH).

Sildenafil (Revatio) is a rebranded version of Viagra that is still used today in an emergency to treat PAH.

Tadalafil (Adcirca), another rebranded medication, is used to treat an enlarged prostate, also known as BPH. However, this medication can also be used to treat PAH.

Tracleer (bosentan) is another PDE5 used to treat ED and other conditions in an emergency, such as PAH.

Medications contraindicated with PDE5 inhibitors

PDE5 inhibitors interact with medications containing nitrates, such as those to treat angina (chest pain). Nitrates contain nitroglycerin, a compound commonly used for treating coronary artery disease and heart attacks.

Nitrate medications work similarly to PDE5 inhibitors by dilating blood vessels. Both drugs lower blood pressure. However, PDE5 also increases the level of nitrates in the body leading to an overabundance of nitrates.

Taking both medications together can cause severe low pressure (hypotension), making them dangerous. Severe hypotension can lead to shock and deprive the body of the oxygenated blood it needs.

Types of nitrate medications:

  • Nitroglycerine.
  • Sodium nitroprusside.
  • Isosorbide mononitrate.
  • Isosorbide dinitrate.
  • Alkyl nitrites and nitrates.

Nitrates are a common medication used in an emergency. If you or a loved one is taking a PDE5, notify the doctor before treatment.

Who should avoid PDE5 inhibitors

Not everyone with ED can take PDE5 inhibitors. For patients with prostate issues or damaged nerves or blood vessels that surround the penis, the medication may not work. Damage to this area often stems from prostate surgery or trauma.

For patients with diabetes or cardiovascular disease, the medication may not work for ED — or may require higher doses. Even though both conditions can cause ED, they may be treated with medication contraindicated with PDE5 or lessen the effects.

The way the body processes the medication can also harm particular people. For example, those with liver or kidney disease may also need to avoid taking PDE5 to prevent further damage leading to cirrhosis and worsening disease.

People with heart disease should take precautions when taking PDE5 inhibitors. Certain medications to treat heart disease, such as blood pressure-reducing medications, can cause a significant drop in blood pressure.

Furthermore, certain antibiotics, antifungals, and even anti-HIV medications can boost the levels of PDE5 inhibitors in the bloodstream and should be used with caution or in low doses.

Your healthcare provider can perform a thorough workup to discern the cause of ED and if a PDE5 inhibitor is right for you.

PDE5 inhibitor side effects

Most medication today comes with side effects. Sometimes, side effects are common and occur often; other times, they rarely occur. However, side effects are not to be confused with an allergic reaction, such as hives, redness, swelling, or trouble breathing.

Common side effects include:

  • Headache.
  • Flushing.
  • Nasal congestion.
  • Nasopharyngitis (inflammation of nasal passages and throat).
  • Upset stomach.

Rare side effects include:

  • Prolonged erections lasting longer than four hours (priapism).
  • Visual disturbances.
  • Hearing loss.
  • Back pain.

Drinking alcohol while taking PDE5 inhibitors can worsen the side effects. Consumption of alcohol has similar side effects, such as flushing and upset stomach. Alcohol can also lead to ED, which is counter-productive for using the medication.

If you experience any side effects when taking PDE5 inhibitors or have a substance abuse disorder, please consult your physician before taking or continuing the medication.

Who is at risk for ED?

With ED, the penis is unable to get an erection, sustain an erection for sex, or is too soft to have sex. Chronic disease is the most common link between men and ED, but temporary causes can also lead to the condition.

Some common causes of ED include:

  • Aging — 40 and up.
  • Diabetes.
  • Obesity.
  • Anxiety.
  • Smoking.
  • Cardiovascular disease.
  • Substance abuse.
  • Prostate surgery.
  • Antidepressants.
  • Low self-esteem.

Treating modifiable causes such as drinking and smoking can help lessen the risk of ED. If you or your loved one is experiencing symptoms of ED, contact a physician for a consultation on how they can help.

The relationship between ED and heart disease

If a person has ED or performance issues in the bedroom, it could indicate heart disease.

Studies have shown that 70% of people with ED also have other vascular conditions such as atherosclerosis, high blood pressure (hypertension), and high cholesterol.

Additionally, people with ED are more likely to have other diseases, such as diabetes, depression, and coronary artery disease. Therefore, ED can also be an early predictor for strokes and heart attacks.

Having ED doesn’t mean you will have heart disease, but don't ignore the risk factor. If you have been diagnosed with ED, make sure your physician schedules a heart screening.

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