Introduction

PDE5 inhibitors are among the most commonly used medicines for erectile dysfunction (ED). They include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). These medicines help improve erectile function by supporting the blood-flow process involved in an erection during sexual stimulation.

However, PDE5 inhibitors are not suitable for everyone. One of the most important safety issues is their interaction with nitrate medicines, which are commonly used to prevent or relieve certain types of chest pain, including angina.

Nitrates and PDE5 inhibitors should not be taken together because the combination can cause a significant and potentially dangerous drop in blood pressure. FDA prescribing information for sildenafil, tadalafil, and vardenafil identifies nitrate use as a contraindication.

This guide explains what PDE5 inhibitors and nitrates are, why they interact, whether Viagra, Cialis, or Levitra can be taken with nitrates, and what people should tell emergency healthcare professionals if chest pain occurs after taking an ED medicine.

It also explains how this safety warning applies to Vizagra Gold Tablets, which contain tadalafil 20 mg + dapoxetine 60 mg.

What Are PDE5 Inhibitors?

PDE5 inhibitors are a class of medicines used primarily to treat erectile dysfunction.

Common PDE5 inhibitors include:

• Sildenafil
• Tadalafil
• Vardenafil
• Avanafil

The three medicines most commonly associated with the brand names discussed in this article are:

PDE5 inhibitors work through the nitric oxide/cGMP pathway. They inhibit the PDE5 enzyme, which normally breaks down cGMP. By slowing cGMP breakdown, these medicines help maintain the blood-flow response needed for an erection during sexual stimulation.

An important point is that PDE5 inhibitors do not automatically produce an erection. Sexual stimulation is still necessary.

Viagra, Cialis and Levitra: What Is the Difference?

Viagra, Cialis, and Levitra belong to the same drug class, but they contain different active ingredients.

Viagra — Sildenafil

Viagra contains sildenafil.

Sildenafil is a PDE5 inhibitor used for erectile dysfunction. Its effects are generally shorter-lasting than tadalafil’s, although the exact response varies between individuals.

Cialis — Tadalafil

Cialis contains tadalafil.

Tadalafil is also a PDE5 inhibitor and is known for having a relatively long duration of action compared with sildenafil and vardenafil.

This longer duration is particularly relevant when considering its interaction with nitrate medicines.

Levitra — Vardenafil

Levitra contains vardenafil.

Vardenafil works through the same general PDE5 pathway and is also used to treat erectile dysfunction.

Although these medicines differ in their pharmacokinetic profiles, the nitrate warning applies to all three.

What Are Nitrates?

Nitrates are medicines that widen blood vessels and are commonly used to treat or prevent angina, a type of chest pain associated with reduced blood flow to the heart.

Common nitrate medicines include:

• Nitroglycerin
• Glyceryl trinitrate (GTN)
• Isosorbide mononitrate
• Isosorbide dinitrate

Depending on the medicine, nitrates may be available as tablets, sprays, patches, or other formulations.

Nitrates increase nitric oxide signalling, which causes blood vessels to relax and widen. This can reduce the workload on the heart and help relieve or prevent angina.

Because PDE5 inhibitors also affect the same nitric oxide/cGMP pathway, using the two types of medicine together can produce excessive blood-vessel relaxation.

Why Are Nitrates and PDE5 Inhibitors Dangerous Together?

Nitrates and PDE5 inhibitors can have an additive effect on the nitric oxide/cGMP pathway, potentially causing a substantial fall in blood pressure.

Here is the process in simple terms:

1. Nitrates increase nitric oxide signalling.
2. This increases cGMP activity and relaxes blood vessels.
3. PDE5 inhibitors slow the breakdown of cGMP.
4. When both medicines are present, the blood-vessel-relaxing effects can become excessive.
5. Blood pressure can fall to a dangerous level.

This is known as hypotension.

A severe fall in blood pressure can cause:

• Dizziness
• Lightheadedness
• Fainting
• Weakness
• Reduced blood flow to important organs
• Serious cardiovascular complications

The FDA prescribing information for Viagra specifically states that sildenafil potentiates the hypotensive effects of nitrates. Tadalafil and vardenafil carry the same important contraindication.

This is why nitrates should not be combined with PDE5 inhibitors as a routine treatment combination.

Can You Take Viagra With Nitrates?

No. Viagra (sildenafil) is contraindicated with nitrate medicines.

FDA prescribing information states that Viagra should not be administered with nitric oxide donors such as organic nitrates or organic nitrites in any form. This includes regular and intermittent nitrate use.

Examples include:

• Nitroglycerin
• Glyceryl trinitrate
• Isosorbide mononitrate
• Isosorbide dinitrate
• Other organic nitrate or nitric oxide donor medicines

The concern is not simply that both medicines lower blood pressure independently. Sildenafil can potentiate the blood-pressure-lowering effects of nitrates, potentially producing clinically significant hypotension.

What if someone takes Viagra and then develops chest pain?

If chest pain occurs after taking sildenafil, the person should seek urgent medical attention and clearly tell the healthcare professionals:

• That sildenafil was taken
• The approximate time it was taken
• Any other medicines being used

Do not independently take nitrate medication after sildenafil use unless directed by the healthcare professionals managing the situation.

This information is important because the medical team needs to consider the recent PDE5 inhibitor exposure when deciding how to manage chest pain.

Can You Take Cialis With Nitrates?

No. Cialis (tadalafil) is contraindicated with nitrate medicines.

Tadalafil can potentiate the blood-pressure-lowering effects of nitrates, which is why concurrent use is contraindicated.

The interaction deserves particular attention with tadalafil because it has a longer duration of action than sildenafil and vardenafil.

That means the potential interaction can remain relevant for longer after a dose.

What Does the 48-Hour Rule Mean for Tadalafil?

This point needs careful explanation.

FDA Cialis prescribing information states that in a patient who has taken Cialis, if nitrate administration becomes medically necessary in a life-threatening situation, at least 48 hours should elapse after the last tadalafil dose before nitrate administration is considered. Even then, nitrates should only be administered under close medical supervision with appropriate hemodynamic monitoring.

This is not a self-treatment instruction.

A person should not calculate a 48-hour interval and decide independently when to take nitroglycerin or another nitrate. Emergency healthcare professionals must make that decision based on the patient’s condition, the timing of tadalafil use, and the circumstances.

Can You Take Levitra With Nitrates?

No. Levitra (vardenafil) is contraindicated with nitrates.

FDA prescribing information states that Levitra should not be used with nitrates or nitric oxide donors because PDE5 inhibition can potentiate the blood-pressure-lowering effects of nitrates.

Unlike tadalafil, the official vardenafil labeling does not establish a specific safe time interval for nitrate administration after vardenafil.

Therefore, someone taking vardenafil should tell healthcare professionals about the medicine if emergency treatment for chest pain becomes necessary.

Nitrates and PDE5 Inhibitors: Quick Comparison

The important takeaway is simple:

There is no PDE5 inhibitor that should be routinely combined with nitrate medicines.

What Medicines Count as Nitrates?

People sometimes know their heart medicine by its brand name rather than its active ingredient. Because brand names differ between countries, knowing some common active ingredients can be useful.

Common nitrate medicines include:

Nitroglycerin

Also known as glyceryl trinitrate (GTN).

It may be used for rapid relief or prevention of angina depending on the formulation.

Isosorbide Mononitrate

This nitrate is commonly used as part of ongoing treatment to prevent angina.

Isosorbide Dinitrate

Another nitrate medicine used in cardiovascular treatment.

If you are unsure whether your medicine contains a nitrate, check the active ingredient on the packaging or ask a pharmacist or doctor.

Do not stop or change a prescribed heart medicine because you want to use an ED medicine.

What Happens If Viagra and Nitroglycerin Are Taken Together?

The combination can cause a significant drop in blood pressure.

Possible symptoms include:

• Severe dizziness
• Lightheadedness
• Fainting
• Weakness
• Very low blood pressure
• Cardiovascular complications

The reason is that sildenafil can increase the blood-pressure-lowering effects of nitroglycerin and other nitrates.

This combination should never be deliberately tested to see how the body responds.

If the medicines have already been taken together, seek urgent medical help and tell healthcare professionals exactly what was taken and approximately when.

What Should You Do If You Develop Chest Pain After Taking a PDE5 Inhibitor?

Chest pain after sexual activity or after taking an ED medicine should be taken seriously.

If this happens:

1. Stop sexual activity.
2. Seek urgent medical attention.
3. Tell the medical team which PDE5 inhibitor was taken.
4. Tell them approximately when it was taken.
5. Tell them about all other medicines currently being used.
6. Do not independently take nitrate medication after PDE5 inhibitor use unless instructed by the healthcare professionals treating you.

The information about the PDE5 inhibitor is important because it can affect decisions about nitrate treatment.

Can People With Heart Disease Take PDE5 Inhibitors?

Having heart disease does not automatically mean that every PDE5 inhibitor is unsuitable.

However, the individual’s:

• Cardiovascular condition
• Blood pressure
• Current medicines
• Exercise tolerance
• Stability of the heart condition
• Suitability for sexual activity

all need to be considered.

Men with cardiovascular disease should discuss ED treatment with an appropriate healthcare professional.

The key distinction is:

Nitrates are a specific and important contraindication, but not every cardiovascular medicine is a nitrate.

For example, FDA Viagra labeling notes potential additional blood-pressure lowering with alpha-blockers and antihypertensive medicines, but this is different from the absolute nitrate contraindication.

Are All Heart Medicines Contraindicated With Viagra?

No.

This is an important misconception.

Nitrates are the major contraindicated heart medicines with PDE5 inhibitors.

Other cardiovascular medicines may require caution because of possible additive effects on blood pressure or other interactions, but they should not automatically be treated as equivalent to nitrates.

For example, Viagra labeling warns about possible additional blood-pressure lowering when used with alpha-blockers or antihypertensive medicines.

Therefore, someone with heart disease should provide their healthcare professional with a complete list of medicines rather than simply assuming that all cardiovascular medicines are prohibited.

PDE5 Inhibitors and Nitrates: Why the Interaction Matters for ED Treatment

The nitrate interaction is one reason why choosing an ED medicine should involve more than simply selecting a popular brand.

Before using a PDE5 inhibitor, a healthcare professional may need to know:

• Whether you have heart disease
• Whether you use nitrate medicines
• Whether you use blood-pressure medicines
• Whether you use alpha-blockers
• Whether you have had a recent cardiovascular event
• What other medicines you take
• Whether sexual activity is medically appropriate

This is particularly important in men who have both erectile dysfunction and cardiovascular disease.

What About Vizagra Gold Tablets?

Vizagra Gold Tablets contain Tadalafil 20 mg + Dapoxetine 60 mg.

Tadalafil is a PDE5 inhibitor, while dapoxetine is used for premature ejaculation.

Because Vizagra Gold contains tadalafil, the same nitrate contraindication that applies to tadalafil also applies to Vizagra Gold.

Can You Take Vizagra Gold With Nitrates?

No. Vizagra Gold should not be combined with nitrate medicines.

The reason is the tadalafil component.

The presence of dapoxetine does not remove or reduce the tadalafil-nitrate interaction.

Therefore, men taking nitrate medicines should speak with a qualified healthcare professional before considering Vizagra Gold or any other tadalafil-containing medicine.

This is an important safety point for anyone searching for Vizagra Gold, tadalafil, Cialis, or other ED medicines.

Vizagra Gold and Other PDE5 Inhibitors

Vizagra Gold contains tadalafil, so it belongs to the broader group of products containing a PDE5 inhibitor.

The addition of dapoxetine in Vizagra Gold does not change the nitrate warning associated with tadalafil.

Nitrates, PDE5 Inhibitors and Erectile Dysfunction: What Should You Remember?

There are several key points worth remembering:

1. Viagra contains sildenafil

Sildenafil is a PDE5 inhibitor and should not be used with nitrate medicines.

2. Cialis contains tadalafil

Tadalafil is a PDE5 inhibitor and is contraindicated with nitrates. Because tadalafil lasts relatively long, its interaction with nitrates requires particular attention.

3. Levitra contains vardenafil

Vardenafil is also contraindicated with nitrates and nitric oxide donors.

4. Nitroglycerin is a nitrate

Nitroglycerin, also called glyceryl trinitrate or GTN, is an important example of a nitrate medicine.

5. Vizagra Gold contains tadalafil

Therefore, the nitrate warning applies to Vizagra Gold as well.

6. Never change prescribed heart treatment to use an ED medicine

If you take nitrates, discuss ED treatment with a healthcare professional rather than stopping or skipping your heart medicine.

Frequently Asked Questions

Can you take Viagra with nitrates?

No. Viagra (sildenafil) is contraindicated with nitrate medicines because sildenafil can potentiate the blood-pressure-lowering effects of nitrates and cause potentially dangerous hypotension.

Can you take Cialis with nitrates?

No. Cialis (tadalafil) is contraindicated with nitrates. Tadalafil can increase the blood-pressure-lowering effects of nitrates.

Can you take Levitra with nitrates?

No. Levitra (vardenafil) is contraindicated with nitrate medicines and nitric oxide donors because the combination can cause excessive blood-pressure lowering.

Why can’t Viagra and nitrates be taken together?

Sildenafil and nitrates affect the nitric oxide/cGMP pathway in ways that can combine to produce excessive blood-vessel relaxation and a potentially dangerous fall in blood pressure.

What are common nitrate medicines?

Common examples include nitroglycerin (glyceryl trinitrate), isosorbide mononitrate, and isosorbide dinitrate.

Is tadalafil safe with nitrate medicines?

No. Tadalafil should not be combined with nitrate medicines. If nitrate treatment becomes medically necessary in a life-threatening emergency after tadalafil use, healthcare professionals must determine when and how it can be administered. FDA Cialis labeling specifies at least 48 hours after the last tadalafil dose before nitrate administration is considered in such a situation, with close medical supervision.

What happens if Viagra and nitroglycerin are taken together?

The combination can cause a substantial drop in blood pressure, potentially resulting in dizziness, fainting, or serious cardiovascular complications. Seek urgent medical attention and tell healthcare professionals what medicines were taken and when.

Can someone with heart disease take Viagra?

It depends on the person’s cardiovascular condition, medicines, and whether sexual activity is considered appropriate. Heart disease does not automatically mean that every PDE5 inhibitor is prohibited, but nitrate use is an important contraindication.

What should I tell emergency doctors if I took Viagra?

Tell them that you took sildenafil (Viagra), approximately when you took it, and what other medicines you use. This information can affect emergency treatment decisions.

Does Vizagra Gold contain a PDE5 inhibitor?

Yes. Vizagra Gold contains tadalafil 20 mg, which is a PDE5 inhibitor. It also contains dapoxetine 60 mg.

Can you take Vizagra Gold with nitrates?

No. Vizagra Gold contains tadalafil, so it carries the same important nitrate contraindication as other tadalafil-containing medicines.

Are all heart medicines contraindicated with PDE5 inhibitors?

No. Nitrates are the major contraindicated cardiovascular medicines. Other medicines may require caution because of blood-pressure effects or other interactions, so patients should provide their healthcare professional with a complete medication list.