Erectile dysfunction affects around 22% of men over 40 in the U.S. Since there are about 64 million men over 40 in the U.S., that means that almost 14 million of them have trouble getting an erection.
That explains why erectile dysfunction drugs are such a hit. These drugs -- most commonly known as Viagra, Cialis and Levitra -- all come from a class of medication called PDE5 inhibitors. Originally created to help patients with cardiac disease, these drugs had a certain side effect that became much more lucrative than their original use.
The problem with PDE5 inhibitors is their tendency to interact with other drugs that cause a similar action in the body. Nitrates (nitroglycerin is the most common) cause blood vessels to dilate -- increase in size and carry more blood with less resistence. Nitrates help heart muscle work less hard while allowing more blood to the muscle tissue, which means patients experiencing heart-related chest pain (angina) may take nitroglycerin to make their pain go away.
PDE5 inhibitors work in a similar way. Unfortunately, when you mix PDE5 inhibitors and nitroglycerin, the effects can double or triple and cause a sudden dangerous drop in blood pressure. The combination of these two types of drugs is so dangerous, the American Heart Association suggests patients should not take nitroglycerin within 24 hours of taking PDE5 inhibitors.
Before you ever take a PDE5 inhibitor, you need to have a conversation with your doctor to understand the interaction between this class of medication and other medicines you may be taking.
Understanding the way these two classes of medication interact is important even to those men who don't take nitrates. I've always said you should call 911 for chest pain. If you happen to be taking a PDE5 inhibitor when you get your chest pain, you'll need to tell the emergency responders.
Standard emergency treatment for heart-related chest pain involves giving nitroglycerin right away. Before giving any drug, paramedics and other healthcare providers are taught to ask about allergies to medications. We're also supposed to ask about PDE5 inhibitors before giving nitroglycerin, but that question is uncomfortable to ask and many responders won't.
You need to speak up if you're taking a medication for erectile dysfunction, regardless how uncomfortable it is to say.
List your PDE5 inhibitor on your medication list if you keep one. It's quite possible you keep the drug in a different place than all the rest of your medications -- say in your nightstand. You'll have to be proactive if you want to stay safe.
Not all PDE5 inhibitors are FDA approved, either. In fact, the FDA requested a recall of True Man Sexual Energy Nutrient Capsules and Energy Max Energy Supplement Men's Formula Capsules, both contain versions of PDE5 inhibitors even though they are advertised as "all natural" supplements. If you're taking supplements that claim male enhancement or treatment of erectile dysfunction then you need to tell the paramedics.
It's up to you, but I would think that embarassment is worth avoiding a potentially fatal drug interaction. Remember, there are 14 million others out there with the same condition; it's nothing to be ashamed of.
Laumann, E.O., et al."Prevalence and correlates of erectile dysfunction by race and ethnicity among men aged 40 or older in the United States: from the male attitudes regarding sexual health survey." The journal of sexual medicine. Jan 2007 PMID: 17081223
" FDA Requests Recall of 'True Man Sexual Energy,' 'Energy Max' Dietary Supplements." 2 Nov 2007. FDA News. FDA. 13 Nov 2007
Webb, D.J., et al."Sildenafil citrate and blood-pressure-lowering drugs: results of drug interaction studies with an organic nitrate and a calcium antagonist." The American journal of cardiology. 4 Mar 1999 PMID: 10078539
Kloner, R.A. "Sex and the patient with cardiovascular risk factors: focus on sildenafil." The American journal of medicine. 18 Dec 2000 PMID: 11137498
O’Rourke, M, and Jiang Xiong-Jing. "Sildenafil/Nitrate Interaction." 2000. Circulation Electronic Pages. AHA. 13 Nov 2007