Viagra & Alcohol – What You Need To Know

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viagra-pfizer-100mg-4-tablets_2Sildenafil or as it is more widely known, Viagra, is a drug used in the treatment of Erectile Dysfunction or male impotence. It is a phosphodiesterase type-5 inhibitor. Since its launch just over ten years ago this ‘wonder pill’, as it is commonly referred to, has been prescribed for over 30 million men in 120 countries and following its release was prescribed at a rate of 10,000 a day. Comparing this to alcohol, which is so widely sold in the UK that figures have shown that the average drinker has fifteen and a half litres of pure alcohol a year (equivalent to 775 pints of beer), putting the UK as one of the top alcohol consuming countries in the world. Bearing these figures in mind what are the risks of combining these two substances? After all, for many, sexual intercourse and alcohol go hand in hand, so, what are the main concerns?

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As mentioned Viagra is a phosphodiesterase inhibitor and it works by maintaining levels of messenger cyclic guanosine monophosphate which relaxes smooth muscle allowing a penis to become erect when sexually stimulated. This process occurs by arteries in the penis dilating, thereby, increasing blood flow. Blood perfusion into the erectile tissues aids this mechanism. Viagra is best taken on an empty stomach and takes approximately one hour to become effective and the effects can last for up to six hours. Since the approval of Viagra in 1998, Sildenafil has been effective in over 100 clinical trials involving over 8000 men with erectile dysfunction. Sildenafil is the first line therapy in the treatment of erectile dysfunction compared to other drugs of the same pharmacological class, such as Tadalafil and avanafil. Although Sildenafil is not listed for NHS prescribing in the BNF, exemptions may apply when the prescriber feels that the condition is causing the patient significant distress or a marketed effect on interpersonal relationships.

The Relationship between Alcohol and ED

Firstly, it is significant to consider the relationship between alcohol and erectile dysfunction which have been significantly linked.

Alcohol in small amounts can act as a stimulant maximising all sensations thus aiding erections, conversely, in excessive amounts acts as a sedative. Sedatives work by depressing the central nervous system. This is problematic as the brain needs constant stimulation and physical sensations to maintain an erection, therefore, alcohol can reduce these signals to the brain causing erectile dysfunction.

The Research on Alcohol and Erectile Dysfunction

Looking at research on this particular topic several key issues are mentioned in a variety of medical and pharmacological based articles may be of interest to patients concerning this particular area involving alcohol consumption. Online resources such as this, as well as other literature, state that while no significant clinical evidence suggests that consuming alcohol and taking Viagra simultaneously can cause significant adverse effects it may be beneficial to flag some areas of concern for patients.

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Product Description

How does Viagra and Sildenafil work?

Viagra (Sildenafil) helps men to get and maintain an erection when sexually stimulated and/or excited. The medicine relaxes the blood vessels in the penis which results in more blood flowing to the penis when you are sexually excited.

How do I take it?

You should take Viagra (Sildenafil) approximately 1 hour before planning to have intercourse. Within a window of between 30 minutes and 4 hours after you take the medicine, it will be easier to keep and maintain an erection when you are sexually excited. If you take this medicine after a meal with a high fat content it may take a little longer to start working. This medicine will only work when you are sexually excited. You won’t get an erection just by taking Viagra (Sildenafil).

Dosage

The standard recommended dose for Viagra (Sildenafil) is 50mg and this will be suitable for most people.  If this dose is not effective, you can try 100mg and if 50mg gives you side effects you can also reduce the dose to 25mg tablets.

You must not take more than 100mg daily of Sildenafil/ Viagra. Clinical trials have been conducted in patients taking up to 200mg sildenafil and it was found that ‘doses of 200mg did not result in increased efficacy but did increase the incidence of adverse reactions (headache, flushing, dizziness, dyspepsia, nasal congestion, and altered vision).’

In addition, in patients taking more than 100mg daily, there have been reports of rhabdomyolysis (a breakdown in skeletal muscle tissue the byproducts of which can lead to kidney failure), visual perception changes, vertebral artery dissection (a tear in the artery supplying blood to the brain), heart attacks and aggressive behaviour.

If the 100mg strength doesn’t work for you, there may be alternatives you can try and we recommend that you call us for a free consultation with our pharmacist or doctor to discuss any underlying conditions you may have. We recommend that all men taking medicine for erectile dysfunction have regular tests for blood pressure, cholesterol, diabetes and hormone imbalances. For instance, it may be that by fixing a hormone imbalance such as testosterone, your Viagra medication will be even more effective.

In addition, drug manufacturers do not advise patients to split tablets in half to get the correct dosage as they cannot guarantee that the active ingredient will be distributed evenly throughout the tablet.  For instance, if you cut a 100mg tablet in two, you may find that you get 80mg in one half of the tablet and 20mg in the other half leading to either an overdose (increased risk of side effects) or a suboptimal dose (the medication may not work).

It is important that you choose the correct dose for you. If you wish to talk to our pharmacist or doctor about this, please contact us in the pharmacy on 01625 460621 or email [email protected]

Side Effects

Viagra (Sildenafil) is normally well tolerated, however, side effects can include:

  • Headache
  • Dizziness
  • Nausea

Side effects normally subside after a few hours, however, if you experience a prolonged or painful erection (longer than 4 hours), then you must contact your doctor immediately.

Drug interactions

There are a number of medicines which interact with Sildenafil/ Viagra. For an exhaustive list please see the patient information leaflet (see section below) or call us in the pharmacy to discuss your specific situation. The main drug interactions are listed here:

Recreational drugs such as ‘poppers’ or amyl nitrate
Alpha blockers used for urinary retention or blood pressure problems (eg Flomax or Cardura)
Anti- arrhythmic drugs such as disopyramide
Antibiotics such as erythromycin
Antifungals such as itraconazole
Antivirals such as drugs used to treat HIV
Bosentan
Cobicistat
Calcium channel blockers to treat blood pressure and angina such as amlodipine
Dapoxetine (Priligy – used to treat premature ejaculation)
Grapefruit juice**
Nicorandil
Nitrates
Riociguat
Cimetidine (to treat stomach ulcers)

Please do not take Sildenafil/Viagra if you have taken any of the above drugs within the last 60 days without first consulting with either us in the Pharmacy ([email protected] / 01625 460621) or via email with our doctor [email protected]

**We advise not to take Sildenafil/Viagra with grapefruit juice as the blood concentration of Sildenafil will possibly be increased resulting in side effects.

Patient Information Leaflets

Please click here for the patient information leaflet for Viagra.

For Actavis Sildenafil please see the following leaflets: 100mg, 50mg, 25mg.

Storing Medicines Safely

Please keep your medicine out of the reach of children and store at room temperature.  Unwanted medicine can be disposed of by returning it to any local pharmacy or indeed to us here for us to dispose of it for you.

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Firstly, both substances are blood thinners. A consequence of taking both Viagra and alcohol can have a cumulative effect of reducing blood pressure, potentiating the risk of tachycardia. This particular issue is also mentioned by the manufacturers of the medication who advise patients to avoid blood thinners while on medication, perhaps an indicator of the significance. Secondly, alcohol in large amounts is a significant danger to liver function. Indeed, figures show that in the last thirty years mortality of alcohol-induced liver disease has increased by 450%. This is important in that any liver disease caused by alcohol consumption will increase the build-up of Viagra in our bodies, thereby, increasing the risks of side effects.

BrainFinally, looking at the process of an erection itself it is recognised that the brain needs constant stimulation to maintain an erection and alcohol dampens these signals. Although Viagra can help alleviate the problem, the alcohol is still theoretically working against the effects of Viagra.

Other literature from The UK Health centre also warns that a combination of alcohol and Viagra can worsen the symptoms of Viagra such as dizziness, rapid heart rate and low blood pressure. Furthermore, both have the ability to cause problems, an example being headaches; therefore, an intake of both may have a cumulative effect meaning a potential headache is twice as likely compared to when either substance is taken in isolation. Healthcare professionals also express the concern that Viagra should be used, where possible, as a short-term use medication and that because alcohol has negative effects both physically and psychologically, it can lengthen the period on which a patient need rely on the medication.

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One relevant study to mention would be the research of Leslie et al, titled, ‘No adverse hemodynamic interaction between Sildenafil and red wine ‘. The experiment involved a four-way, randomized crossover study in which eight young men received either Viagra, red wine (750ml of a 13.5% by volume), a combination of both or a placebo supplement. Parameters investigated included blood pressure, heart rate and cardiac index which were measured every fifteen minutes for three hours. Results of the test showed no clinically significant hemodynamic interactions between Sildenafil and alcohol. However, it should be noted that testing was performed on a small group of men who fell in a specific age bracket and didn’t have sexual intercourse throughout the duration of the study. Therefore, it could be argued the results are unrepresentative of the range of patients taking Sildenafil.

So What If You Think Sildenafil Isn’t Working For You?

A final question for patients to consider; what if you think Sildenafil isn’t working for you? It shouldn’t be assumed that because of drinking alcohol, Sildenafil isn’t working because as information from literature sources state that Viagra should be attempted approximately eight times before considering changing to an alternative. Furthermore, when taking Viagra it is important to tell your healthcare professional any medicines you are currently taking, including, prescribed medications, herbal medications, vitamins and recreational substances. The latter of which will include alcohol. This can reduce risk chance of interactions with any other medications. Any side effects experienced while taking Viagra, such as dizziness and visual disturbances should be reported immediately.

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Conclusion

In conclusion, as with many medications; taking alcohol can reduce the efficacy of it. However, consuming alcohol and then Viagra tablets is not a cause for major concern as it poses no major interaction. That said, it is worth noting that caution should be exercised, reasons being; it reduces the effectiveness of the medication, it worsens the symptoms of potential side effects and it increases the need for taking the medication in the first place.

 

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Assured Pharmacy is not liable for the currency or accuracy of the information contained in this blog post. For specific information about your personal medical condition, please contact our doctors or pharmacists for advice on [email protected].