Is Viagra Dangerous or Safe?

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Pfizer’s wonder drug, Viagra® has been given many nicknames since it took the world by storm in 1998. The “little blue pill” and “impotence cure” are among some of the more common descriptions for Viagra®. For those still wondering, Viagra® or sildenafil citrate is a drug indicated for use in treating Erectile Dysfunction (ED). ED in a nutshell is basically the difficulty faced by some men in achieving a rigid penis hard enough for sex.

So what is the big deal with ED? If left untreated, it can have a massive impact on a man’s sexual relationship with his partner and his self-esteem which can later lead to depression. There are several causes of ED but Viagra® only deals with the physical causes of ED. The active ingredient in Viagra®, sildenafil citrate, works by suppressing the action of the phosphodiesterase 5 (PDE5) enzyme which breaks down cGMP.

Blood-Vessels-WebThe substance cGMP is the resulting outcome of a cascade reaction which is triggered by the presence of chemicals known as nitric oxide (NO). NO is only released into the blood vessels of the penis when a man becomes sexually stimulated. Increased concentrations of cGMP will lead to widening (vasodilation) of the blood vessels in the penis, allowing more blood to fill the spongy tissue in the penis which causes the penis to grow in size and become rigid enough for penetrative sex. Therefore, sildenafil citrate works as an aid together with the presence of sexual stimulation to enable a man to achieve an erection.

All of this sounds great for men who have been suffering in silence after having been forced to live with what is considered to be an embarrassing illness. However, some men have often wondered if Viagra® is safe for consumption or not. As with all the other drugs out there in the market, there are certain circumstances where Viagra® should be used with caution or not used at all. This drug has been legally approved by the FDA and MHRA for treating ED in men age 18 and above. It would generally be unsafe for women to take the drug as the effects on women have not been fully ascertained yet. Viagra® is definitely not suitable for use in children even though there is another form of sildenafil known as Revatio® which may occasionally be used to treat children with certain cardiovascular conditions despite Revatio® not being licensed for use in children.

Midlife CrisisErectile dysfunction has always had a reputation as one of the many mid-life crises that men experience as they approach their late-thirties. Obviously, this is not entirely true as ED can occur at any age although middle-aged men are more prone to developing ED than men of other age groups. Men within that age group also tend to be at risk of developing various long-term health conditions such as cardiovascular diseases and/or diabetes especially if they live a sedentary lifestyle. Hence, it is not surprising to find men taking medication for hypertension and angina which generally reduces blood pressure. Sildenafil citrate itself has vasodilatory effects which helps widen blood vessels in the penis. Taking Viagra® together with these medications is NOT recommended as it can cause a huge fall in blood pressure which is very dangerous. It is best to inform your doctor if you are taking medications which belong to the nitrates group such as glyceryltrinitrate (GTN) and isosorbide dinitrate. These medications should NOT be taken with Viagra® under ANY circumstances.

Blood pressure medication such as Prazosin, Tamsulosin and Doxazosin fall under the alpha-blockers family of drugs which are designed to lower your blood pressure. Sildenafil can further lower your blood pressure in addition to the effect of those medications mentioned above. Other medication interactions worth mentioning are those between Viagra® and ritonavir. Ritonavir is an anti-viral used in the treatment of HIV/AIDS. Ritonavir also happens to inhibit the Cytochrome P450 3A4 (CYP 3A4) enzyme which metabolises sildenafil before it is removed from the body. By inhibiting CYP3A4, the concentration of sildenafil will accumulate to toxic levels in the blood as it cannot be removed from the body, giving rise to adverse effects of sildenafil.

Apart from that, medications known as Concomitant Guanylate Cyclase (CG) Stimulators such as ricoguat are not to be taken together with sildenafil due to the potential of sildenafil to heighten the ability of CG stimulators to lower blood pressure. More importantly, for obvious reasons, sildenafil should not be taken together other medications containing sildenafil or drugs belonging to the same family as sildenafil such as tadalafil (Cialis®) and vardenafil (Levitra®).

GPDespite these interactions, Viagra® can still be taken even if you are also taking some of the medicinal drugs mentioned above. Your GP may ask you to take these medications at different times to reduce the risk of a drug interaction. Alternatively, your GP may adjust the dose of sildenafil by reducing it to the lowest dose (i.e. 25mg sildenafil once daily) in the case of alpha-blockers usage if he/she is confident that you are responding well to alpha-blocker therapy. However, you should still refer to your GP before doing so and you should definitely keep your GP informed of any new medications you are taking.

It is certainly not unusual to find ED patients suffering from kidney and/or liver problems. Fortunately, it is still safe for these patients to take Viagra® as long as the dose is adjusted to account for the impaired liver and/or kidney functions. Taking a similar dose to other people may cause adverse reactions as they will not be able to efficiently metabolise and remove the drug from the body. The usual starting dose for those with impaired kidney and liver functions is 25mg once daily. Viagra® can be taken by elderly folks above the age of 65 without the need for dose adjustment unless they have liver and kidney problems.

Grape FruitUltimately, you should stick to your prescribed dose. Viagra® should not be treated like a daily supplement and should only be taken 30 minutes to an hour before sex. The drug can be taken with a glass of water but it cannot be taken with grape fruit juice as it has the potential to inhibit the CYP3A4 enzyme which breaks down the drug before it is excreted out of the body. Never take a dose of sildenafil if you are unable to remember the last time you took the previous dose. Unintentionally or intentionally taking a dose above the prescribed dose can lead to unwanted side effect such as headache, flushes, dizziness and even more serious side effects such as sudden loss of hearing and vision. Another uncommon but equally serious side effect is priapism which results in sustained erections over a period of 4 hours or longer. Such prolonged erections which last even without sexual stimulation can be very painful and may even cause nerve damage. Therefore, you should immediately seek medical attention if this were to occur.

Viagra’s popularity has at times attracted unwanted attention from people seeking to misuse it. Some youths may have previously taken Viagra® together with party drugs known as ‘poppers’ which contain substances such as butyl nitrate and amyl nitrate, while under the impression that Viagra® is an aphrodisiac. This is extremely dangerous as nitrates are known to cause a sharp drop in blood pressure when taken together with sildenafil citrate, potentially resulting in death in some cases.

Assured Pharmacy LogoAt the end of the day, any drug available out there in the market can only be as safe as the user who uses it. Always seek medical assistance immediately by calling emergency services when faced with an unknown adverse effect while taking this drug. Also, it is imperative that people be well-informed about using any prescribed drug which includes Viagra®. One of the ways we can be sure that we are receiving good advice about our medication is by purchasing it from recognised suppliers such as Assured Pharmacy. All customers seeking to buy Viagra® from Assured Pharmacy will be screened by a London-based, UK qualified GP who will determine if Viagra® is suitable for you before issuing a prescription. The doctor and pharmacists also provide counselling advice for patients, to ensure that you derive only the benefits from your therapy. For any queries at all, you can contact the pharmacy team by telephone on 01625 460621 during operational hours (9-5pm Monday to Friday) or by email; team@assuredpharmacy.co.uk outside working hours. Further information is found on the website:

 

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References

http://labeling.pfizer.com/ShowLabeling.aspx?id=652#section-10
https://www.medicines.org.uk/emc/medicine/1474

 

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 team@assuredpharmacy.co.uk.

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