Thomas Lee, M.D., is the chief executive officer for Partners Community HealthCare Inc. He is a professor of medicine at Harvard Medical School. He is an internist and cardiologist at Brigham and Women's Hospital. Dr. Lee is the chairman of the Cardiovascular Measurement Assessment Panel of the National Committee for Quality Assurance.
Question:
Can I safely use Viagra after a heart attack? If I do use Viagra, how can I prevent having to take nitrates?
Answer:
Your query brings up a few important points:
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People who have had heart attacks can safely have sex. The strain on your heart from sex is about the same as making a bed or walking up stairs. If you can do those activities without having chest pain, there is pretty good chance you can have sex safely. If you ARE having symptoms doing those other activities, ask your doctor is your medications should be increased or if you should have a catheterization to see if your blockages can be relieved.
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People who have had heart attacks often have erectile dysfunction. This can come from atherosclerosis (narrowing of the arteries that can significantly reduce the blood supply to vital organs such as the heart), nerve damage from diabetes, or as a side effect of medications. Psychological factors also can play a role. Thus, your problem is a common one.
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Viagra and other drugs that help erectile dysfunction can lower blood pressure. This can be dangerously severe and difficult to relieve in men who are also taking any nitrate drug. Someone who gets chest pain during sex after taking Viagra could have a life-threatening drop in blood pressure if they took a nitroglycerin tablet. Men taking long term nitrates to control their symptoms should not take Viagra.
If you are taking nitrates, ask your doctor whether your symptoms can be controlled without these medications. A trial of another type of drug might be successful, and the danger of using Viagra much lower. If you really need to take nitrates, I would consider whether you should undergo a catheterization to see if you are a candidate for angioplasty or even bypass surgery. I would also consider whether you really need the Viagra. Many men take Viagra even if they can achieve erections sufficient for intercourse without the drug. I would suggest not taking the drug if that were the case.
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