What drugs interact with Sildenafil Medication? Full Guide
Sildenafil (Viagra) can interact with several medications that can affect blood pressure.
Drugs, especially nitrates (for angina), and alpha-blockers (for blood pressure or prostate issues).
And, certain antifungals (like ketoconazole), antibiotics (like erythromycin), and HIV medications can interact with Sildenafil.
These drug interactions may increase the risk of low blood pressure, dizziness, or other side effects.
Understanding how Sildenafil interacts with other medications is crucial for ensuring safe and effective treatment.
Let’s explore common interaction risks, what to avoid, and how to use Sildenafil safely under medical supervision.
What are the Drug Interactions for Sildenafil Citrate:
Nitrates
Nitrates, such as isosorbide mononitrate and nitroglycerin, are used to treat chest pain and can interact with Sildenafil.
These drugs also widen blood vessels and lower blood pressure in health-related conditions.
Sildenafil, used for erectile dysfunction and pulmonary hypertension (as Revatio), also dilates blood vessels.
When taken together, these drugs can dangerously lower blood pressure.
The combination should be strictly avoided, and patients should consult a doctor for safe alternatives if they need ED treatment while on nitrates.
Alpha-blockers
Alpha-blockers, such as tamsulosin, alfuzosin, and doxazosin, treat high blood pressure and an enlarged prostate by relaxing blood vessels.
Also, sildenafil works similarly when combined with alpha-blockers, which can cause dangerously low blood pressure.
If both are needed, doctors may adjust the dosages carefully.
Seek immediate medical attention if symptoms like dizziness or fainting occur.
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Guanylate cyclase(GC) stimulator
Guanylate cyclase (GC) stimulators, such as riociguat, aid in the treatment of certain types of pulmonary hypertension.
These drugs relax blood vessels and lower blood pressure, similar to the effects of sildenafil.
Sildenafil, a PDE5 inhibitor, enhances the effects of nitric oxide and increases cgmp.
Combining GC stimulators with sildenafil is dangerous because both significantly amplify vasodilation.
The interaction may lead to severe hypotension (dangerously low blood pressure), fainting, and even life-threatening outcomes.
CYP3A4 Inhibitors / Protease Inhibitors:
Drugs such as ritonavir, ketoconazole, and erythromycin inhibit CYP3A4, the enzyme responsible for breaking down sildenafil.
This increases sildenafil levels in the blood, raising the risk of side effects like low blood pressure, headache, or priapism.
If you take CYP3A4 inhibitors, your doctor may lower the sildenafil dose or suggest spacing the timing.
CYP3A4 Inducers / Some Antibiotics:
Drugs like rifampin, carbamazepine, and phenytoin speed up sildenafil breakdown, making it less effective.
Higher doses may be needed, but only under medical supervision to avoid complications.
Other PDE5 Inhibitors:
Taking sildenafil with other PDE5 inhibitors like tadalafil or vardenafil increases the risk of side effects such as hypotension, dizziness, and priapism.
Never combine multiple PDE5 inhibitors.
You can use only one as prescribed.
How to Prevent Dangerous Interactions:
The following approaches may help your doctor adjust dosages or suggest safer alternatives.
Disclose Your Full Medical History:
Please always inform your doctor about any existing heart conditions, blood pressure issues, liver or kidney disease, and any past adverse reactions to medications.
It will help avoid harmful interactions, especially with drugs like nitrates or alpha-blockers.
Use a Medication Review Checklist:
- List all current medications (prescription, OTC, supplements).
- Inform about using nitrates, alpha-blockers, CYP3A4 inhibitors, protease inhibitors, or other ED drugs.
- Mention any herbal remedies or antibiotics.
- Update the list regularly and review it with your doctor or pharmacist before starting sildenafil.
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Avoid taking sildenafil with nitrates like nitroglycerin, isosorbide dinitrate, or mononitrate. Combining these can cause a dangerous drop in blood pressure. Always inform your doctor about all medications you’re using.
Best Alternatives of Sildenafil include tadalafil (Cialis), vardenafil, and avanafil (Stendra). Non-pill options like alprostadil injections (Caverject, Edex) are also effective for treating ED.
Studies show no interaction between azithromycin and sildenafil, so no dosage adjustment is necessary when taking both together.
Sildenafil is generally safe with most blood pressure medications. However, avoid using it with alpha-blockers like doxazosin or prazosin, as the combination can cause a serious drop in blood pressure.
Yes, Statins may even enhance erectile function. Combining statins with sildenafil has shown better improvement in ED symptoms than sildenafil alone in clinical studies.
Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil) are generally safe for heart patients with stable conditions. They can typically be prescribed six months after a heart attack, but dosage and timing should be monitored by a doctor.