Nitrates and Viagra: a Dangerous Combo
What Are Nitrates?
Nitrates or nitrovasodilators belong to the group of medications with vasodilatory features and varying in their chemical structure. Nitrates are united by operation mechanism: as a result of complex chemical transformations all nitro-vasodilators turn into nitrogen oxide (NO). NO is a substance analogous to the so-called endothelium-dependent relaxant. Nitrogen oxide activates guanylate cyclase causing production of cyclic guanosine monophosphate capable to relax vascular smooth muscle cells.
Nitrates are organic compounds. According to the peculiarities of their chemical composition, they are divided into the following groups:
- Nitroglycerin and its derivatives
- Medicines with isosorbide dinitrate (isosorbide dinitrate, isoket, cardicat, etc.)
- Isosorbide mononitrate medicines
- Derivatives of nitrosated peptone (erinite).
According to the duration of action nitrates are divided into fast-release drugs (nitroglycerin) and slow-release drugs (erinite, isosorbide dinitrate, cardix, cardicat, etc)
What Nitrates Are Used for?
All nitrates are transformed into nitrogen oxide in organism which determines activity of these medications. Nitrates are used for treatment of almost all forms of coronary heart disease. Presence of expressed antianginal and anti-ischaemic activity allows using successfully these medications for prophylactic purposes and attacks inhibition for patients suffering from stable effort angina. Nitrates take a positive effect on tolerability of physical activity reducing the number of anginal attacks. In total, anti-anginal effectiveness of nitrates for patients with stable angina is associated to effectiveness of anti-anginal medications of other groups (calcium antagonists, beta-blockers).
But it should be noted that clinical efficiency of nitrates in case of effort angina depends on what medication and in accordance to what dose, form of administration and dosage schedule it is applied. Nitrates, like anti-anginal medications are also used for treatment of unstable angina and vasospastic angina pectoris. Nitrates are usually prescribed in case of acute myocardial infarction in the form of intravenous drugs, but their effect on the prediction of this disease is not stated yet. Earlier nitrates were widely used for treatment of patients suffering from chronic cardiac failure, but nowadays they were almost completely forced out by angiotensin-converting enzyme inhibitors.
What Is Viagra
Viagra is a world-wide popular medicine falling into the group of PDE5 inhibitors for treatment of erectile dysfunction. This medication is dedicated to achieve a steady and long-lasting erection in case of a natural sexual excitement. The active constituent of Viagra is sildenafil.
Viagra’s affects the improvement of blood supply to pelvic area. The unstriated muscle gets relaxed and this ensures filling of cavernous bodies with blood. Numerous scientific trials attested Viagra’s positive effect and long-lasting erection.
Viagra and Nitrates
Relaxation of unstriated muscles of penis’s cavernous bodies occurs under the effect of nitrogen oxides, a chemical compound released by nerve endings. As a matter of interest, the process of relaxation of all blood vessels in our organism is managed by means of analogous mechanism. This principle is used for the treatment of angina when a patient is prescribed nitroglycerin or the nitrates of prolonged action. These medications activate a cyclic guanosine monophosphate causing relaxation of blood vessels including cardiac vasculature and resulting in improvement of blood circulation of heart and anginal attack blockage.
Viagra inhibits enzyme destroying a cyclic guanosine monophosphate in penis’s cavernous bodies. It goes without saying that Viagra takes the same action on the blood vessels of the whole body which is a little bit less than on the vessels of penis. In the majority of cases this doesn’t cause any consequences apart from a small and insignificant reduction of arterial blood pressure.
BUT, if a patient takes nitroglycerin or any other nitrates-compound simultaneously with Viagra, things take a following turn. Anti-anginal medications (nitrates) cause increased production of cyclic guanosine monophosphate which widens blood vessels and removes pectanginous symptoms. At the same time Viagra slows down the process of destruction of a cyclic guanosine monophosphate. And although the influence of Viagra on blood vessels is not as strong as on penis’s cavernous bodies, such combination of these medicines may cause an extremely large widening of blood vessels, considerable drop of blood pressure and in some cases – a fatal outcome. It is absolutely clear that the patients taking nitroglycerin and other nitrates are strictly prohibited to use Viagra. This is not just a mere warning; this combination may be at the expense of your own life!
Medications containing nitrates are issued under various trademarks. Therefore, before starting using Viagra, you should consult your doctor to make sure you do not use nitrate containing drugs. Men expose themselves to a real danger while taking Viagra along with nitrates as well as patients suffering from serious cardiac diseases whose heart is not able to take sexual activities whether they use Viagra or not.
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Are there any Organic Substitutes for Nitrates Compatible with Viagra?
Nitrates have been used in a clinical practice for 100 years. The main representatives of the group of organic nitrates is nitroglycerin (glycerol triacetate), isosorbide dinitrate and isosorbide mononitrate. The latter is a natural metabolite of isosorbide dinitrate. All groups of organic nitrates have a similar operation mechanism – they belong to vasodilating agents. Anti-anginal effect is realized by means of decrease of myocardial oxygen demand and improvement of myocardial perfusion. Organic nitrates act by releasing of nitrogen oxide which is an analogue of endothelium-dependent relaxant.
Notwithstanding the universal nature of pharmacological mechanism of action of organic nitrates, the representatives of this group have considerable differences. Principal significance here is the interaction of organic nitrates with PDE inhibitors, including sildenafil. Since the usage of this combination is fraught with development of dangerous arterial hypotension. The intake of sildenafil is possible only after 24-hour pause in nitrates usage, including nitroglycerin. So, the combination of Viagra with any nitrates of their substitutes may cost your life. Nitrates medicines are produced under various names and marks. Thus, before you begin using sildenafil, make sure to consult a doctor and have extensive information of all medicines you are going to combine. Do not take risks of taking Viagra along with nitrates.
Nitrates Combined With Other Remedies
The enhancement of hypotensive action is shown while combining nitrates with barbiturates, opioids, tricyclic antidepressants, and other medicines decreasing arterial blood pressure. Reduction of vasolidating effect is possible due to the one-time intake of organic nitrates along with carbacholinum, norepinephrine, phenylephrine, histamine, angiotensin, CNS stimulants, M-cholinoblockers (atropine). Phenobarbital activates hepatic metabolism of nitrates resulting in reduction of their bioaccessibility in medical forms for peroral intake.
Continued Intake of Nitrates: Possible Danger
One of the main issues connected with a long-term intake of nitrates is the development of tolerability. Tolerability to nitrates means decrease of clinical effectiveness of the medication in its repeated administration. The development of tolerability to nitrates varies in different patients. For instance, a regular intake of tableted isosorbide dinitrate by 10-30mg 4 times per day during 1 month is accompanied by a complete loss of anti-anginal effect among 10-15% of patients suffering from stable angina, among 60-70% – efficiency decreases considerably and among 10-15 % – the effect of the drug remains stable.
In order to prevent from tolerability development it is highly recommended to prescribe nitrates with obligatory availability of free-of-drugs-action time within 24 hours. It is recognized that for prevention of tolerability it is enough to have a without-nitrates period equal to 8-12hours per day.
