Sildenafil is commonly used to treat erectile dysfunction (ED). Because high blood pressure is also common among men with erectile dysfunction, many people who are prescribed sildenafil are already taking medication to control their blood pressure.
This raises an important question:
Can sildenafil be taken with blood pressure medicine?
In many cases, sildenafil can be used alongside certain blood pressure medicines, but the combination may lower blood pressure further. Some medications require additional caution, while nitrate medicines must not be combined with sildenafil because the combination can cause a dangerous fall in blood pressure.
Understanding your medications and discussing them with a healthcare professional is therefore important before using sildenafil.
How Does Sildenafil Work?
Sildenafil belongs to a group of medicines called phosphodiesterase type 5 (PDE5) inhibitors.
During sexual stimulation, the body releases nitric oxide, which increases levels of cyclic guanosine monophosphate (cGMP). This relaxes smooth muscle in blood vessels within the penis and allows more blood to enter the erectile tissue.
Sildenafil blocks the PDE5 enzyme that normally breaks down cGMP. Maintaining higher cGMP levels helps improve blood flow and makes it easier to achieve and maintain an erection when sexually stimulated.
However, sildenafil can also relax blood vessels elsewhere in the body. Because of this vasodilating effect, it can produce a temporary reduction in blood pressure.
Can You Take Sildenafil If You Have High Blood Pressure?
Having high blood pressure does not automatically mean that you cannot take sildenafil.
Erectile dysfunction drugs such as sildenafil are generally considered usable for many people with stable cardiovascular disease, provided they are not taking medicines that have dangerous interactions, particularly nitrates. The American Heart Association notes that ED medicines are generally safe in people with cardiovascular disease but should not be used with nitrate therapy.
Your individual situation still matters.
A healthcare professional may consider:
How well your blood pressure is controlled
Which blood pressure medicines you take
Your usual blood pressure readings
Whether you experience dizziness or fainting
Whether you have heart disease
Whether you use nitrates for chest pain
Whether you take alpha-blockers
Other medicines and medical conditions
Do not stop taking prescribed blood pressure medication simply because you want to use sildenafil.
Sildenafil With Common Blood Pressure Medicines
Many people with hypertension take more than one medicine. Common classes include ACE inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, calcium channel blockers and diuretics.
ACE Inhibitors
Examples include:
Enalapril
Sildenafil may sometimes be used in people taking ACE inhibitors. However, because both treatments can contribute to lower blood pressure, some people may experience dizziness or light-headedness.
Angiotensin Receptor Blockers (ARBs)
Examples include:
Olmesartan
ARBs relax blood vessels and lower blood pressure. Sildenafil may further reduce blood pressure, so patients should follow their healthcare professional’s advice when combining the medicines.
Calcium Channel Blockers
Examples include:
Nifedipine
Verapamil
Calcium channel blockers also lower blood pressure by affecting blood vessels or heart function. Sildenafil can have an additional blood-pressure-lowering effect.
This does not automatically prevent their combined use, but monitoring may be appropriate, particularly when treatment is first started or doses change.
Beta-Blockers
Examples include:
Atenolol
Metoprolol
Bisoprolol
Propranolol
Sildenafil can sometimes be used with beta-blockers. However, patients taking several medications that lower blood pressure may be more likely to experience symptoms such as dizziness.
Some blood pressure medicines can themselves be associated with sexual difficulties. The American Heart Association lists sexual or erectile dysfunction among possible adverse effects of some beta-blockers.
Patients should not stop a beta-blocker suddenly because of sexual side effects. Instead, discuss the problem with a healthcare professional.
Diuretics
Examples include:
Hydrochlorothiazide
Chlorthalidone
Indapamide
Furosemide
Diuretics lower blood pressure partly by reducing excess salt and fluid.
If sildenafil is used at the same time, blood pressure may fall further, particularly in someone who is dehydrated or already has relatively low blood pressure.
Sildenafil and Alpha-Blockers: Extra Caution Is Needed
Alpha-blockers require particular attention.
Examples include:
Doxazosin
Prazosin
Terazosin
Tamsulosin
These medicines may be prescribed for high blood pressure or symptoms associated with an enlarged prostate.
Both alpha-blockers and sildenafil can relax blood vessels. Combining them can therefore cause symptomatic hypotension, which means blood pressure becomes low enough to cause symptoms such as dizziness, weakness or fainting.
FDA prescribing information advises that patients should generally be stable on alpha-blocker treatment before sildenafil is introduced and that sildenafil should be started cautiously at the lowest appropriate dose when the two are used together.
Patients taking an alpha-blocker should tell their doctor before using sildenafil rather than adjusting the timing or doses themselves.
Sildenafil and Nitrates: Do Not Combine Them
The most important sildenafil interaction involves nitrate medicines.
Examples include:
Nitroglycerin (glyceryl trinitrate or GTN)
Isosorbide mononitrate
Isosorbide dinitrate
Nitrates are commonly used to prevent or treat chest pain caused by angina.
Sildenafil must not be taken together with nitrates.
Both medicines widen blood vessels. When they are combined, blood pressure can fall suddenly and severely, potentially producing a life-threatening medical emergency.
The FDA specifically identifies regular or intermittent nitrate use as a contraindication to sildenafil. The American Heart Association also warns against combining PDE5 inhibitors such as sildenafil with nitrates.
The NHS similarly advises that sildenafil is not normally prescribed together with nitrates used for chest pain.
This warning also applies to recreational “poppers” containing amyl or alkyl nitrates, which can interact dangerously with sildenafil.
What About Riociguat?
Sildenafil should also not be combined with riociguat, a medicine used for certain forms of pulmonary hypertension.
Both medicines affect pathways that dilate blood vessels, and combining them can result in excessive lowering of blood pressure.
Always provide your doctor or pharmacist with a complete medication list before starting sildenafil.
What Happens If Blood Pressure Becomes Too Low?
Low blood pressure may cause symptoms such as:
Dizziness
Light-headedness
Weakness
Blurred vision
Feeling faint
Fainting
Unusual fatigue
The risk may be higher if someone already has low blood pressure, is dehydrated or takes several medicines that reduce blood pressure.
The American Heart Association notes that blood pressure medicines as well as erectile dysfunction drugs can contribute to hypotension, particularly when ED drugs are combined with nitroglycerin.
If severe dizziness, fainting, chest pain or other serious symptoms occur after taking sildenafil, seek urgent medical attention.
Should You Skip Your Blood Pressure Medicine Before Taking Sildenafil?
No. Do not skip or stop prescribed blood pressure medication unless your healthcare professional specifically tells you to do so.
Stopping hypertension medication may cause blood pressure to rise and could increase cardiovascular risk.
Instead, tell your healthcare professional that you are interested in using sildenafil. They can review your current treatment and decide whether the combination is appropriate.
The American Heart Association advises patients not to stop prescribed blood pressure medication without discussing it with their healthcare professional.
Can High Blood Pressure Cause Erectile Dysfunction?
Yes. Hypertension itself can contribute to erectile dysfunction.
Long-term high blood pressure can damage blood vessels and affect circulation. Because an erection depends on adequate blood flow to the penis, vascular damage may make it more difficult to achieve or maintain an erection.
The American Heart Association recognizes erectile dysfunction as one potential consequence of long-term high blood pressure.
This means ED in someone with hypertension should not simply be ignored. It may provide an opportunity for a healthcare professional to review cardiovascular health and risk factors.
When Should You Talk to Your Doctor Before Taking Sildenafil?
Medical advice is particularly important if you:
Take nitrates for chest pain
Take alpha-blockers
Take several blood pressure medicines
Have consistently low blood pressure
Frequently experience dizziness or fainting
Have recently had a heart attack or stroke
Have unstable chest pain
Have significant heart disease
Have serious liver or kidney disease
Take medicines for pulmonary hypertension
Take other erectile dysfunction treatments
Your healthcare professional can check for interactions and determine whether sildenafil is appropriate for you.
Frequently Asked Questions
1. Can I Take Sildenafil With Amlodipine?
Some people may use sildenafil while taking amlodipine, but both medicines can lower blood pressure. A healthcare professional should review the combination, particularly if you already experience low blood pressure or dizziness.
2. Can I Take Sildenafil With Losartan?
Sildenafil may sometimes be used with an ARB such as losartan. Because both may reduce blood pressure, individual medical assessment is recommended.
3. Can I Take Sildenafil With Ramipril?
Sildenafil is not automatically contraindicated with ACE inhibitors such as ramipril. However, the combined blood-pressure-lowering effect should be considered.
4. Can Sildenafil Be Taken With Beta-Blockers?
It may be possible to use sildenafil with beta-blockers such as atenolol, bisoprolol or metoprolol. Patients taking multiple cardiovascular medicines should discuss sildenafil with their healthcare professional first.
5. Can Sildenafil Be Taken With Tamsulosin?
Extra caution is necessary. Tamsulosin is an alpha-blocker, and combining an alpha-blocker with sildenafil can increase the risk of symptomatic low blood pressure. A doctor may need to consider your current dose, blood pressure and treatment stability before recommending the combination.
6. Can I Take Sildenafil With Nitroglycerin?
No.
Nitroglycerin and other nitrate medicines must not be combined with sildenafil because blood pressure can fall dangerously low.
The Bottom Line
Sildenafil can sometimes be taken with blood pressure medicine, but it depends on which medication you use and your overall cardiovascular health.
Common antihypertensive medicines such as ACE inhibitors, ARBs, beta-blockers, calcium channel blockers and diuretics may sometimes be used alongside sildenafil under medical guidance.
Alpha-blockers require additional caution because the combination can produce symptomatic low blood pressure.
Most importantly, sildenafil must not be combined with nitrate medicines such as nitroglycerin, isosorbide mononitrate or isosorbide dinitrate because the combination can cause a potentially dangerous drop in blood pressure.
If you take medication for hypertension, heart disease, chest pain or pulmonary hypertension, tell your healthcare professional exactly what you take before starting sildenafil.
