The Link Between Erectile Dysfunction and Heart Disease: Is It Safe to Take Medications Like Viagra?

If you have heart disease, you may also have trouble getting or keeping an erection at some point in time. You’re not alone. In fact, erectile dysfunction (ED) is especially common in men who have heart disease. That’s because many of the risk factors that lead to heart disease also cause ED. 

If ED happens regularly, you might feel frustrated or embarrassed. And you may begin to wonder about your treatment options and whether it’s safe to treat ED if you have a heart condition. Let’s take a closer look at how medications that treat ED, like Viagra (sildenafil), affect heart health.

What is erectile dysfunction?

Erectile dysfunction (ED) is a condition where you have trouble getting or keeping an erection long enough to have sex. And it affects millions of men around the world. 

ED medications like Viagra (sildenafil) and Cialis (tadalafil) are very popular, so it can be tempting to run out to get a prescription if ED is a problem for you. But ED can be the result of many different causes, including heart disease. Understanding the underlying cause of your ED and treating that issue is critical for helping you stay as healthy as possible.

Quiz: Is it erectile dysfunction?

What is heart disease?

“Heart disease” might sound like a broad term. That’s because it is. Heart disease includes a range of conditions related to the heart itself and/or the blood vessels. Common examples are:

• Heart failure

• Heart attack

• Stroke

• Irregular heartbeat (arrhythmia)

Some people are born with heart defects. But, more often than not, a person develops heart disease over time.

Four of the biggest risk factors for developing heart disease include:

• High blood pressure (hypertension)

• High cholesterol

• Diabetes

• Smoking

These happen to be major risk factors for ED, too. So, if you have any of these risk factors and also have ED, you should see your primary care provider. They can check to see if you have signs of heart disease as well.

How are heart disease and erectile dysfunction related?

The heart and blood vessels are very important when it comes to erections. After all, erections happen when the blood vessels in the penis open up and allow for more blood flow. If for some reason that blood flow is interrupted, blocked, or slowed, you might not be able to get or keep an erection.

Depending on the condition, heart disease can change blood flow in different ways. Blood flow may be affected if the:

• Heart isn’t pumping strongly enough (due to heart failure)

• Blood vessels are damaged (due to high blood pressure)

• Blood vessels are blocked (due to high cholesterol)

Because they’re closely linked, ED can often be one of the first signs that you might have an underlying heart condition.

Can medications that treat ED affect heart conditions?

Medications that treat ED work by blocking an enzyme in the lining of the blood vessels. They increase the amount of nitric oxide in the bloodstream. This causes the vessels to dilate and allows more blood to flow into the penis. These medications include:

• Sildenafil (Viagra)

• Avanafil (Stendra)

• Tadalafil (Cialis)

• Vardenafil (Levitra)

In the past, there have been concerns about whether these medications are safe to use in people with heart conditions. But experts agree that most people with heart conditions can take ED medications. When used correctly, medications like Viagra are safe and effective. And they can help improve the quality of life of people with ED and heart disease.

The only absolute exception is people who take nitrate medications. If you have heart disease and take medications like isosorbide dinitrate or nitroglycerin, you should not take medication for ED. 

Nitrate medications can interact with ED medications like Viagra and cause an unsafe drop in blood pressure. You’ll need to talk with your provider about alternative treatments. It’s also important to talk with your provider if you have a history of unstable blood pressure or are being treated for coronary artery disease.

Can medications that treat heart disease cause erectile dysfunction as a side effect?

Yes, some medications that treat blood pressure and other heart conditions can cause ED as a side effect. Some types of medications that can contribute to ED include:

• Diuretics (like hydrochlorothiazide, spironolactone, and furosemide)

• Beta blockers (like atenolol and metoprolol)

• Calcium channel blockers (like amlodipine, diltiazem, and verapamil)

• Other medications that lower blood pressure (like methyldopa and clonidine)

• Medications to help with the pumping action of the heart (like digoxin) 

• Statins (like atorvastatin and simvastatin) 

• Fibrates (like fenofibrate and gemfibrozil)

Let your provider know if you have ED and take medications to keep your heart healthy. They will need to figure out if your ED is happening as a side effect of the medication. Or they’ll need to see if your medications aren’t effective in treating your heart disease so that you can keep an erection. You and your provider may need to work together to change your dose or consider other medications.

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Written by:

Megan N. Freeland, PharmD, RPh

Megan began her career as a public health pharmacist and transitioned into healthcare copywriting and content marketing as the CEO of StockRose Creative, LLC. As a public health pharmacist, Megan supported the Centers for Disease Control and Prevention (CDC) in medication safety, health communications, and regulatory affairs. After receiving her Bachelor of Arts in Spanish from Emory University and her doctorate degree in pharmacy from Mercer University, she completed fellowship training in drug information and health communications.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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