Is Viagra Safe for ED?

Treatment options for erectile dysfunction (ED) like Viagra® are known to be effective in managing sexual dysfunction. And for most users, the active ingredient in Viagra — sildenafil citrate — is generally considered safe.

However, like any medication, Viagra can have side effects, ranging from more mild effects like headaches and nasal congestion to rare but more severe ones, such as vision loss and painful erections. Viagra also can interact with other medications you may be taking.

Below, we explain how Viagra works, as well as its common side effects and drug interactions that you should know about before using Viagra to treat ED.

Viagra (or its generic, sildenafil) is a generally safe medication that works by relaxing the blood vessels of your penis to improve blood flow. That said, it can cause some particularly serious medical conditions, such as vision issues, among others. Incidences of allergic reactions are extremely rare.

Approved by the FDA in 1998, sildenafil, the active ingredient in Viagra, belongs to a class of drugs called phosphodiesterase type 5 inhibitors, or PDE5 inhibitors. These inhibit the effects of the PDE5 enzyme, which is part of a reaction leading to the contraction of the smooth muscles in the blood vessels that supply blood to your penis. This inhibition of PDE5 increases blood flow to the penis, making it easier for you to get and maintain an erection.

Sildenafil is also used for other conditions that can be treated with vasodilation, including pulmonary arterial hypertension (a form of high blood pressure that affects the lungs).

Overall, Viagra’s safety record is very good. However, like almost every medication, it can cause certain side effects. Most of these side effects are mild and transient, meaning they gradually go away as Viagra is processed by your body.

Common side effects of Viagra include:

• Headaches

• Flushing

• Dyspepsia (indigestion)

• Nasal congestion

• Back and/or muscle pain

• Dizziness

• Skin rashes

• Vision issues, such as blurred vision, changes in color vision or other abnormal vision

Of these side effects, headaches are generally the most common, affecting between 16 and 28 percent of men who used Viagra in clinical trials.

However, Viagra can also cause more serious side effects, including the following:

• Vision loss

• Sudden hearing decrease or loss of hearing

• Priapism (painful and/or long-lasting erections)

These side effects are uncommon. If you develop any serious side effects after using Viagra, it’s important to contact your healthcare provider or seek medical assistance as soon as you can.

Side effects like long-lasting, painful erections may sound alarming, and make you wonder, “Is Viagra dangerous?”. But it’s important to put these side effects in context: Only a small percentage of men who use either sildenafil, or its brand-name Viagra, develop any adverse effects, and an even smaller percentage experience serious issues.

Currently, there is no high-quality evidence to suggest that Viagra causes long-term side effects or health issues.

For example, priapism (painful and prolonged erections) is one of the most well-known sildenafil side effects, largely thanks to sensational media reporting. Despite being so well-known, priapism from sildenafil is extremely rare. In fact, just 74 cases of priapism involving sildenafil were recorded in the FDA’s adverse event reporting system during the entire year of 2007, despite millions of men using sildenafil on a regular basis.

Put simply, although mild side effects from Viagra do occur on a somewhat regular basis, major or dangerous side effects are very uncommon. Most men who take the ED med have a good experience on Viagra, seeing real improvements in erectile function and encountering few issues worthy of concern.

Like many medications, Viagra can interact with other drugs.

Sildenafil, the active ingredient in Viagra, causes a mild drop in blood pressure. In a study from 2002, researchers found that a typical dose of sildenafil decreased systolic blood pressure by 6 mm Hg and diastolic blood pressure by 4.5 mm Hg in a small group of men.

When Viagra is combined with other medications that also reduce blood pressure, it can cause a sudden, significant drop in blood pressure that may be dangerous or even life-threatening.

Cardiovascular medications that may interact with Viagra include nitrates such as isosorbide dinitrate (Isordil®) or nitroglycerin (Nitrostat®), as well as alpha-blockers and certain other antihypertensive medications.

Viagra also can interact with medications that inhibit the CYP3A4 enzyme, such as itraconazole, ketoconazole and the antiretroviral medication ritonavir.

Some recreational drugs, such as “poppers” containing nitrites, can also cause dangerous changes in blood pressure when used with Viagra or other drugs for erectile dysfunction.

To avoid any interactions, it’s important to inform your healthcare provider about all medications, supplements and recreational drugs you currently use or have recently used before taking Viagra. Based on that information, your healthcare provider will determine if Viagra is safe for you, and if so, advise you on how to use it properly.

There’s a common misconception that Viagra and other ED medications have a negative effect on cardiovascular health, or that these medications can trigger myocardial infarction (heart attack) and other medical emergencies. In post-marketing studies, these effects have been seen in temporal relation to Viagra use, but it’s difficult to say how frequent they are or if Viagra is even the cause.

If you’re in good health and don’t suffer from any cardiovascular health issues, you can likely use these medications safely as directed by your healthcare provider.

That said, if you’ve been diagnosed with a heart condition, it’s best to exercise caution when it comes to ED medications.

Before using Viagra or similar medication, make sure to inform your healthcare provider about your condition. Let them know if you currently use or have previously used medication for any heart conditions, or if you’ve previously suffered a cardiovascular event.

Viagra is generally safe for those with active lifestyles. But for individuals with serious heart disease or other heart problems, it’s important to seek medical advice before making substantial changes to your activity level.

It’s also important to keep in mind that sex itself is a form of exercise, and enhanced sexual activity is one of the most common Viagra uses. In fact, a 2012 article in the journal Circulation notes that sex is comparable in its level of physical exertion to climbing up several flights of stairs or walking briskly for a short period of time.

As such, if you have a heart condition, the physical activity involved in sex may cause you to experience chest pain or other symptoms.

Make sure to inform your healthcare provider if you experience any concerning problems while having sex, or if you feel out of breath or unable to perform during sexual activity.

Viagra is generally safe and effective when it’s used as prescribed. However, taking Viagra on an overly frequent schedule, taking an excessive amount of Viagra or using Viagra recreationally may increase your risk of experiencing side effects.

Viagra is typically prescribed for use as needed, meaning before sexual activity. Most men who have ED and are prescribed Viagra as a treatment are advised to take this medication at least one hour before they plan to have sex.

You should not take Viagra more than once per day. If you plan to have sex more than once a day and find that Viagra doesn’t last long enough for you, you may want to consider talking with your healthcare provider about switching to a different type of ED medication.

Some ED medications, such as tadalafil (the active ingredient in Cialis®), can be used daily and offer longer-lasting relief from erectile dysfunction.

Another common misconception about Viagra is that it can damage your penis or cause you to become dependent on medication to get an erection.

Contrary to popular belief, Viagra doesn’t have any significant impact on your sex drive or level of sexual stimulation. All it does is make it easier for blood to flow into your penis when you feel sexually aroused.

In very rare cases, men who use Viagra may experience priapism — a type of persistent, painful erection that can last for several hours. This issue develops when blood becomes trapped in the penis.

Priapism is a serious issue that requires urgent medical attention. When untreated, it may cause damage to the penis.

The good news is that priapism is extremely rare and affects only a tiny percentage of men who use Viagra or similar medications to treat ED.

As for physical dependency, there’s no scientific evidence that Viagra is physically addictive, nor is there any evidence that Viagra can make ED or other forms of sexual dysfunction worse.

Most men can take Viagra without any issues. However, as we mentioned above, it’s important not to use Viagra — or at least to talk to your healthcare provider before you consider using this medication — if you:

• Have a history of health issues. Viagra may not be safe to use if you have cardiovascular disease, or if you’ve previously suffered from a heart attack, stroke or life-threatening arrhythmia. Likewise, men with sickle cell anemia, retinitis pigmentosa or Peyronie’s disease should seek medical advice about how to safely take Viagra with these conditions.

• Have blood pressure issues. Given interactions between Viagra and blood pressure, Viagra may not be safe to use if you have hypertension (high blood pressure) or hypotension (low blood pressure). This includes if you currently use medication to control your blood pressure levels.

• Have heart failure or unstable angina. These conditions may also make using Viagra or similar ED medications unsafe for you.

• Take medication for high blood pressure or angina. Some medications for managing chest pain, such as nitrates, can cause dangerous interactions when used with Viagra or other PDE5 inhibitors. This includes nitroglycerin and nitrites like “poppers” as well.

• Have risk factors for non-arteritic anterior ischemic optic neuropathy (NAION). In some cases, Viagra can contribute to an elevated risk of NAION, a rare cause of loss of vision or decreased vision that can occur with PDE5 inhibitors. Make sure to inform your healthcare provider if you have a history of eye problems, or if other members of your family have eye conditions.

• Experience hearing loss while using Viagra. If you experience sudden hearing loss, tinnitus or dizziness while using Viagra, it’s important to stop taking this medication and talk to your healthcare provider as soon as you can.

Used as directed, Viagra can improve your sexual performance and provide relief from erectile dysfunction without significant negative effects on your health. Follow these tips to safely get the best results from Viagra:

• Start with a low or moderate dosage. Viagra comes in several strengths, ranging from 25mg to 100mg per tablet. If you’re concerned about side effects, consider starting with a low or moderate dosage of Viagra.

• Take Viagra roughly one hour before sex. As for how to take Viagra for optimal results, you should aim to do so at least one hour before you plan to have sex. A single dose of Viagra will last for around four hours. You can take Viagra with or without food.

• Never take Viagra more than once a day. Viagra is designed for use one time per day, and not more — there is such a thing as too much Viagra. If you prefer a longer-acting medication for ED, consider talking to your healthcare provider about tadalafil (the active ingredient in Cialis).

• Avoid drinking alcohol with Viagra. Using Viagra with alcohol can increase your risk of side effects. It’s best to reduce your alcohol consumption or avoid drinking while using Viagra or other ED medications. There are also a select few foods to avoid with Viagra to ensure maximum efficacy.

• Avoid over-the-counter Viagra alternatives. Contrary to popular belief, non-prescription products like supplements are not necessarily safer than Viagra. Many contain unlabeled, illicit ingredients, including some that are potentially harmful.

• If Viagra doesn’t work, tell your healthcare provider. You may need to try several different dosages of Viagra to identify the one that works best for you. Make sure not to change your recommended dose of Viagra without first talking to your healthcare provider.

Like all prescription drugs, Viagra should be used responsibly. This means closely following your healthcare provider’s instructions and informing them if you experience any issues from taking the medication. In general, though:

• Whether you’re prescribed Viagra or sildenafil, its generic, it’s one of the most well-known and effective treatments for erectile dysfunction.

• When used as directed, Viagra is a safe medication that can produce real, noticeable improvements in your sexual function — all without significant negative effects on your health or well-being.

• Side effects of Viagra are rare, but if you experience any, you should share that with a healthcare professional. It’s also important that you inform them of any other health conditions you have before accepting a prescription.

Interested in using Viagra? We offer sildenafil, tadalafil and other FDA-approved medications for ED online, following a consultation with a licensed physician who will determine if a prescription is appropriate.

You can learn more about these medications and other options for stopping erectile dysfunction and improving your sexual performance in our full guide to the most common ED treatments.