Can you take Viagra with high blood pressure?

Yes, Viagra can lower your blood pressure. Sildenafil, the active ingredient, causes mild and short-lived fall in blood pressure. In most men, the fall does not translate into anything you are likely to notice.²

Why it happens?

When you take Viagra, your blood vessels relax, and this causes the drop in blood pressure.² You can read more in our guide to how Viagra works.

Yes, however your blood pressure should be well controlled and gives you no symptoms. Your GP will make a decision on this for you. Before starting any treatment for erectile dysfunction, the GP will consider your cardiovascular status,. This is because there is a degree of cardiac risk when having sex.²

If your high blood pressure is uncontrolled, or you do not know your reading

Uncontrolled high blood pressure is likely to mean sildenafil is not suitable for you.⁴

High blood pressure is very common, especially in older adults, and usually causes no symptoms.⁵ If yours has not been checked recently, you should check this before using Viagra.

If your blood pressure is low, or you have recently had a heart attack or stroke

Viagra must not be taken, if your blood pressure is below 90/50 mmHg or you have recently had a stroke or heart attack.²

There are a few medicines that if you are taking them, rule Viagra out completely. These include;

Nitrates, including GTN sprays and tablets

Sildenafil strengthens the blood-pressure-lowering effect of nitrates, so taking it with nitrates is not allowed.²

Glyceryl trinitrate, or GTN, is the spray or tablets used for chest pain.⁴

Poppers (amyl nitrite)

Poppers, or amyl nitrite, are nitric oxide donors. Viagra (Sildenafil), is contraindicated for the same reason as with nitrates. This includes poppers you have bought yourself, not only medicines on your repeat list.

Nicorandil

Nicorandil is a medicine used for angina. It is a hybrid of a potassium channel activator and a nitrate, and the nitrate component gives it the potential to result in a serious interaction with sildenafil.²

Riociguat

Riociguat is used to treat pulmonary hypertension. This is high blood pressure in the blood vessels of the lungs.⁸ You ca not take Viagra with Riociguat, because the combination may lead to symptomatic hypotension. This is a fall in blood pressure big enough to feel.²

How long after GTN can you take Viagra?

There is no waiting time that makes this combination safe. Nitrates and sildenafil are not taken together at all. If you use a GTN spray, even rarely, your prescriber needs to know before any erectile dysfunction treatment.

Taking sildenafil alongside an alpha-blocker may lead to hypotension in susceptible men.²

If that happens, it will most likely be within 4 hours of the sildenafil dose.² You should let your GP know if you are taking these medicines.

Alpha-blockers include

• alfuzosin
• doxazosin
• tamsulosin

Why timing and dose matter

You should be stable on your alpha-blocker before sildenafil is started. A 25mg starting dose should be considered.² Our guide to sildenafil dose sets out the strengths. Your GP will help you choose yours, based on your medical history.

What to do if you feel dizzy or faint on standing

Stop the treatment and ask your GP what to do next. Treatment should be stopped if symptoms of postural hypotension occur. If that happens, you should get advice from the GP on what to do.³

Amlodipine and the other main classes of blood pressure medicine are not contraindicated with Viagra.²

Erection problems are common in men taking these medicines, and our guide to medicines that can cause erectile dysfunction goes through the prescriptions involved.

Amlodipine

Taking Viagra with Amlodipine can further lower your lying blood pressure.

Never stop amlodipine so that you can take sildenafil. Stopping suddenly can be dangerous, and only a doctor should tell you to stop.¹⁰

If you take two or more blood pressure medicines

How well your blood pressure is controlled is more important than how many blood pressure medications you might be on. The number of tablets you take is not a reason for a "No", to Viagra on its own.

Sacubitril/valsartan

In men with high blood pressure taking it, a dose of sildenafil lowered blood pressure significantly more than sacubitril/valsartan alone. Caution is advised when sildenafil is started, to prevent potential dizziness.²

Before prescribing, a GP will assess whether any underlying condition you have could be impacted by taking Viagra.

Who needs to speak to a doctor first

Speak to your doctor before you resume sexual activity if you have been diagnosed with any of these:³

• uncontrolled high blood pressure
• moderate to severe valve disease
• a weakened left ventricle, called left ventricular dysfunction
• a disease of the heart muscle, called cardiomyopathy
• a significant heart rhythm problem, called an arrhythmia

Even the low-risk group is told to consult a doctor first, so this list is not a line between allowed and not allowed.

Who must not use it at all

Sildenafil and other erectile dysfunction treatments should not be used by men for whom sexual activity is not recommended. This includes men with severe heart or circulation problem like unstable angina or severe heart failure.²

Call 999 for a suspected heart attack. For dizziness or faintness after a dose, stop and speak to your doctor.

Chest pain

Call 999 if you are taking sildenafil and think you might be having a heart attack.⁴

The NHS describes the chest pain that needs a 999 call as sudden pain or discomfort in your chest that does not go away. It can feel like squeezing or pressure inside your chest, burning or indigestion.⁵

Dizziness or fainting

Dizziness is a common side effect of sildenafil. If you feel dizzy or your vision blurs after a dose, do not drive, ride a bike or use machinery until the symptoms have gone.¹³

On an alpha-blocker, the first 4 hours after a dose are when a drop big enough to feel is most likely, and the advice then is to stop and ask your doctor what to do. Our guide to the side effects of Viagra covers the rest of the list.

• The fall in blood pressure is small and does not last, and most men feel nothing from it.
• If your reading is well controlled and gives you no symptoms, sex itself is considered low risk for your heart.
• A nitrate of any kind, including the spray in your pocket, is the one combination with no version that is allowed.
• On an alpha-blocker, the first few hours after a dose are when a drop is most likely.
• Some heart conditions mean the answer is no, whatever your blood pressure reading says.
• Chest pain that does not go away is a 999 call, not a wait-and-see.