Oral medications such as Sildenafil and Tadalafil do not affect heart health directly, but it is not safe for all. This vasodilator can reduce blood pressure and thus increase the risk of cardiovascular issues in some.
Sildenafil and tadalafil are the commonly prescribed first-line treatments for erectile dysfunction (ED) in men. These phosphodiesterase inhibitors work by relaxing muscles, improving blood circulation and reducing blood pressure. When taken in recommended doses, they effectively treat ED in healthy men. A 2024 study published in Journal of the American College of Cardiology reveals that the combination of sildenafil or tadalafil with nitrate-based medicines can increase the risk of cardiovascular issues, including heart attacks, in men. Dr M Sudhakar Rao, consultant cardiologist, Manipal Hospital, Sarjapur, Bangalore, explains, “Nitrate-based medicines further lower blood pressure, leading to potential cardiovascular issues.”
A 2020 study examined that the prevalence of erectile dysfunction in men between 40-49 years of age was nearly 17% and the numbers are increasing steadily. Hence, the need for oral medications is also on the rise. “One must never self-prescribe oral medications, including sildenafil and tadalafil,” cautions Dr Naveen M N, urologist and urogynecologist, Gleneagles BGS hospital, Kengeri, Bangalore. The same applies to male enhancement pills.
Mechanism of action: Sildenafil and tadalafil
Sildenafil and tadalafil are vasodilators. Within 30 minutes of consuming tadalafil and 60 minutes of consuming sildenafil, the blood vessels dilate, relaxing soft muscle tissues such as those in the penis, aiding in erection. Dr Naveen says, “This dilation affects the entire body. In those taking sildenafil, the effects last up to four hours, while those using tadalafil experience its effects for 24-36 hours.”
Sildenafil and tadalafil: Risk of heart attack associated with nitrate-based medication
When a healthy man takes sildenafil or tadalafil, his blood pressure falls by at least 5 mmHg (millimeters of mercury), which is not harmful, says Dr Rushikesh S Patil, interventional cardiologist, Dr L H Hiranandani Hospital, Powai, Mumbai. However, he warned, “In individuals who are taking nitrates — medications commonly prescribed for chest pain, BP and other issues — along with these oral medications, blood pressure can drop by 25 to 50 mmHg, which can be fatal.” Therefore, those on nitrates for cardiac or hypertension-related issues should avoid these ED medications.
Can advancing age add to the risk of heart attack?
Experts agree that the risk of cardiovascular issues from sildenafil and tadalafil does not increase with age if a man has no comorbidities like hypertension or cardiac issues. However, Dr Naveen notes that men aged 45 to 60 with cardiovascular issues are at a higher risk. Considering that myocardial infarction (heart attack) and other cardiac issues are more common in men over 40, this age group is also more likely to take nitrate-containing drugs, raising their risk of complications when combined with erectile dysfunction medications.
Recommended dosages and signs of overdose
Dr Naveen emphasizes that the recommended dosage for sildenafil is 50 mg and for tadalafil is 10 mg. “Using the appropriate dosage of these medicines can protect the heart. It also has a synergistic effect with other antihypertensives to control blood pressure,” he confirms.
Overdosing on sildenafil, tadalafil or other oral medications can lead to symptoms such as increased body temperature, hot flashes, headache, dyspepsia or indigestion, gastritis, rhinitis and myalgia (muscular pain) due to the activation of the sympathetic nervous system.
In rare cases, maintaining a gap of at least 24 to 48 hours between the consumption of nitrate-based medicine and sildenafil or other oral ED medications also helps, advises Dr Naveen.
Takeaways
It is always safer to consult a doctor before using sildenafil or tadalafil.
Oral medications such as sildenafil or tadalafil do not increase the risk of heart attack in healthy men.
Men at risk of hypertension and cardiovascular issues, and those on nitrate-based medicines are at higher risk for heart attacks and other cardiac complications.
