Can you take Viagra with nitroglycerin? No, never. Nitroglycerin, also called glyceryl trinitrate, is the angina spray or tablet used under the tongue, and taking it with sildenafil can cause a severe drop in blood pressure that may be difficult to treat. Every Viagra and Cialis label rules the pair out. If you get chest pain after taking Viagra, do not use a nitrate spray: call triple zero (000).
Why can't you take Viagra with nitroglycerin?
Because together they can make blood pressure fall severely. The Australian Viagra leaflet puts it in capitals: "YOU MUST NOT TAKE VIAGRA IF YOU ARE TAKING NITRATES OR NITRITE MEDICATIONS. IT MAY LEAD TO A SEVERE DROP IN YOUR BLOOD PRESSURE, WHICH MAY BE DIFFICULT TO TREAT" (Viagra CMI). Both medicines act on the same nitric oxide pathway: sildenafil on its own causes "mild and transient decreases in blood pressure" and "potentiates the hypotensive effect of nitrates" (Viagra PI (Australia); EMA — Viagra). healthdirect says "People who use nitrates in any form or are being treated for pulmonary hypertension should not take sildenafil" (healthdirect — Sildenafil).
Which forms of nitroglycerin does this cover?
All of them, however rarely you use them. The Australian product information names "glyceryl trinitrate (injection, tablets, sprays or patches)" and rules out nitrates with Viagra "either regularly or intermittently" (Viagra PI (Australia)), so an occasional spray counts. The Viagra leaflet's list also includes isosorbide mononitrate and dinitrate, nicorandil and sodium nitroprusside, and it rules out amyl nitrite, "sometimes called 'poppers'", and riociguat (Viagra CMI). The whole class, from long-acting tablets to patches, is covered in can nitrates be taken with Viagra?
What should you do if you get chest pain after taking Viagra?
Do not use the spray, and get help. The Viagra leaflet says: "If you get an angina attack do not take nitrate medicines to relieve the pain but tell your doctor immediately. Make sure your doctor knows you are taking VIAGRA" (Viagra CMI). The European leaflet's advice for chest pain during or after sex is to "Get in a semi-sitting position and try to relax" and not to use nitrates (EMA — Viagra). The leaflet for the Australian glyceryl trinitrate spray tells men prescribed Viagra, Cialis or a similar medicine who get an angina attack to "immediately go to the emergency department at your nearest hospital" (Nitrolingual Pumpspray CMI). Call triple zero (000) and ask for an ambulance if chest pain is severe, getting worse or has lasted 10 minutes (healthdirect — Chest pain); healthdirect's general advice to take a dose of your angina medicine does not apply here, because both leaflets rule the nitrate out. Tell the ambulance and hospital staff that you have taken Viagra, and when; the Cialis leaflet asks men on tadalafil to do the same (Cialis CMI).
How long after Viagra is nitroglycerin safe?
No sildenafil label gives a time, so this page does not either: the Australian and European labels simply rule the pair out (Viagra PI (Australia); EMA — Viagra). Where the other ED medicines' labels mention time, they describe a study or a doctor's decision in an emergency, not a schedule for alternating them:
| Medicine | What the label says about time and nitrates |
|---|---|
| Sildenafil (Viagra) | No interval given; contraindicated "either regularly or intermittently" (Viagra PI (Australia)) |
| Tadalafil (Cialis) | In a life-threatening situation, at least 48 hours in most men, and 4–5 days in the elderly, after the last dose "before nitrate administration is considered", then only "under close medical supervision" (Cialis PI (Australia)) |
| Vardenafil | No blood-pressure effect when nitroglycerin was taken 24 hours after 20 mg in healthy volunteers, but "no information" in patients, so still contraindicated (EMA — Levitra) |
| Avanafil (Spedra) | Within 12 hours of a dose, the risk of a dangerous drop in blood pressure with an emergency nitrate is higher (EMA — Spedra) |
What if you use a nitroglycerin spray and have erection problems?
Then the PDE5 tablets are not for you. The Australian spray's leaflet says: "Do not use phosphodiesterase inhibitors (e.g. Viagra®, Cialis®, Levitra® or others) if your doctor or pharmacist has asked you to use Nitrolingual Pumpspray" (Nitrolingual Pumpspray CMI), and healthdirect's advice for all erectile dysfunction medicines is not to take them if you use nitrates (healthdirect — ED medicines). healthdirect lists other treatments when these tablets don't suit: alprostadil injections, vacuum erection devices, and counselling or sex therapy. Sex itself may place a strain on the heart, so the doctor who looks after your angina is the one to ask (Viagra CMI). Other heart medicines are covered in Viagra after a heart attack or with heart medicines and Viagra with a beta-blocker.
The short answer
Nitroglycerin and Viagra must never be combined, in any form, and no sildenafil label names a safe gap between them. If you use a nitroglycerin spray, the ED tablets are ruled out; if you get chest pain after Viagra, leave the spray, call 000 and tell the ambulance staff what you took. Every other combination is covered in our guide to taking Viagra or Cialis with other medicines.
