Viagra & Alcohol – What You Need To Know.
Sildenafil or as it is more widely known, Viagra, is a drug used in the treatment of erectile dysfunction or male impotence. It is a phosphodisesterase type-5 inhibitor. Since its launch just over ten years ago this ‘wonder pill’, as it is commonly referred to, has been prescribed for over 30 million men in 120 countries and following its release was prescribed at a rate of 10,000 a day. Comparing this to alcohol, which is so widely sold in the UK that figures have shown that the average drinker has fifteen and a half litres of pure alcohol a year (equivalent to 775 pints of beer), putting the UK as one of the top alcohol consuming countries in the world. Bearing these figures in mind what are the risks of combining these two substances? After all, for many, sexual intercourse and alcohol go hand in hand, so, what are the main concerns?
As mentioned Viagra is a phosphodiesterase inhibitor and it works by maintaining levels of messenger cyclic guanosine monophosphate which relaxes smooth muscle allowing a penis to become erect when sexually stimulated. This process occurs by arteries in the penis dilating, thereby, increasing blood flow. Blood perfusion into the erectile tissues aids this mechanism. Viagra is best taken on an empty stomach and takes approximately one hour to become effective and effects can last for up to six hours. Since the approval of Viagra in 1998, Sildenafil has been effective in over 100 clinical trials involving over 8000 men with erectile dysfunction. Sildenafil is the first line therapy in the treatment of erectile dysfunction compared to other drugs of the same pharmacological class, such as, tadalafil and avanafil. Although Sildenafil is not listed for NHS prescribing in the BNF, exemptions may apply when the prescriber feels that the condition is causing the patient significant distress or a marketed effect on interpersonal relationships.
Firstly, it is significant to consider the relationship between alcohol and erectile dysfunction which have been significantly linked.
Alcohol in small amounts can act as a stimulant maximising all sensations thus aiding erections, conversely, in excessive amounts acts as a sedative. Sedatives work by depressing the central nervous system. This is problematic as the brain needs constant stimulation and physical sensations to maintain an erection, therefore, alcohol can reduce these signals to the brain causing erectile dysfunction.
Looking at research on this particular topic several key issues are mentioned in a variety of medical and pharmacological based articles may be of interest to patients concerning this particular area involving alcohol consumption. Online resources such as this, as well as other literature, state that while no significant clinical evidence suggests that consuming alcohol and taking Viagra simultaneously can cause significant adverse effects it may be beneficial to flag some areas of concern for patients.
Firstly, both substances are blood thinners. A consequence of taking both Viagra and alcohol can have a cumulative effect of reducing blood pressure, potentiating the risk of tachycardia. This particular issue is also mentioned by the manufacturers of the medication who advise patients to avoid blood thinners while on medication, perhaps an indicator of the significance. Secondly, alcohol in large amounts is a significant danger to liver function. Indeed, figures show that in the last thirty years mortality of alcohol induced liver disease has increased by 450%. This is important in that any liver disease caused by alcohol consumption will increase the build up of Viagra in our bodies, thereby, increasing the risks of side effects.
Finally, looking at the process of an erection itself it is recognised that the brain needs constant stimulation to maintain an erection and alcohol dampens these signals. Although Viagra can help alleviate the problem, the alcohol is still theoretically working against the effects of Viagra.
Other literature from The UK Health centre also warns that a combination of alcohol and Viagra can worsen the symptoms of Viagra such as dizziness, rapid heart rate and low blood pressure. Furthermore, both have the ability to cause problems, an example being headaches; therefore, an intake of both may have a cumulative effect meaning a potential headache is twice as likely compared to when either substance is taken in isolation. Healthcare professionals also express the concern that Viagra should be used, where possible, as a short term use medication and that because alcohol has negative effects both physically and psychologically, it can lengthen the period on which a patient need rely on the medication.
One relevant study to mention would be the research of Leslie et al, titled, ‘No adverse hemodynamic interaction between Sildenafil and red wine ‘. The experiment involved a four way, randomized crossover study in which eight young men received either Viagra, red wine (750ml of a 13.5% by volume), a combination of both or a placebo supplement. Parameters investigated included blood pressure, heart rate and cardiac index which were measured every fifteen minutes for three hours. Results of the test showed no clinically significant hemodynamic interactions between Sildenafil and alcohol. However, it should be noted that testing was performed on a small group of men who fell in a specific age bracket and didn’t have sexual intercourse throughout the duration of the study. Therefore, it could be argued the results are unrepresentative of the range of patients taking Sildenafil.
A final question for patients to consider; what if you think Sildenafil isn’t working for you? It shouldn’t be assumed that because of drinking alcohol, Sildenafil isn’t working because as information from literature sources state that Viagra should be attempted approximately eight times before considering changing to an alternative. Furthermore, when taking Viagra it is important to tell your healthcare professional any medicines you are currently taking, including, prescribed medications, herbal medications, vitamins and recreational substances. The latter of which will include alcohol. This can reduce risk chance of interactions with any other medications. Any side effects experienced while taking Viagra, such as dizziness and visual disturbances should be reported immediately.
In conclusion, like with many medications; taking alcohol can reduce the efficacy of it. However, consuming alcohol and then Viagra tablets is not a cause for major concern as it poses no major interaction. That said, it is worth noting that caution should be exercised, reasons being; it reduces the effectiveness of the medication, it worsens the symptoms of potential side effects and it increases the need for taking the medication in the first place.
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