Viagra: mixtures that should not be made

When it comes to drugs, no precaution should be overlooked, and you can never be too careful. In the case of Viagra (Sildenafil, its active ingredient), being a phosphodiesterase 5 inhibitor drug that acts in a systemic way, it can have a variable behavior depending on the patient who ingests it, and many other factors.

There is talk of an interaction between drugs when one drug influences or alters the effects of another when administered together; this can be clinically significant if one drug decreases the therapeutic effects of another, or if it increases its toxicity, risks and/or side effects.

If there are two substances that share the same way of being processed by the body, and they do so through the same enzymes or mediators, it may be that they compete, increase the presence or elimination of the drug from the blood, participating and altering its effects (which can be increased or decreased), or increasing the possibilities of adverse toxic reactions.

In the specific case of Viagra, there are numerous substances that cannot be combined or taken at the same time as this drug, because it puts at risk a patient who needs a quick response to his sexual performance problems and who is even exposed to risks of adverse reactions according to dose and mode of administration; which combined with an inadequate mixture between treatments, can carry several negative consequences for the user.

Mixtures that should not be made with Viagra

There are some drugs that are not compatible with Viagra. Some of them are:

  • Nitrates: any nitric oxide donor (nitrates, nitrites), administered together with Viagra (Sildenafil, its active ingredient) can increase the concentration of the mediator they have in common (called cGMP) in an uncontrolled way in the smooth muscle of the blood vessels, and generate an extremely serious hypotension. Therefore, the joint administration of any type of nitric oxide donor agent and viagra is contraindicated.
  • Alpha-blockers (treatment for arterial hypertension): together with Sildenafil (viagra), it can cause symptomatic hypotension.
  • CYP3A4 inducers and inhibitors: Sildenafil (Viagra) is a phosphodiesterase 5 inhibitor, and its metabolism is done through cytochrome P450, isoenzyme 3A4 in the digestive system; therefore, any drug that induces or inhibits these isoenzymes competes with Viagra in its clearance (elimination), and can generate changes in the blood presence of the drug. Some of these drugs are ketoconazole, erythromycin, cimetidine, ritonavir, indinavir, saquinavir. Joint administration of these drugs with Viagra, while not an absolute contraindication, should be done with caution and starting with the lowest possible doses of phosphodiesterase 5 inhibitor.
  • Other phosphodiesterase 5 inhibitors: although one might think that taking two phosphodiesterase 5 inhibitors at the same time (such as vardenafil, tadalafil, with Viagra), could enhance a satisfactory erection, there is nothing further from the truth. The truth is that this mixture is absolutely contraindicated and could only exacerbate the adverse effects and toxicity of both drugs, even representing a vital risk to the user.
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Although to be able to use some of these medicines simultaneously with the taking of Viagra, it could be enough in some cases to reduce or increase the dose in the way that best suits the patient, given that its ingestion alters the presence of the other in the bloodstream, the ideal would be to consult the doctor before, or avoid the concomitant taking.

Alcohol and Viagra do not make a good combination

Alcohol shares many of its adverse reactions with Viagra, such as palpitations, headache, dizziness, and others. Combining Viagra with alcohol could even produce severe hypotension, as both substances lower blood pressure values, and mixed can be enhanced in this effect.

It should also not be forgotten that alcohol alone can generate impotence and erectile dysfunction, and in some serious cases this may not have enough relief with Viagra. In any case, it could be more difficult to get an erection if you drink too much alcohol, even taking a treatment for sexual performance such as Viagra.

In general, mass consumption of alcohol at the same time as treatment with Viagra is extremely dangerous and is best avoided. It carries a high risk of cardiovascular and other serious adverse reactions.

Drinking large amounts of alcohol also creates an impediment to getting an erection, and in some cases, instead of relieving anxiety about sexual performance, it can make it worse. Small amounts of alcohol have been reported without adverse effects or any reaction, but in general, the risk is significant enough to avoid drinking alcohol and Viagra together.

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Problems caused by grapefruit

Grapefruit, also known as grapefruit, is a citrus fruit widely consumed in different parts of the world. Although it is very nutritious and healthy, its intake together with Viagra is contraindicated.

As mentioned above, the isoenzyme CYP3A4 is responsible for metabolizing Viagra; grapefruit is a selective inhibitor of this isoenzyme. By addressing its inhibition, it increases systemic exposure to Viagra (Sildenafil), i.e. it increases the absorption of the drug into the bloodstream. This higher concentration, as a result, may also increase the adverse effects of the drug.

A solution to not stop taking grapefruit juice at the same time as taking Viagra treatment for erectile dysfunction is to reduce the dose of erectile dysfunction with the assistance of the doctor, however it is risky and the safest option is to avoid concomitant consumption.