Managing Erectile Dysfunction: Considerations for men taking heart medications
Erectile dysfunction (also known as ED or impotence) affects more than half of all men over 50 years of age and can have many causes. Mental health, stress, cardiovascular health and medications can all play a role. In older men, the risk of erectile dysfunction increases due to underlying blood circulation and heart issues. ED affects 60 to 70 percent of people with diagnosed chronic heart failure. Erectile dysfunction could be an early sign of circulatory disease that can lead to heart failure. In this brief, we will describe how a Personalized Medicine approach can help to manage erectile dysfunction and heart medications to improve sexual health and reduce the risk of severe side effects.
Heart medications such as digoxin, beta-blockers, diuretics and spironolactone can cause erectile dysfunction. Erectile dysfunction medications sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis) and avanafil (Stendra) relax blood vessel muscles in the heart, lungs and penis. ED drugs can help and are generally safe, but the vast majority of men who might benefit from ED medications don’t try these drugs due to stigma. Half of the men who do try ED drugs along with other heart disease treatments stop after a short time due to significant side effects.
If you’re a man experiencing reduced libido or erectile dysfunction, it is essential to assess your heart health with qualified healthcare providers. Ignoring the signs of decreased sexual function can degrade one’s health.
Personalized Medicine for Heart Conditions and ED Management
Men with hypertension and other chronic conditions often take multiple medications to reduce blood pressure, cholesterol levels and blood clotting to improving circulation and prevent heart failure. Adding an ED drug to the mix of heart medications is known to lead to severe side effects. It is an issue that remains largely unresolved, and for some men, the side effects of ED medication outweigh the benefits. Stopping the ED drug helps to resolve most side effects but can leave men frustrated with reduced sexual function. Pharmacogenetic testing assesses your rate of drug metabolism (controlled by enzymes in the liver). It helps to guide safe drug selection and dosing that is appropriate for your genetics and reduces the risk of negative side effects for erectile dysfunction drugs and heart medications.
Statins and ED
Some ED-induced side effects can be caused by excessive statin dosage. Statins are metabolized by the CYP3A4 and SLCO1B1 liver enzymes. Men who have inherently reduced function of either of these enzymes (which is based on genetics) are at higher risk of experiencing muscle or joint pain known as ‘statin-induced myopathy.’ For these individuals, the addition of ED drugs can amplify muscle pain, fainting and other side effects. Depending on your DNA, a simple reduction of statin dosage could help to reduce the symptoms and allow safer ED treatment. At the same time, the addition of atorvastatin has been shown to improve response in men who did not respond favourably with Viagra. Pillcheck consulting pharmacists can confidentially assess medication selection, advise on appropriate statin dosage, and whether ED drug dose reduction will help to mitigate side effects.
Using ED-drugs sildenafil, vardenafil, tadalafil, together with nitroglycerin, is not recommended due to increased risk of fainting and heart failure. Other medications for controlling blood pressure – such as amlodipine (Tekamlo, Norvasc) and combination drugs such as Amturnide that contain amlodipine – should not be used along with ED drugs either. Combining these medications may cause blood pressure to fall excessively, which can lead to cardiovascular collapse. Pillcheck tests can help to assess your metabolism of blood pressure medications, statins and other drugs, to better guide your heart and ED therapy.
If you or a loved one is concerned about erectile dysfunction and heart medication, Pillcheck can help. Pillcheck includes a pharmacogenetic (PGx) test and an online medication review by a clinical pharmacist. Pillcheck can improve the management of heart disease and help you to maintain ED therapy safely. Pillcheck test results and your medication history are held strictly confidential. Pillcheck clinical pharmacists will advise your doctor on how to adjust treatment to improve libido and tolerance to heart and erectile dysfunction medications.
- Reduced sexual function can be caused by psychological stress and/or undiagnosed heart disease.
- Excessive heart medication or antidepressant doses can suppress libido and worsen erectile dysfunction.
- Personalized drug and dose selection, matched to your DNA, improves management of ED and heart conditions.
- Pillcheck pharmacists can advise as to how your treatment can be adjusted to reduce the risk of drug-induced side effects and improve your tolerance to treatment.
Senthilkumaran, Subramanian et al. “Priapism, pomegranate juice, and sildenafil: Is there a connection?” Urology annals vol. 4,2 (2012): 108-10. doi:10.4103/0974-7796.95560
Dadkhah at al., Atorvastatin improves the response to sildenafil in hypercholesterolemic men with erectile dysfunction not initially responsive to sildenafil International Journal of Impotence Research (2010): 22, 51–60