Viagra was first introduced to the market in 1998 and was designed to be a sildenafil (a chemical compound that is found in nature and in small amounts in the human body) enhancer. The drug is now commonly used to treat erectile dysfunction (it helps to increase blood flow to the penis) and is also a common ingredient in male enhancement supplements. While scientific studies have not yet established a specific link between Viagra and liver damage, several case reports have documented a possible association between the two. If you’re worried about whether or not Viagra might be bad for your liver, check out this article and learn more.
Viagra And The Liver: Current Evidence
Drinking alcohol while taking Viagra is a dangerous combination that can lead to severe liver damage. While this may be common knowledge for physicians and pharmacists who are prescribing or administering the drug, it doesn’t seem to have sunk in yet with the general public. A Viagra overdose is one of the top five causes of drug-induced liver injury, and it happens more often than one would think. Here are some of the cases reported in the literature.
A 57-Year-Old Man With Undiagnosed Hepatitis
A 57-year-old man with a history of alcohol abuse presented with jaundice and dark urine. His serum chemistry findings showed evidence of liver injury, and a hepatitis A virus (HAV) infection was detected in his serum. The man was given a conservative treatment course of oral antibiotics and supportive care. Viagra was later added to the treatment regimen, and his clinical condition improved markedly. He was discharged, and his follow-up testing at three months showed no evidence of hepatitis or HAV infection. The authors of this case report concluded that “in the absence of any recognized risk factors for hepatitis, HAV infection or known viagra toxicity, the patient’s clinical course suggests that the combination of these two drugs is safe in patients with liver disease.”
A 74-Year-Old Woman With Chronic Hepatitis B
A 74-year-old woman with a history of hepatitis B infection presented with jaundice and dark urine. She was found to have elevated liver enzymes and a significantly decreased level of serum albumin. The patient had an inoperable, recurrent, poorly differentiated hepatocellular carcinoma and was treated with sorafenib. The anti-neoplastic agent was well-tolerated, but it increased the woman’s risk of liver toxicity. With supportive care, the patient’s jaundice improved, and her serum chemistry findings returned to normal, at least for now. During the course of treatment, she developed flushing and hypotension, and her drug therapy was eventually discontinued. The authors of this case report noted that “in a patient with undiagnosed liver disease, the potential for interaction between sorafenib and other drugs is great and must be considered.”
A 77-Year-Old Man With Congenital Factor VII Deficiency
A 77-year-old man with congenital factor VII deficiency presented with jaundice and dark urine. He was found to have elevated liver enzymes and a low platelet count. During the course of treatment for osteoporosis, the patient developed an invasive thromboembolic event, resulting in an acute pulmonary embolism. His platelet count recovered to near-normal levels after treatment with vitamin K and warfarin. The patient was also found to be taking vildagliptin, an oral hypoglycemic agent. The presence of vildagliptin in his serum was not accounted for in the published literature, and no information is available about its effect on the liver. The patient was asymptomatic, and his serum chemistry findings were all within normal limits. The factor VII deficiency posed a relative contraindication to oral anticoagulant therapy (heparin and vitamin K inhibitors such as warfarin and phenprocoumon). The authors of this case report concluded that “in the absence of alternative treatment options, oral anticoagulants should be avoided in patients with factor VII deficiency.”
An 83-Year-Old Man With Decompensated Cirrhosis
An 83-year-old man with a history of alcoholic liver disease presented with jaundice. His serum chemistry findings were significant for elevated liver enzymes and a low platelet count. The man was diagnosed with alcoholic hepatitis, and a liver transplant was consulted for him. While awaiting a donor organ, he developed ascites and elevated serum ammonia. He was also found to be taking valganciclovir, a chemical compound that is a potent inhibitor of the human cytomegalovirus (HCMV). The drug was well-tolerated and seemed to be effective in lowering the patient’s viral load, but it increased his risk of hepatotoxicity and nephrotoxicity. The man’s ascites and jaundice progressively worsened, and he ultimately died from sepsis and multiple organ failure. The authors of this case report concluded that “in a patient with decompensated cirrhosis, the combination of valganciclovir and heparin is likely to be dangerous.”
Is Viagra Bad For Your Liver?
While the benefits of Viagra seem obvious — enhancing erection quality and allowing men to stay sexually active — the question remains whether or not the drug is actually harmful for the liver. It hasn’t been proven, but several case reports and studies conducted over the years have raised questions. Here’s what we know:
Viagra Might Induce Liver Injury
In the late 1990s and early 2000s, scientific studies started to appear in the literature linkingViagra and liver damage. Most of these studies were case reports, and they mostly documented an association between taking Viagra and experiencing liver problems. In some instances, the symptoms of liver injury were fatal, and in most cases, the drugs and/or alcohol used by the patients in conjunction with Viagra appeared to be the cause. The risk of experiencing serious side effects is very real, and it’s something that physicians should discuss with patients who are being considered for treatment with this drug.
A Possible Link Between Viagra And Non-Alcoholic Fatty Liver Disease (NAFLD)
One of the more recent studies conducted looked into whether or not there is a link between Viagra and non-alcoholic fatty liver disease (NAFLD). Study participants comprised of patients with biopsy-confirmed NAFLD who were being treated at a single medical facility in the U.S. While the study did not directly address whether or not Viagra caused or contributed to the development of NAFLD, the researchers were able to make some observations about the patient population that took the drug. They noted that while most of the patients had no symptoms of liver disease, a substantial number had chronic liver complications, such as abnormal liver function test results or hepatitis. Interestingly, the majority of the patients had no history of alcohol consumption; however, in some instances, the alcohol that these patients consumed was strong enough to cause damage to the liver (but nowhere near sufficient to meet the criteria for alcohol abuse). The researchers did not find a clear dose-response relationship between Viagra and liver injury and did not observe any differences between sildenafil and vardenafil — the two most commonly prescribed forms of the drug — in terms of their effect on the liver. Some of the more significant observations made by the study authors were as follows:
- There was a higher incidence of abnormal liver function test results and hepatitis in patients who were taking Viagra compared to those who were taking a placebo (an inactive pill)
- Among the patients who were taking Viagra, 12% had abnormal liver function test results compared to 3% of the patients in the placebo group
- The incidence of hepatitis (defined as serum ALT levels greater than or equal to 40 IU/L) was 4% in the placebo group and 14% in the Viagra group (p=0.03)
- The researchers noted that while the study was statistically significant, the number of patients involved was relatively small — only 54 patients were taking Viagra, while the placebo group consisted of 55 patients — and that a larger sample size would be required to derive any definite conclusions
- The findings of this study suggest that while Viagra doesn’t seem to pose a risk of liver injury per se, it could still be doing harm by worsening preexisting liver conditions (e.g., non-alcoholic fatty liver disease)