While the side effects of Viagra are typically mild and transient, some patients may experience serious complications, particularly if the drug is administered intravenously or by injection.
The US Food and Drug Administration (FDA) has approved the use of Viagra for treating erectile dysfunction (ED) in men. Since then, the drug has been on the market and is frequently prescribed to men who want to treat their ED.
If you’re currently taking or considering taking Viagra for ED, you may be wondering about its long-term side effects. Are there any risks associated with taking the drug for a prolonged period of time?
Here, we’ll discuss some of the possible side effects of Viagra, how and when you should stop taking the drug, and what you need to understand about the risks posed by Viagra compared to other ED treatments.
Viagra and Long-Term Health
The short-term side effects of Viagra are well known. Flushing, headaches, and heartburn are the most commonly reported adverse events related to the drug. While these side effects are generally mild and transient, they may contribute to a menopausal-like state in some patients. Additionally, a small number of patients experience severe allergic reactions to the drug which may lead to anaphylaxis or other serious complications.
There are also some more rare but potentially serious side effects associated with Viagra. Intravenous injection may cause thrombophlebitis (clotting in the veins) which in some cases has led to amputation of the affected limb. Intravenous injection also carries with it the risk of pulmonary embolism (blood clots in the lungs). Other serious side effects include liver damage and rhabdomyolysis (breakdown of muscle fibers leading to the release of myoglobin, a substance which stains urine dark red).
The potential side effects of Viagra are outlined in greater detail in its prescribing information. Due to its risk of adverse effects, many physicians will typically only prescribe the drug for short-term use.
Viagra and Other Treatments for ED
While the short-term side effects of Viagra are well documented, its long-term effects are not well known. What is the risk of developing serious complications from taking Viagra for ED?
There are some data suggesting that the risk of developing heart disease, liver disease, and diabetes increases with age. Therefore, it’s possible that men who start taking Viagra as part of an aging process may experience more serious complications in the long run.
It’s also possible that patients who take Viagra for longer than two weeks may experience additional side effects not included in its prescribing information. For instance, hypotension (low blood pressure) has been observed in patients who are currently taking or who have recently taken the drug. This may be a side effect of prolonged systemic absorption of the drug or it may be due to the drug’s action on the cardiovascular system.
When Should You Stop Taking Viagra?
Due to the short-term side effects of Viagra and the lack of long-term data, physicians typically do not recommend taking the drug for long periods of time. They also advise against abruptly stopping the drug, especially if it’s been shown to be effective in treating ED. It’s best to gradually reduce the dose over a number of weeks or months until the benefits no longer outweigh the risks.
However, there are some cases where stopping Viagra may be necessary. Patients who have developed a resistance to the drug or have experienced severe adverse reactions may require alternative treatments. Before discontinuing the use of Viagra, your doctor will likely recommend one of the following alternatives:
- Injections – intracavernosal injection of vasoactive substances, such as alprostadil, to enhance blood flow into the penis;
- Medication – oral administration of phosphodiesterase inhibitors, such as sildenafil (Viagra) or tadalafil (Cialis), to boost blood flow to the penis;
- Vacuum Erectile Dysfunction Therapy – placement of a vacuum device around the penis to improve blood flow into the corpora cavernosa, the two meaty folds at the base of the penis;
- Penile Prosthesis – implantation of a prosthetic penis featuring three cylinders – two for holding the urine and one for holding the semen –to create a tighter seal around the base of the penis and restore normal function;
- Incision and Dilatation – placement of a penile prosthesis and insertion of a narrow instrument, called a dilator, into the urethra to enlarge the urethra and increase the diameter of the meatus (the opening at the base of the penis);
- Surgery – surgical correction of anomalies, such as hypospadias (an incorrect development of the penis which leads to underdeveloped folds of skin at the base of the penis) or epispadias (a congenital condition where the penis is completely absorbed in the urethra, making it appear smaller than usual);
- Phytotherapy – use of plant-based medicines to treat ED, such as yohimbine or stinging nettles;
- Intracavernosal Injection – injection of vasoactive agents, such as nitroglycerin, into the penis. This can be done using a needleless injection system or a disposable syringe.
In some instances, patients will require combinations of the above treatments. Regardless of which treatment or treatments you choose, it is very important to follow your doctor’s instructions and take the medication as prescribed. This will decrease the risk of experiencing additional side effects and complications.
How Is Viagra Different From Other ED Treatments?
While all of the above treatments for ED have side effects, not all of them are created equal. Some medications carry additional health risks – particularly when used long-term – that Viagra does not. Take nitroglycerin for instance. This is a vasodilator which opens up the blood vessels and allows more blood into the penis. It’s also a very potent vasodilator which can lead to significant damage if injected intravascularly. There have been reports of gangrene (a severe damage to the tissues resulting in necrosis and possibly amputation) due to nitroglycerin use.
That being said, nitroglycerin has been shown to be more effective at treating ED than the drug Viagra. The difference in effectiveness is due to the fact that Viagra is a prodrug which must undergo hepatic (liver) activation before it can exert its medicinal effects. Once activated, Viagra has been known to work in two different ways. First, it promotes smooth muscle relaxation by binding to receptors on the surface of smooth muscle cells. The second way that Viagra works is by inhibiting the breakdown of adenosine triphosphate (ATP) by cytochrome P450 enzymes. As previously stated, ATP is an essential component of the body, required for many functions, including cellular respiration and DNA synthesis. Inhibition of ATP breakdown can therefore lead to DNA damage and possible cell death. In other words, Viagra can cause genetic mutations which may lead to birth defects or diseases in the future (e.g. birth defects associated with chromosomal disorders and cancer).
Other medications which are known to cause similar complications as Viagra are methylphenidate (Ritalin) and amphetamine. These medications act on the central nervous system (CNS) and are frequently prescribed to treat attention deficit hyperactivity disorder (ADHD). The health risks of taking these medications are well known and although they have many benefits, they must be used cautiously by patients who want to get pregnant or are already parents.
What Is The Difference Between The Risk Of Developing Complications Associated With Viagra And The Risk Of Developing Complications Associated With Hypotension?
The above discussion on the comparisons between Viagra and other treatments for ED is relevant here as well. Since the side effects of hypotension and Viagra are the same (i.e., liver damage and muscle damage), the question is: “What is the risk of developing each one?”