OTC Drug Interactions with ED Medications
October 31, 2022
The little blue pill (sildenafil) was the first medication to receive Food and Drug Administration (FDA) approval as a treatment option for erectile dysfunction. Five years after the introduction of Viagra, tadalafil (Cialis) was FDA-approved as the first oral ED medication with sustained efficacy for up to 36 hours. Over the past twenty-five years, pharmaceutical companies have continued to develop phosphodiesterase type 5 inhibitors that work by blocking the degradative action in the smooth muscle cells that line blood vessels and supply blood to tissue in the penis.
PDE5 is an enzyme that directly affects cell signaling. By inhibiting production of the enzyme, it can help to relax soft tissues and increase blow flow to specific areas of the body. Along with more recently approved PDE5 inhibitors like vardenafil (Levitra) and avanafil (Stendra), these drugs are well-tolerated in most people, but not in all men. Common side effects are generally mild and include headaches, upset stomach, back pain, flushing, and diarrhea. More serious side effects include a decrease in blood pressure and vision changes, particularly in men who suffer from heart disease or diabetes.
How enzymes and blood flow cause an erection
Generally speaking, penile erection is mediated by nitric oxide and its chemical messenger cyclic guanosine monophosphate or cGMP. According to multiple studies published by the National Center for Biotechnology Information, this activity is modulated by phosphodiesterase, which is the most important physiological isoform of the enzyme. Since PDE5 inhibitors are known to interact with certain medications, your physician or a men’s health specialist should discuss the exact medicines to avoid when taking oral ED treatments.
Absolute Contraindication: American College of Cardiology recommends patients using long-acting nitrates as a treatment regimen (prophylaxis for chronic angina or ischemic heart disease) should not take nitrates concomitantly with the use of PDE5 inhibitors. Moreover, the treatment of any serious medical conditions should be carefully monitored by a physician when PDE5 inhibitors are prescribed.
Risks of Using Over-the-Counter ED Treatments
There are over-the-counter treatments and herbal remedies that claim they are able to improve erectile dysfunction. Unfortunately, what is often overlooked is exactly how OTC medications and supplements for improving ED can have dangerous interactions. Discussed below are ED supplements that have not been approved by the FDA, such as:
DHEA – Dehydroepiandrosterone is an important hormone that is naturally produced by the adrenal glands. It is commonly sold to boost energy, enhance immunity, slow natural aging, and improve weight loss, but there is not enough evidence to support DHEA supplements as being effective for treating ED. Moreover, DHEA can cause hormone imbalances or have negative interactions with other medications.
L-arginine – This amino acid is converted by the body into nitric oxide, which may help blood flow by dilating vessels in the penis. Research has identified that a significant number of men who suffer from erectile dysfunction due to arterial insufficiency may have low levels of L-arginine. The safety of long term use of the supplement taken in high doses is currently unknown. But, among known side effects are cramping, bloating, diarrhea, and nausea as well as L-arginine can interact with certain medications including ED drugs like Viagra and Cialis.
Propionyl-L-carnitine – As a naturally occurring amino acid derivative of L-carnitine, propionyl-L-carnitine supplements act as an antioxidant and have been prescribed to address blood flow and other circulatory issues. Although studies are somewhat limited, older research found combinations of propionyl-L-carnitine and/or acetyl-L-carnitine with Viagra worked better than sildenafil alone for treating ED in men with diabetes or post prostatectomy. Negative side effects can include pain in stomach and chest, vomiting, and a fishy odor in the sweat, breath, and urine.
Ginseng – Since ancient times, a particular red ginseng plant that grows in Asia has been used in traditional Chinese medicine as an aphrodisiac. It also has been linked to increased alertness and lessening the severity of symptoms of heart disease. Ginseng contains ginsenosides, which are chemical messengers that promote nitric oxide. Studies using red ginseng to help with ED have been mixed with some showing positive effects and others no improvement. Side effects include insomnia, headaches, interaction with medications, and interference with blood thinners.
Yohimbe – The bark of this African evergreen tree contains a compound called yohimbine. Similar to red ginseng, yohimbe has a long history of traditional uses as an aphrodisiac. Its list of claims as a natural supplement include weight loss, improvement of erectile function, lowering of high blood pressure, and reversing diabetic nerve damage. However, according to the National Center for Complementary and Integrative Health, recent research suggested it was no more effective than a placebo for treating ED. Side effects include increased blood pressure and heart rate that can be fatal in high doses.
A common complaint from men suffering with erectile dysfunction is that they don’t feel the same zest for life as they once did. Whereas there is no doubt that stress, tension, anxiety, and depression can take a toll on a man’s sexual relationships, relying on OTC ED pills to feel more energetic may come with dangerous side effects, especially when combined with PDE5 inhibitors. So, OTC supplements should not be considered a substitute for conventional ED medications or other treatment protocols that a physician would use to treat erectile dysfunction.
ED Treatment Options at GAINSWave Jacksonville
Men often resort to OTC medicines to self-treat symptoms of erectile dysfunction rather than seeking the diagnosis and advise of a medical professional. Although some dietary supplements have gained mainstream popularity, none have sufficient evidence for proving treatment efficacy. In addition, some have nasty interactions with prescription medications whiles others can be dangerous to your health. If you were searching online for ED treatments, OTC options bypass an important physical exam, review of your medical history, and a diagnosis by a physician or men’s health specialist. That can prove costly to your wallet and your well-being.
Since the cause of erectile dysfunction is often a build up of plaque in the penile blood vessels, ED medications cannot correct the physical cause. This means always having to rely on expensive medications to ensure your sexual performance. Fortunately, over the past twenty years, new technologies have been applied to develop non-surgical treatment options with longer lasting results.
Low intensity shockwave therapy has been used for decades by cardiologists to improve myocardial ischemia and by urologists to break up painful kidney stones. Since erectile dysfunction is a systemic medical condition, the cause of your problems should be accurately diagnosed before a treatment regimen is prescribed. Here at GAINSWave Jacksonville, our men’s sexual health physician can determine whether or not non-invasive extracorporeal shockwave treatments can be used to break up plaque in penile blood vessels to improve your sex life. If the little blue pill isn’t working for you, call GAINSWave Jacksonville today at (904) 500-5500.
Earl Eye, M.D., FACCP, is a men’s healthcare physician with multiple medical specialties and over forty years of experience in treating male patients. Dr. Eye conducts a thorough exam to identify the most probable cause of your sexual performance issues and recommends the best treatment options based on your specific medical problem including issues related to diabetes and other chronic health conditions.
