Atrial Fibrillation, PVCs and Viagra?

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Submitted by Dr T on March 7, 2014 – 1:19pm

Question: 
Hello Doctor,
Thanks for taking my question. I deeply appreciate whatever info you can tell me.
History: Three bouts of Atrial Fibrillation since 1992. PVCs began in 2002. My EKG’s come back Abnormal from the arrythmias. Nothing else. No pain or shortness of breath. Lab work, thyroid, etc is normal. Had Echocardiograms in 2002 and December of 2012. No structural heart issues and an E.F. around 60. Was on Inderal for 9 years and now take Metoprolol, 50mg twice a day.
My question: Does any of this make Viagra an unsafe option? At age 58, my love life is finally blossoming but I have been non functional south of the belt line since about 1990. My internist gave me several packages to try. My cardio doc just shrugs at the question.
I do not smoke, drink or use recreational drugs. Any comments or suggestions? Thanks very much!

Hi Doug,

The short answer: You can use viagra or other drugs like it (such as including levitra, cialis, staxyn, and stendra) while on lopressor (metoprolol) medication. Take it and see what happens, but I’d recommend to start with a smaller dosage, such as 1/2 or 1/4 pill.

A more comprehensive answer:

Impotence (or Erectile Dysfunction or ED for short) may be caused by many factors, therefore (before recommending treatment) questions your doctor should ask include :

  • Did you have ED issues before you were started on lopressor?
  • Do you have ED at all times, or f.i. not in the morning. The latter would indicate that your “machinery” is essentially intact.
  • Questions about your libido (desire for sex), such as questions about anxiety whether you can “perform” when needed.

If a person does develop sexual side effects while using a beta blocker, such as impotence or a decreased libido, it is difficult to pinpoint whether these problems are caused by another condition or metoprolol itself. However, if you develop ED while taking metoprolol, make sure to talk with your healthcare provider. There are treatments he or she may be able to recommend such as viagra. Other options: adjust your metoprolol dosage or try other Atrial Fibrillation or high blood pressure medications.

Drugs like viagra are called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, they work by enhancing the effects of a chemical called nitric oxide that relaxes smooth muscles in the penis and increase the local blood flow during sexual stimulation, which will create an erection. Patients with atherosclerosis and blockages in the arteries to their lower body may not be able to increase the blood flow even with a PDE inhibitor.

With what you have told me, I don’t believe that is an issue in your case. Be aware it takes 1/2-1 hr before you’ll notice the effect. Till you know how your body responds, you should be careful with sudden changes of position because you may develop a sudden drop in blood pressure with changing to an upright position (orthostatic hypotension).

Hope this helps,

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    I’ve had an atrial flutter ablation a few months ago but not for afib as it was unclear if Ibhad afib. I’ve only had two fainting episodes in two years and I’m in NSR otherwise. I’m takind toprol, losartan and a baby aspirin. My question is: Is it safe to take an ED drug prior to having sex or could it trigger an afib or atrial flutter episode?

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