Can I take Viagra with antiretrovirals (ARVs) for HIV?
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
When you’re taking an essential medication for your health, the last thing you want to worry about is taking another medication that might not mix well with that drug. ARVs (antiretroviral drugs) are an excellent example of medications you need to be extra careful with—after all, you’re taking ARVs to keep your HIV under control. That’s pretty important. But what if you have erectile dysfunction (ED), too? That’s a common condition for men with HIV. Can you take sildenafil (Viagra) to treat your ED without worrying about how it will impact your ARVs?
Let’s take a look at how these drugs interact.
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Sildenafil interactions with ARVs
Sildenafil (brand name Viagra; see Important Safety Information) is an oral medication for ED (erectile dysfunction) and part of a class of medications known as PDE5 inhibitors; these include vardenafil (brand names Levitra, Staxyn), tadalafil (brand name Cialis; see Important Safety Information), and avanafil (brand name Stendra). These drugs help the blood vessels in your penis to open up, allowing blood to flow in and produce an erection when you’re sexually stimulated.
ARVs are drugs that keep levels of HIV (a retrovirus) in the blood low by stopping or slowing HIV’s normal replication cycle. It’s not a cure, but it can help HIV-positive individuals lead normal lives with normal life expectancies.
Since erectile dysfunction is common among HIV-infected men, it’s important to know if combining these drugs is safe (Crum-Cianflone, 2007).
Can I take sildenafil with my ARVs?
Problems can occur if you take sildenafil certain HIV medications. To avoid potentially dangerous drug interactions, it’s always important to tell your healthcare provider what medications you’re currently taking, including prescription and over-the-counter medications, vitamins, and herbal supplements.
When you talk to your healthcare provider about starting Viagra or another PDE-5 inhibitor, it’s especially important to let them know if you’re taking any medications for the treatment of HIV, including (AETC, n.d.):
- Delavirdine (Rescriptor)
- Amprenavir (Agenerase)
- Indinavir (Crixivan)
- Ritonavir (Norvir)
- Saquinavir (Fortovase, Invirase)
- Elvitegravir/cobicistat/TDF/FTC (Stribild)
- Fosamprenavir (Lexiva)
- Atazanavir (Reyataz)
- Darunavir (Prezista)
- Lopinavir/ritonavir (Kaletra)
- Nelfinavir (Viracept)
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Certain ARVs, especially those listed above, have the potential to increase the concentration of sildenafil in your body, which can make it more likely that you experience common Viagra side effects, such as headache, low blood pressure, and flushing. If you take any of these HIV medications, your healthcare provider may start you on a lower Viagra dosage, decrease your Viagra dosage, or recommend that you take Viagra less frequently, like every other day.
Some HIV medications, like etravirine (Intelence), may also lower the concentration of Viagra in the body, so your healthcare provider may adjust your dose depending on how effective Viagra is for you (OARAC, 2021).
Other HIV medications not listed above may also have interactions with sildenafil, so be sure to discuss all your medications with your healthcare provider.
Potential side effects of Viagra
Common side effects of Viagra include dizziness, headache, flushing, upset stomach or indigestion, increased sensitivity to light, blurred vision, a stuffy or runny nose, back pain, insomnia, rash, and muscle pain (Dhaliwal, 2020).
Less common side effects of Viagra include priapism (a prolonged erection that won’t go away), and ringing in the ears, or hearing loss. If you experience any of those, seek medical advice right away.
If you’re taking ARVs, talk to your healthcare provider about how Viagra may affect you, and always follow your healthcare provider’s dosing instructions. Viagra isn’t safe for everyone. People who take certain drugs, including ARVs, or have certain health conditions, like liver or kidney disease, may need to adjust their Viagra dose in order to take Viagra safely.
References
- AIDS Education and Training Center (AETC). (n.d.). Recreational Drugs and HIV Antiretrovirals Retrieved from https://aidsetc.org/sites/default/files/resources_files/2014_Recreational Drug Interaction Guide.pdf
- AIDS Research Advisory Council (OARAC). (2021). Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Retrieved from https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/AdultandAdolescentGL.pdf
- Crum-Cianflone, N. F (2007). Erectile dysfunction and hypogonadism among men with HIV. AIDS Patient Care and STDs, 21(1), 9–19. doi: 10.1089/apc.2006.0071. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/17263654/
- Dhaliwal, A. & Gupta, M. (2020). PDE5 inhibitor. In: StatPearls [Internet]. Retrieved on Dec. 14, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK549843/
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Important Safety Information for Sildenafil (Viagra)
What are the most important things I need to know about VIAGRA® (sildenafil citrate) 25 mg, 50 mg, and 100 mg tablets and generic VIAGRA®?
Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate emergency medical attention.
- VIAGRA® and generic VIAGRA® can cause serious side effects. Serious, but rare, side effects include:
- an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, seek emergency medical attention right away. If it is not treated right away, priapism can permanently damage your penis.
- sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking VIAGRA and call your healthcare provider right away if you have any sudden vision loss
- sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking VIAGRA and contact a doctor right away
Who should not take VIAGRA® or generic VIAGRA®?
Do not take VIAGRA® or generic VIAGRA® if you:
- Take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
- Are allergic to sildenafil, as contained in VIAGRA® and REVATIO®, or any of the ingredients in VIAGRA® or generic VIAGRA® tablets.
- Are a women or a child
When should I call my primary provider?
Call your primary provider right away if you:
- Have an erection that lasts longer than 4 hours
- Experience a sudden loss of vision in one or both eyes
- Experience a sudden decrease in or loss of hearing
- Experience chest pain, dizziness, or nausea during sex
- Take too much Viagra or sildenafil citrate
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.
What are the most common side effects of VIAGRA® and generic VIAGRA®?
The most common side effects are:
- headache
- flushing
- upset stomach
- abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision
- stuffy or runny nose
- back pain
- muscle pain
- nausea
- dizziness
- rash
What should I tell my Roman-affiliated provider before taking VIAGRA® and generic VIAGRA®?
Before you take VIAGRA® or generic VIAGRA® , tell your healthcare provider if you:
- Have or have had heart problems such as a heart attack,irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
- Have had heart surgery within the last 6 months
- Have pulmonary hypertension
- Have had a stroke
- Have low blood pressure, or high blood pressure that is not controlled
- Have a deformed penis shape
- Have had an erection that lasted for more than 4 hours
- Have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia
- Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
- Have ever had severe vision loss, including an eye problem called NAION
- Have bleeding problems
- Have or have had stomach or intestinal ulcers
- Have liver problems
- Have kidney problems or are having kidney dialysis
- Have any other medical conditions
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works, causing side effects.
Especially tell your healthcare provider if you take any of the following:
- Medicines called nitrates
- Medicines called guanylate cyclase stimulators such as Adempas® (riociguat)
- Medicines called alpha-blockers such as Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), Jalyn® (dutasteride and tamsulosin HCl), or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of VIAGRA® with alpha-blockers can lead to a drop in blood pressure or to fainting
- Medicines called HIV protease inhibitors, such as ritonavir (Norvir®), indinavir sulfate (Crixivan®), saquinavir (Fortovase® or Invirase®), or atazanavir sulfate (Reyataz®)
- Oral antifungal medicines, such as ketoconazole (Nizoral®) and itraconazole (Sporanox®)
- Antibiotics, such as clarithromycin (Biaxin®), telithromycin (Ketek®), or erythromycin
- Other medicines that treat high blood pressure
- Other medicines or treatments for ED
- VIAGRA® contains sildenafil, which is the same medicine found in another drug called REVATIO®. REVATIO® is used to treat a rare disease called pulmonary arterial hypertension (PAH). VIAGRA® should not be used with REVATIO® or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil])
Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.
What is the FDA-approved use of VIAGRA® and generic VIAGRA®?
VIAGRA® (sildenafil citrate) is prescription medicine used to treat erectile dysfunction (ED).
Roman-affiliated doctors may prescribe VIAGRA® or generic VIAGRA® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment. While this is not an FDA-approved use of the drug, the American Urological Association has included the use of sildenafil citrate in the treatment of PE in its Guideline on the Pharmacologic Management of Premature Ejaculation.
You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see the full Prescribing Information for complete safety information.
Product names referenced herein are trademarks of their respective owners.
Important Safety Information for Tadalafil (Cialis)
What Is The Most Important Information I Should Know About CIALIS® (tadalafil) and generic CIALIS®?
- CIALIS® and generic CIALIS® can cause serious side effects. Serious, but rare, side effects include:
- An erection that won’t go away (priapism). If you get an erection that lasts more than 4 hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis, including the inability to have erections.
- Changes in vision. Color vision changes, such as seeing a blue tinge (shade) to objects or having difficulty telling the difference between the colors blue and green.
- Sudden decrease or loss of vision. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including CIALIS® and generic CIALIS®) reported a sudden decrease or loss of vision in one or both eyes. It is uncertain whether PDE5 inhibitors directly cause the vision loss. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including CIALIS® and generic CIALIS®, and call a healthcare provider right away.
- Sudden loss or decrease in hearing. Sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness, has been rarely reported in people taking PDE5 inhibitors, including CIALIS® and generic CIALIS®. It is not possible to determine whether these events are related directly to the PDE5 inhibitors, to other diseases or medications, to other factors, or to a combination of factors. If you experience these symptoms, stop taking CIALIS® and generic CIALIS® and contact a healthcare provider right away.
- ED is a condition where the penis does not fill with enough blood to harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his healthcare provider for help if the condition bothers him.
- CIALIS® and generic CIALIS® help increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away. Some form of sexual stimulation is needed for an erection to happen with CIALIS® or generic CIALIS®.
- CIALIS® and generic CIALIS® do not:
- Cure ED
- Increase a man’s sexual desire
- Protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your healthcare provider about ways to guard against sexually transmitted diseases.
- Serve as a male form of birth control
- Take CIALIS® or generic CIALIS® exactly as your healthcare provider prescribes it. Your healthcare provider will prescribe the dose that is right for you. Do not change your dose or the way you take CIALIS® or generic CIALIS® without talking to your healthcare provider.
Who Should Not Take CIALIS® or generic CIALIS®?
Do not take CIALIS® or generic CIALIS® if you:
- Have severe liver disease. Tell your doctor if you have mild to moderate liver disease as you may need dosage reductions.
- Have severe kidney disease. Tell your doctor if you have mild to moderate kidney disease as you may need dosage reductions
- Take any medicines called “nitrates”
- Use recreational drugs called “poppers” like amyl nitrite and butyl nitrite
- Take any medicines called guanylate cyclase stimulators, such as riociguat
- Are allergic to CIALIS®, tadalafil or ADCIRCA®, or any of its ingredients
When should I call my primary provider?
Call your primary provider right away if you:
- Have an erection that lasts longer than 4 hours
- Experience a sudden loss of vision in one or both of your eyes
- Experience a sudden decrease or loss hearing
- Take too much CIALIS® or generic CIALIS®
- Have an allergic reaction to CIALIS® or generic CIALIS®
- Symptoms of an allergic reaction may include:
- Rash
- Hives
- Swelling of the lips, tongue, or throat
- Difficulty breathing or swallowing
Call your healthcare provider or get help right away if you have any of the symptoms of an allergic reaction listed above.
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.
What Should I Tell My Roman-affiliated Provider Before Taking CIALIS® and generic CIALIS®?
Tell your Roman-affiliated provider about all your medical problems, including if you:
- Have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. Ask your healthcare provider if it is safe for you to have sexual activity. You should not take CIALIS® and generic CIALIS® if your healthcare provider has told you not to have sexual activity because of your health problems.
- Have pulmonary hypertension
- Have low blood pressure or have high blood pressure that is not controlled
- Have had a stroke
- Have liver problems
- Have kidney problems or require dialysis
- Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
- Have ever had severe vision loss, including a condition called NAION
- Have stomach or intestinal ulcers
- Have a bleeding problem
- Have a deformed penis shape or Peyronie’s disease
- Have had an erection that lasted more than 4 hours
- Have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia
Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.
Especially tell your healthcare provider if you take any of the following:
- Medicines called nitrates
- Medicines called guanylate cyclase stimulators, such as riociguat (Adempas®), used to treat pulmonary hypertension
- Medicines called alpha blockers. These include Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), 4 Jalyn® (dutasteride and tamsulosin HCl) or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. If CIALIS® or generic CIALIS® is taken with certain alpha blockers, your blood pressure could suddenly drop. You could get dizzy or faint.
- Other medicines to treat high blood pressure (hypertension)
- Medicines called HIV protease inhibitors, such as ritonavir (Norvir® , Kaletra® )
- Oral antifungals such as ketoconazole (Nizoral® ), itraconazole (Sporanox® )
- Antibiotics such as clarithromycin (Biaxin® ), telithromycin (Ketek® ), erythromycin (several brand names exist. Please consult your healthcare provider to determine if you are taking this medicine).
- Other medicines or treatments for ED.
- Tadalafil is also marketed as ADCIRCA® for the treatment of pulmonary arterial hypertension. Do not take both CIALIS® or generic CIALIS® and ADCIRCA®. Do not take sildenafil citrate (Revatio®, Viagra®) with CIALIS® or generic CIALIS®.
Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.
What are the most common side effects of CIALIS® or generic CIALIS®?
The most common side effects with CIALIS® and generic CIALIS® are:
- Headache
- Indigestion
- Back pain
- Muscle aches
- Flushing
- Stuffy or runny nose
What is the FDA-approved Use of CIALIS® and generic CIALIS®?
CIALIS® and generic CIALIS® are prescription medicines used to treat erectile dysfunction (ED), symptoms of benign prostatic hyperplasia (BPH), or both.
Roman-affiliated doctors may prescribe CIALIS® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment.
You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see the full Prescribing Information for complete safety information.
