Part two: Q&A about Viagra and Cialis

The second interview with Dr. Marian Davis, PharmD, a medical content reviewer associated with Crossroads Pharmacy. Read Part One of the interview.

Viagra was initially created for something like that, wasn’t it?

Yes, sildenafil was originally studied in cardiovascular contexts before its erectile dysfunction use became clear. The major safety issue involves nitrate medications, which may be used for angina or chest pain. Nitrates relax blood vessels and can lower blood pressure.

When a PDE-5 inhibitor such as sildenafil or tadalafil is combined with nitrates, blood pressure can drop too much. That interaction can be dangerous, so men using any nitrate medication should not take ED medication unless a licensed clinician has specifically reviewed their situation.

And what about alcohol? Is it safe to drink some wine?

Alcohol can affect erections and can also add to dizziness, flushing, headache, and blood-pressure effects in some men. A small amount may not cause problems for every patient, but heavy drinking can reduce sexual performance and may increase side-effect risk, especially with tadalafil. Patients with heart disease, blood pressure problems, or multiple medications should ask a clinician what level of alcohol, if any, is safe for them.

Is it more effective if taken on an empty stomach? Can it be affected by food absorption?

Food can affect timing for some ED medications, especially sildenafil when taken with a heavy or high-fat meal. Tadalafil is less dependent on meal timing for many patients, but individual response can still vary. The practical point is to follow the prescriber’s directions and avoid turning medication timing into another source of performance anxiety.

At what point do you decide to prescribe the medication? Like, if an individual walks into your office and says, “I want Viagra”, do you simply give it to him, or is there a series of questions?

Some people ask about ED medication when the main issue may actually be premature ejaculation, painful orgasm, performance anxiety, or another sexual health concern. That is why the first step is making sure the problem is truly erectile dysfunction before focusing on a specific medication.

A proper ED evaluation should include basic health questions, medication review, cardiovascular risk factors, smoking, weight, diabetes, blood pressure, and whether the problem is truly erectile dysfunction rather than another sexual health concern. Medication may help some patients, but it should not replace evaluation of underlying health issues.

When ED appears vascular or occurs alongside risk factors such as diabetes, high blood pressure, smoking, chest pain, or reduced exercise tolerance, cardiovascular review may be appropriate. ED medication may help with symptoms, but long-term sexual health is often connected with heart health, metabolic health, smoking cessation, exercise, and weight management.

Can patients get addicted to these medications?

PDE-5 inhibitors are not considered addictive in the way substances of abuse are, but some men can become psychologically reliant on medication if anxiety is a major part of the problem. For younger men with performance anxiety, medication may be only one part of care, alongside reassurance, counseling, stress reduction, and treatment of contributing health factors.

Using sildenafil or tadalafil does not mean a man will automatically lose the ability to have erections without it. However, persistent ED should still be evaluated rather than handled only with repeated medication use. The goal is to understand the cause and choose a safe, sustainable approach.

What supports cardiovascular health often supports sexual health as well: regular exercise, a balanced diet, smoking cessation, weight management, blood pressure control, and diabetes management. Some clinics also discuss device-based or procedural options for selected ED patients, but these should be reviewed with a qualified clinician rather than treated as a simple consumer choice.

Is it painful?

Some ED clinics discuss low-intensity shockwave therapy for selected patients with vascular ED, but protocols, availability, evidence quality, and regulatory status can vary. Patients should ask whether a treatment is guideline-supported, who performs it, what outcomes are realistic, what risks exist, and what alternatives are available.

Before considering any procedure or device-based therapy, patients should have a proper evaluation of cardiovascular risk, medication safety, and the likely cause of ED.

Tell us more about the test that checks whether blood flow is adequate.

Penile Doppler ultrasound is a diagnostic test used by specialists to evaluate blood flow in and out of the penis. In some cases, medication is used during the test to help create an erection so the clinician can measure vascular response.

The results may help distinguish between different vascular patterns, such as reduced arterial inflow or venous leak. This type of testing is usually considered when the diagnosis is unclear, symptoms suggest a vascular cause, or treatment decisions require more detail.

Anything you’d like to say to summarize our today’s talk?

Sildenafil, tadalafil, and related ED medications can be useful when prescribed appropriately, but they are not risk-free. Patients should not increase dose, combine ED medicines, or change frequency on their own. Higher exposure can increase the risk of side effects, interactions, low blood pressure, and prolonged erection.

The safest approach is to use ED medication only after appropriate medical review and to combine treatment with broader health steps when relevant: regular exercise, balanced diet, smoking cessation, weight management, diabetes control, and cardiovascular risk management.