Viagra (Sildenafil) Triggers Both Erections and Heartburn

Viagra is a household word. It is now available generically as sildenafil. This drug has revolutionized the treatment of erectile dysfunction. It works by relaxing smooth muscle in the penis. The result is inflow of blood to the corpus cavernosum. As this spongy erectile tissue expands, an erection can be sustained. The very process that permits smooth muscle relaxation can cause erections and heartburn.

Sildenafil Side Effects:

There are several sildenafil side effects. One is headache, which can be disagreeable during love making. Another is flushing, but that may not be as troublesome. Nasal congestion can be unpleasant but should not interfere with intercourse. Heartburn, on the other hand, can be problematic, as this reader reports.

Sildenafil Leads to Erections and Heartburn:

Q. I take sildenafil (Viagra) for erectile dysfunction. It works quite well. But not long after taking it I experience pretty unpleasant heartburn. Needless to say, this interferes with the romantic mood. Do you have any recommendations?

Sildenafile and a Tale of Smooth Muscle:

A. All of the erectile dysfunction drugs (sildenafil, tadalafil and vardenafil, aka Viagra, Cialis and Levitra) can cause heartburn as a side effect. They work by relaxing smooth muscle that lines the blood vessels going into the penis.

However, smooth muscle elsewhere in the body, such as that in the lower esophageal sphincter in the digestive tract, also relaxes in response to these drugs. That promotes acid reflux.

Heartburn and Indigestion:

Dietary indiscretion is not the only cause of indigestion. Doctors use an old-fashioned word to describe this: dyspepsia. According to the Merriam-Webster Dictionary,  the word comes from the Greek dys (impaired or faulty) and pessein (to digest).

When people feel irritation or discomfort below their breast bone, it is frequently diagnosed as heartburn, indigestion or gastroesophageal reflux disease (GERD). What’s really happening, though, is that acid, partially digested food and other stomach contents are splashing up into the esophagus. How does that happen?

The problem arises at the bottom of the eating tube where a small ring of muscle separates the esophagus from the stomach. Think of your stomach as if it were an inflated balloon. As long as you pinch off the end tightly, no air can escape. But relax your fingers and whoosh, the air will come racing out.

Beware a Lazy Lower Esophageal Sphincter:

Like an inflated balloon, your stomach has greater pressure inside than out. Stomach acid, bile, gastrin and other irritating substances can escape into your esophagus were it not for a ring of muscle called the lower esophageal sphincter (LES). Like your fingers holding tight on a balloon and keeping air in, so too that ring of muscle helps keep stomach contents down where they belong.

If that sphincter gets weak or lazy, watch out! Heartburn is like to follow. Drugs like sildenafil that help relax smooth muscle in the penis can also relax smooth muscle in the LES (Alimentary Pharmacology & Therapeutics, Oct. 1, 2006).  The authors of this study did not report GERD in their experimental subjects even though the sphincter was relaxed. That said, the official prescribing information lists dyspepsia in 17% of subjects taking Viagra vs. 2% of people getting placebo. In other words, both erections and heartburn could result when smooth muscle relaxes.

What to Do About Erections and Heartburn?

We consulted a radiation oncologist who frequently has to help patients who complain of erectile dysfunction after treatment for prostate cancer. The recommendation: Take an acid-suppressing drug a few hours before swallowing sildenafil.

Any of the H2 antagonists should be helpful. That includes cimetidine (Tagamet), famotidine (Pepcid) and ranitidine (Zantac). Pepcid Complete contains both famotidine and the antacids calcium carbonate and magnesium hydroxide. It might work if taken an hour or two prior to love making.