Sildenafil, the active ingredient in Viagra, is used to treat erectile dysfunction. But can you take alcohol with sildenafil, and if you do, what are the consequences, if any?
Generally, it is not recommended to drink alcohol whilst taking sildenafil; it may seem a good idea at the time since alcohol is often the social lubricant needed in certain situations. However, alcohol can interfere with the ability of the body to absorb and process the sildenafil, making it less effective. At the same time, alcohol can increase the risk of side effects such as dizziness, drowsiness, and low blood pressure.
So, to ensure that you get all the benefits of sildenafil or Viagra without the risk of increasing side effects, it is best to avoid or limit alcohol consumption to a small amount.
Low testosterone and erectile dysfunction
Testosterone, the male sex hormone, is a vital hormone to ensure you enjoy a healthy sex life. In fact, in a men’s health clinic I used to run, when a man first presented with erectile dysfunction, I would immediately check his testosterone levels. Nine times out of ten, the testosterone levels would be below normal and prescribing testosterone replacement therapy or TRT usually reversed the erectile dysfunction with the bonus of increasing his libido. When you return a man’s testosterone levels to what he had in his twenties, he will then start to experience an erection every time the wind blows.
The andropause, the male menopause
As men age, their testosterone levels gradually decrease, and this slow decline is sometimes called andropause and often compared to the similar reduction of oestrogen that females experience, called menopause. However, with women, their hormone levels, not just oestrogen, by the way, but also testosterone and progesterone, decline rapidly as they have fallen off a cliff. However, men experience a slower, meandering decline, like a stream slowing making its way down the side of a mountain. Because it is a gradual effect, many men dismiss their accumulating symptoms down to ageing. One of the first signs of low testosterone is loss of the morning wood, with erectile dysfunction being another barn door sign of low testosterone.
SHBG and alcohol
When talking about testosterone levels, it’s not just their absolute value but also their carrier hormones, such as sex hormone binding globulin or SHBG, which the testosterone uses to get around the body. The point here is that once bound to the SHBG, the testosterone is not free to enter cells. You can visualise SHBG as a type of mop that sucks up free testosterone. Your testosterone is still there, but you can’t use it. So, you could have high bound testosterone levels but still suffer from low free testosterone when you have excess SHBG, which effectively sucks up the testosterone.
With regards to erectile dysfunction, it is also important to point out that excess alcohol can lead to liver damage and overproduction of sex hormone binding globulin (SHBG), thus leading to lower testosterone levels and erectile dysfunction. [1]
Testosterone and oestrogen
Remember we said women had testosterone earlier? Well, where do you think their oestrogen comes from? It comes from the testosterone molecule. With a few tweaks, testosterone can turn into oestrogen. So, again, you could have high testosterone levels, but if most of it is converted to oestrogen, you will have less free testosterone acting on cells in the body. What has this got to do with alcohol? Well, excess alcohol can promote this conversion of more of the testosterone to oestrogen. [1]
Alcohol, testosterone, SHBG and oestrogen
So, alcohol delivers a one-two combination to your testosterone; it promotes more SHBG production and converts more of the testosterone to oestrogen.
Since testosterone is a vital hormone for a healthy sex life, low testosterone levels lead to lowered libido; cutting back on alcohol is a good idea for a healthy erection.
Alcohol and nitric oxide
Alcohol is a depressant drug, and as blood alcohol levels rise, sexual arousal drops and it may even become more challenging to climax. It is also a nerve toxin, and excess can destroy the nerves that stimulate the penis. And it gets worse. Alcohol also disrupts the Nitric Oxide (NO), that wonderful molecule that causes vasodilation and allows blood to flood the penis, seriously hurting this erection-empowering flow. [2]
It has been estimated that up to half of all alcoholics have erectile dysfunction [3] or whisky dick. So, to make sure you have an erection, you need to remember to say ‘NO’ to alcohol.
The benefits of sildenafil
Phosphodiesterase type 5 inhibitors (PDE5i) such as sildenafil might also have an additional benefit other than treating erectile dysfunction. Researchers have found that sildenafil might also help prevent the unwanted gastric side effects of alcohol and non-steroidal anti-inflammatory drugs. [4] Truly, sildenafil is the gift that keeps on giving!
The dangers of alcohol and sildenafil in spontaneous intracerebral haemorrhage.
There is no large-scale data to suggest that there is an increase in the risk of spontaneous intracerebral haemorrhage due to the combined ingestion of alcohol and sildenafil. However, some doctors have identified several cases where spontaneous intracerebral haemorrhage (stroke) occurred after ingestion of alcohol and sildenafil. Where there is smoke, there is fire. Case studies are usually the first sign that a serious interaction could be causing serious consequences, such as stroke or heart attacks.
One case study identified a 57-year-old male patient with no underlying disease who suffered a middle cerebral artery (MCA) infarction(stroke) after taking two tablets of sildenafil with alcohol. The doctors speculated that the development of severe hypotension caused this infarction (blockage of a blood vessel) due to alcohol use with sildenafil.
However, this is just one case study, and more work needs to be done to discover if there is a causation or link between heart attacks and stroke and combining sildenafil with alcohol. [5]
Summary
The last sobering (forgive the pun) case study regarding the potential danger of a spontaneous cerebral infarction (stroke) when taking alcohol and sildenafil together should be enough to encourage you at least to moderate drinking whilst taking sildenafil.
Whilst all of our content is written and reviewed by healthcare professionals (me!), it is not intended to be substituted for or used as a substitute for medical advice. If you find what you read interesting and want more advice, get in touch. I would like to hear from you, especially if you have made it to the end of this article!
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References:
- Sinclair, M., Grossmann, M., Gow, P.J. and Angus, P.W., 2015. Testosterone in men with advanced liver disease: abnormalities and implications. Journal of gastroenterology and hepatology, 30(2), pp.244-251.
- Aydinoglu, F., Yilmaz, S.N., Coskun, B., Daglioglu, N. and Ogulener, N., 2008. Effects of ethanol treatment on the neurogenic and endothelium-dependent relaxation of corpus cavernosum smooth muscle in the mouse. Pharmacological Reports, 60(5), p.725.
- Wein, A.J. and Van Arsdalen, K.N., 1988. Drug-induced male sexual dysfunction. Urologic Clinics of North America, 15(1), pp.23-31.
- Duffin, R., Shaw, C.A. and Rossi, A.G., 2008. Sildenafil reduces alcohol?induced gastric damage: just say ‘NO’. British Journal of Pharmacology, 153(4), pp.623-624.
- S?PAH?O?LU, H., Bulut, K. and ESMAO?LU, A., 2021. Middle cerebral artery infarction associated with sildena?l citrate (Viagra) use. Journal of Emergency Medicine Case Reports, 12(1), pp.25-27.
