Why does Viagra cause heartburn?

If you’re reading this, it’s likely you’ve taken Viagra and are now dealing with an uncomfortable burning sensation in your chest—commonly known as heartburn. Fear not! We’re here to answer your burning  (sorry for the pun) questions about heartburn and Viagra, as well as provide solutions to help you enjoy the benefits of enhanced erections without discomfort. 

But before we dive in and help you understand why you get heartburn after taking Viagra, let’s go over some basics first.

What is erectile dysfunction?

Erectile dysfunction (ED), or impotence, is the difficulty in getting or maintaining an erection firm enough for enjoyable sexual activity [1]. While there’s no strict timeframe for diagnosing ED, experts suggest that experiencing these symptoms consistently for around six months may indicate a persistent issue. Erectile dysfunction is common and often increases with age or certain health conditions, affecting many men as they get older [2].

Erectile dysfunction can sometimes act as a warning sign for other health concerns, such as heart disease, diabetes, high cholesterol, and high blood pressure [3]. This is because many cases of ED are related to issues that affect blood flow, nerve function, hormone levels, or the erectile tissue itself. For instance, endothelial dysfunction—a condition affecting the inner lining of blood vessels—is often seen in men with ED and can be an early signal that blood vessels might need medical attention [4]. In a way, erectile dysfunction can serve as a “canary in the mineshaft,” alerting you to potential cardiovascular risks.

While physical factors are common causes of ED, mental health can also play a role, especially in younger men. Regardless of its cause, erectile dysfunction often affects confidence and relationships, impacting a person’s overall well-being. The good news is that ED is highly treatable, with various options available to help men regain their confidence and improve their quality of life. For more information or to discuss treatment options, contact us at info@medicalmojo.co.uk.

What is Viagra?

Viagra, often referred to as the “little blue pill,” is a medication primarily used to treat erectile dysfunction (ED). It belongs to a class of drugs known as PDE5 inhibitors, which also include:

• Cialis (Tadalafil)
• Spedra (Avanafil)
• Levitra (Vardenafil)

These medications work by relaxing the blood vessels in your penis, making it easier for blood to flow in and create an erection.

How does Viagra work?

Viagra (sildenafil) and other erectile dysfunction medications increase blood flow to the penis, helping men achieve and maintain an erection. These drugs belong to a group called phosphodiesterase type 5 inhibitors (PDE5 inhibitors) and work by boosting levels of a chemical in the body called cGMP [5]. Think of cGMP as the signal that opens the “floodgates” to allow more blood to flow into the tissues in your penis. With the floodgates open, blood rushes in, increasing pressure in the penis and leading to an erection.

What are the side effects of Viagra?

The adverse reactions most commonly observed were flushing (30.8%), headache (25. 4%), nasal congestion (18.7%), and heartburn (10.5%). All events were short-lived and mild [6].

What is heartburn?

Heartburn occurs when stomach acid travels back up into the oesophagus, the tube connecting your throat to your stomach. This can lead to discomfort and a burning sensation in the chest. Common symptoms include:

• A burning feeling in the chest
• An unpleasant bitter or acidic taste in the mouth
• Pain that worsens when lying down or bending over
• Difficulty with swallowing

When does heartburn become gastroesophageal reflux disease (GERD)?

While occasional heartburn is common, experiencing it more than twice a week may indicate gastroesophageal reflux disease (GERD) [7].

Why do you get heartburn?

When you eat, the food has to reach the stomach to begin digestion. It travels to the stomach via the oesophagus. Now, the stomach isn’t a pleasant environment, what with being full of acid. It was thought that even bacteria couldn’t live there until the discovery of the ulcer-causing bacteria Helicobacter Pylori.

The stomach maintains an acidic environment with a pH between 1.5 and 3.5, primarily due to hydrochloric acid (HCl) secretion. This acidity is essential for several vital functions:

1. Protein Digestion: Stomach acid converts pepsinogen into pepsin, an enzyme critical for breaking down proteins into smaller peptides. This step is fundamental for protein digestion, as pepsin works best in acidic environments [8].
2. Protection Against Pathogens: The stomach’s acidity kills or inhibits many harmful bacteria and pathogens that enter the digestive system, providing an immune defence against ingested contaminants [9].
3. Nutrient Absorption: Acidic conditions enhance the absorption of certain nutrients, notably iron and vitamin B12 [10].
4. Enzyme Activation and Digestion Support: Stomach acid helps activate digestive enzymes and break down food particles, making nutrients more accessible for absorption in the intestines.

How the stomach protects itself from acid

To protect itself from this acidic lake,  the stomach is lined with a thick mucus barrier that prevents the acid from damaging the stomach wall, thereby avoiding ulcer formation.

The stomach has several mechanisms to protect itself from the harsh, acidic environment required for digestion. Here’s how these protective measures work:

1. Mucus Barrier

• The stomach lining produces a thick layer of mucus that coats the gastric walls. This mucus is rich in bicarbonate, neutralising any acid that comes into contact with the stomach lining. This barrier protects the stomach wall from the acid’s corrosive effects [11].

2. Epithelial Cell Renewal

• The stomach epithelium rapidly regenerates, replacing cells approximately every 3-6 days. This constant renewal process helps repair any damage caused by acid or other digestive enzymes before it can develop into ulcers or other injuries [12].

3. Tight Junctions Between Epithelial Cells

• The cells lining the stomach are joined by tight junctions, impermeable seals that prevent acid from seeping between cells and damaging deeper layers of the stomach wall [13].

4. Bicarbonate Secretion

• Alongside the mucus layer, stomach cells secrete bicarbonate ions, which help neutralise the acid near the stomach lining [14].

5. Hormonal Regulation of Acid Secretion

• The hormone gastrin plays a role in regulating acid production by signalling parietal cells in the stomach to release hydrochloric acid. When the stomach’s pH reaches a sufficiently low level, negative feedback mechanisms reduce gastrin release, limiting further acid production to avoid excessive acidity that could damage the stomach lining [15].

These mechanisms ensure the stomach can survive in this hostile, acidic environment.

What is reflux?

For a simple organ like the oesophagus, whose main role is to act as a passageway, having the stomach as a “neighbour” isn’t ideal. The stomach holds concentrated acid, separated by a valve prone to leaks. Studies using pH monitoring techniques from the 1970s reveal that, in healthy people, the lower oesophagus can be exposed to stomach acid (pH <4) for up to 5% of a 24-hour period [16].

When the stomach’s acidic contents squeeze back through the leaky valve, the lower oesophageal sphincter (LES), they can damage the oesophagus.

Why does Viagra cause heartburn?

So, we have seen that the lower oesophageal sphincter is like a valve between the acidic environment of the stomach and the acid-free oesophagus. When the LES is leaky, the acid in the stomach can sneak into the oesophagus, which doesn’t have the same defensive mechanisms to deal with the low pH that the stomach does. We then feel this literal burning when this reflux happens. But what is it about Viagra that makes the LES leaky?

What causes the lower oesophageal sphincter, or LES, to leak?

Let’s quickly recap the mechanism of Viagra, which hopefully will shine some light on the leaky lower oesophageal sphincter. Remember that Viagra belongs to a class of drugs known as the phosphodiesterase type 5 inhibitors. This enzyme degrades a molecule, cGMP, responsible for relaxing the smooth muscle in the penile blood vessels. When these smooth muscles relax, blood flows into the penis to initiate an erection. The body turns off the erection by breaking down the cGMP with the enzyme phosphodiesterase.

Phosphodiesterase (PDE) type 5 terminates the actions of cGMP. PDE5 inhibitors such as sildenafil or Viagra, tadalafil, and vardenafil cause cGMP accumulation by inhibiting PDE5, which prompts smooth muscle relaxation [17].

Now the critical thing to bear in mind is that this doesn’t just happen in the penis; it occurs in all organs in the body, including the lower oesophageal sphincter (LES). In the LES, reduced pressure could increase the chance of acid reflux [17]. Viagra or sildenafil is a potent PDE5 inhibitor used in the treatment of erectile dysfunction and has been found to decrease the LES pressure and inhibit oesophageal propulsive force [18].

So, Viagra relaxes smooth muscle tissues, which can include the LES. When this muscle relaxes too much, it may not close properly, allowing stomach acid to flow back up and causing that uncomfortable burning sensation known as heartburn.

How common is heartburn associated with Viagra use?

A study looked at the incidence of side effects in 40 young sexually active men below the age of 40. They were either given sildenafil or a placebo, and the side effects, if any, were recorded in both arms of the study. The most common side effects were flushing (75% and 0%), headache (50% and 5%), dyspepsia (15% and 5%), unintentional incomplete sexual arousal (15% and 0%) and palpitation (15% and 10%) in groups of sildenafil and placebo, respectively [19].

In another study, of 256 participants, the adverse reactions most commonly observed were flushing (30.8%), headache (25. 4%), nasal congestion (18.7%), and heartburn (10.5%). All events were short-lived and mild [20].

Moreover, during sildenafil clinical trials and post-clinical studies, it has been reported that sildenafil induces dyspeptic symptoms as the most frequent adverse event besides headache and flushing [21].

Sildenafil and gastroesophageal reflux disease (GERD)

Since researchers became aware that Viagra use can trigger heartburn, the next question was whether long-term use could increase the risk of developing gastroesophageal reflux disease (GERD). Remember that GERD is defined as the presence of heartburn and/or regurgitation symptoms. These should either be mild and occur at least twice a week or be moderate-to-severe and happen at least once a week [7].

Sildenafil citrate, a specific PDE5 inhibitor commonly used to treat erectile dysfunction, is associated with digestive symptoms (dyspepsia) as a common side effect, alongside headache and flushing. As mentioned earlier, reduced LES pressure is a known risk factor for GERD and thus, it is theoretically possible that Sildenafil use can cause or exacerbate GERD as an adverse effect [22].

Can you use Viagra without heartburn?

While there’s no surefire way to avoid heartburn while taking Viagra, there are steps you can take to minimise your chances of discomfort:

Top tips to reduce heartburn symptoms

Food and Drink:

• Drink plenty of water with your Viagra tablet.
• Avoid large meals before taking your Viagra dose. A high-fat meal can delay the time Viagra takes to start working.
• Avoid heartburn-triggering foods; you know, the ones that taste nice, like fried, high-fat, spicy foods and caffeine.
• Try to avoid having your last meal immediately before bedtime. Leave a window of 3 to 4 hours before you turn in for the night.

Lifestyle Choices:

• Limit or avoid alcohol and smoking, as both can exacerbate heartburn.
• Avoid lying down immediately after taking Viagra; try to remain upright.
• Avoid lying down after eating.
• Choose loose-fitting clothing that doesn’t put additional pressure around your waist.

Medication Options:

• Try the lowest dose of Viagra that gives you a satisfactory erection.
• Try some over-the-counter antacids, such as Gaviscon.
• H2 blockers like famotidine (Pepcid) may help reduce symptoms.

Conclusion

Viagra is an effective solution for many men experiencing erectile dysfunction, but it can also lead to heartburn in some cases. If you find yourself dealing with this uncomfortable side effect, consider implementing the tips mentioned above for relief.

Alternatively, explore other erectile dysfunction treatments that may better suit your needs without the risk of heartburn. These will often involve making some lifestyle changes or even checking your testosterone levels. If you want further guidance about treating erectile dysfunction without PDE5 inhibitors, email us at info@medicalmofo.co.uk.

Getting support and guidance for sexual health

If you’re considering Viagra or other options to improve sexual health, speaking with a healthcare provider is a wise first step. The professionals at Medical Mojo offer expert guidance tailored to your unique health needs, helping you explore ways to enhance sexual satisfaction safely. Discussing personal concerns with a healthcare provider can make all the difference in finding the right approach, so don’t hesitate to ask questions and share any worries. Having professional support matters, especially when considering medications like Viagra.

Why choose Medical Mojo for sexual health support?

Are you thinking about Viagra or ways to boost your sexual health? Getting guidance from experienced professionals ensures that any treatment is both safe and suited to you.

Medical Mojo provides private, supportive telehealth services for men navigating sensitive issues like erectile dysfunction. Their team of qualified pharmacists, doctors, and therapists offers advice on Viagra and other options so you can make confident, informed decisions.

Here’s why Medical Mojo is a top choice for sexual health support:

• Private, judgement-free consultations from home
• Personalised advice based on your complete health profile
• Health screenings to ensure Viagra is right for you
• Ongoing support and follow-up throughout treatment
• Clear guidance on what to realistically expect from Viagra
• Holistic lifestyle advice to support better sexual health
• Access to evidence-based articles on all aspects of sexual health
• Health and lifestyle coaching to help you regain your mojo
• Bespoke medicines compounded by our expert pharmacy team

With Medical Mojo, you’ll gain a clear understanding of what Viagra can—and cannot—do for your sexual health, setting realistic expectations and making informed choices. For more information, get in touch.

Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice.

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