Viagra and nitroglycerine don’t mix

Dear Dr. Roach: My husband is taking Eliquis 5 mg (half a tab daily). He has had erectile dysfunction for 15 to 20 years and is 78 years old. Since we are in a new marriage, he obtained Viagra in Mexico. His cardiologist would not prescribe it. What precautions should he take or symptoms to look for? He also takes hydralazine, metoprolol, Lipitor, and Isordil.

J.B. Answer: While I wish you both a happy marriage, he should absolutely listen to his cardiologist. Viagra cannot be taken with any form of nitroglycerine.

Isosorbide mononitrate (Isordil) is a long-acting form of nitroglycerine. In combination with Viagra or similar medicines, your husband’s blood pressure can drop into a very dangerously low level and stay that way a very long time. He should talk to his regular doctor or a urologist about other options (such as alprostadil) that can be safely taken along with nitroglycerinelike drugs.

Dear Dr. Roach: I am currently dealing with LPR and taking omeprazole and Pepcid. If the reason for my LPR is weakening of the sphincter, how can the surge of acid stop without medication since medication only treats symptoms and does nothing to help the sphincter?

E.M.

Answer: LPR stands for laryngopharyngeal reflux, which is when stomach contents, including stomach acid, go backward (“reflux”) up the esophagus, all the way to the larynx and pharynx. This potentially causes damage to these structures. The major symptoms of LPR are voice changes, cough, throat clearing and a sense of something in the throat.

Initial treatment of LPR should be behavioral: avoiding triggers (like alcohol or chocolate); eating smaller meals; and allowing several hours between eating and exercise or sleep.

Omeprazole and other proton pump inhibitors effectively stop acid production in the stomach. Famotidine (Pepcid) and other H2 blockers reduce acid secretion incompletely. While neither of these stops the stomach contents from backing up, the damage to the tissues is much less and symptoms are decreased when there is less (or no) acid in the backed-up liquid. Treatment to stop reflux, such as surgery, has been tried in people who did not respond to antacid medications. Unfortunately, only 10% had relief of symptoms.