The dangers of mixing erectile dysfunction medicine and ‘poppers’

Many men would have at least heard of, if not used, sildenafil or tadalafil (usually known by their brand names Viagra or Cialis) – two drugs that can help men deal with erectile dysfunction (ED).

In layman's terms, ED is when a man has difficulty getting or keeping an erection or experiences problems engaging in sexual activity due to their penis not being hard enough.

ED is very common and becomes more common as men age – an Australian survey showed at least one in five men over the age of 40 has erectile problems, and about one in 10 are completely unable to have erections. With increasing age, the chance of having erectile problems increases.

To treat ED, many men will be prescribed Phosphodiesterase type-5 (PDE5) inhibitors (of which sildenafil or tadalafil are the best-known).

About half of the Australian men who have ED have used PDE5 inhibitors.

What are PDE5 inhibitors, and how do they work?

Getting and maintaining an erection involves changes in blood flow within your penis in response to nerve stimulation. PDE5 inhibitors work by helping to open up the blood vessels in the penis, allowing blood to flow into the penis, and causing an erection. 

These treatments are safe for most men, although side effects can include headache, nausea, dizziness, nasal congestion, muscle pain and back pain. Although uncommon, sildenafil can also cause more serious side effects such as priapism (prolonged, painful erection) and vision problems (mostly in older men).

No one should use them without first speaking with a health professional. 

However, these medicines can be misused by guys looking to get harder, more reliable erections and increase their sexual performance and self-esteem. 

Sometimes, men mix these prescription medicines with 'recreational' drugs such as 'poppers'.

What are poppers?

Poppers, also known as amyl nitrate, are a liquid drug that can give an instant high when inhaled.

They are sold in small bottles, and it is believed the nickname "poppers" comes from when they were sold in capsules that were cracked or 'popped' to release the chemical. They are particularly popular in the LGBTQ+ community.

Poppers are vasodilators, which means they widen blood vessels. When inhaled, they cause a dip in blood pressure that can result in a short burst of euphoria and/or relaxation.

Poppers are relatively low-risk compared to other illicit drugs, but there are several negative health effects associated with their use.

Poppers can also burn skin on contract and potentially lead to 'poppers maculopathy', which can affect users' vision. 

Why do some people mix Viagra and poppers?

Some men consume ED medicines recreationally and mix them with other drugs such as alcohol, ecstasy, GHB or amphetamine – and sometimes poppers. 

Some men who do this feel poppers help reduce their sexual inhibitions. Poppers can relax some muscles in the body, including those found in the anus and vagina – making anal and vaginal sex more pleasurable or comfortable.

Why is this behaviour risky?

Nitrates or nitrites (the active ingredients in poppers) can interact with PDE5 inhibitors and cause severely low blood pressure that can kill.

PDE5 inhibitors alone can cause blood pressure to drop. Usually, this happens minimally in a young and healthy patient.

However, when another blood pressure-lowering drug is taken with it, this can cause a further drop in blood pressure, which can be deadly.

Besides that, the combination of sildenafil and poppers (or any drug that lowers inhibitions) can potentially increase the risk of contracting a sexually transmitted disease due to risky sexual behaviour, such as:

• Consumers can sustain more and longer sexual encounters
• Decreased inhibitions may potentially lead to risky sexual practices

Poppers can dilate blood vessels in the anal canal and decrease pain sensation, which allows a person to participate longer in anal intercourse, which potentially increases the risk of injury. This can increase the risk of transmitting HIV and STDs.

As with most drugs, the only safe way to use sildenafil or tadalafil is as prescribed by a medical professional. And while poppers are on the lower end of the risk-factor scale of illicit drugs, mixing them with ED medications and other drugs can result in the worst possible outcome.