Clinical Question: Should men avoid drinking alcohol while taking sildenafil?

Setting: Other

Study Design: Crossover trial (randomized)

Synopsis: Eight healthy college students participated in this crossover trial. On separate occasions, each participant received, in a randomized manner, (1) sildenafil in a dose of 100 mg, (2) red wine, (3) red wine and sildenafil, or (4) double placebo (i.e., a sugar pill and a nonalcoholic bottle of wine). When the combination was studied, each participant in the group drank one full bottle of wine over one hour, beginning one hour after the administration of sildenafil. Cardiac index, heart rate, and mean arterial pressure were determined every 15 minutes for three hours. The study design was somewhat artificial and may not have reflected typical use, because the men were young and did not exercise or have intercourse following administration of the wine and/or sildenafil.

Sildenafil given alone reduced mean arterial pressure by 7 percent and peripheral vascular resistance by a maximum of 24 percent with no effect on heart rate or cardiac index. Red wine increased heart rate by 27 percent and cardiac index by a maximum of 15 percent, with an initial small (6 percent) rise in blood pressure followed by a small (7 percent) fall. When given together, there was no difference in heart rate, mean arterial pressure, cardiac index, or peripheral vascular resistance compared with alcohol given alone. This study did not evaluate the effect of the wine on sexual function.

Bottom Line: Drinking alcohol following a dose of sildenafil has no more effect on young men's cardiovascular parameters than alcohol alone. Although we need to conduct more research in more men—especially older men who are exercising—this preliminary information tells us that we do not need to caution men to avoid alcohol if they plan to take sildenafil. (Level of Evidence: 2b)