Nitroglycerin has been known to improve erectile functioning for many years, although no product has ever been commercially available for this indication. While there is currently no recommendation on its use in the American Urological Association guidelines, many men are interested in trying this treatment and hoping it will become available in an FDA approved form soon. About half of men aged 40 to 70 will experience erectile dysfunction, meaning there is a large group of people who could benefit from a more effective or easier to use treatment.
Erectile Dysfunction and Causes
It is known that ED is a multi-factorial condition – there are many possible causes and the causes can vary between individuals. There are psychological causes like stress as well as physical causes such as health conditions like diabetes and cardiovascular issues. Psychological issues may benefit from counseling on sexual health. Eating healthy, getting exercise and finding ways to reduce stress may all help as well. However many men still experience ED even after making lifestyle changes. ED medications that exist currently focus on the physical aspects of ED – how blood flows to and from the genital area to maintain an erection.
What is Nitroglycerin?
Nitroglycerin is in class of drugs called nitrates, which are used for various conditions including most commonly angina pectoris or chest pain associated with heart disease. It is also prescribed to treat anal fissures by reducing blood pressure to the anus. For erectile dysfunction, nitroglycerin cream or gel increases blood flow to the penis. The medication is available in various forms including tablets, patches, ointments, and intravenous solutions. It can be compounded by a pharmacy in strengths that are not commercially available.
Benefits of a Topical ED Medication
Nitroglycerin may work in a few different ways. For one, it helps dilate blood vessels to improve blood flow to the penis. A compound called nitric oxide is also released by nitroglycerin, which helps relax the smooth muscle in the corpus cavernosum. This effectively prevents blood flow away from the penis.
Nitroglycerin topical gel or cream tends to work fast based on clinical trials to-date. Most men will notice its effects within 10 minutes of application. In a clinical trial of 232 men, nitroglycerin 0.2% gel in a proprietary vehicle was shown to be effective. It worked especially well in patients with milder erectile dysfunction. In addition it worked quickly – within 5 minutes of any intercourse attempt in 44% of participants. The reason that the gel worked better in men with milder ED in this study may have been dose related, and a higher dose may be more effective in moderate to severe cases.
It is clear from the research that one of the obvious benefits of nitroglycerin gel may be how quickly it works. If a drug can work in 5-10 minutes of initiating sexual activity this would be much faster than oral medications like sildenafil, which can take a half an hour or more. There are several other benefits to this medication compared to PDE5 inhibitors. A drug like sildenafil has a half life that far exceeds the average duration of sexual activity. The half life of sildenafil is around 3-4 hours while for topical nitroglycerin it is under an hour.
Another benefit of topical administration of an ED medication is that there are fewer interactions between the medication and food and drink that are consumed before its use. This means that with topical nitroglycerin, meals and moderate alcohol intake are OK and do not need to be planned (in addition to planned sexual activity).
The most common side effects associated with nitroglycerin cream are headache and nasopharyngitis (inflammation of the nasal passages). Notably these side effects are also common with PDE5 inhibitors. With nitroglycerin gel or cream, it is possible that some of the medication will transfer to the individual’s sexual partner. In a small percentage of cases the partner then may experience similar side effects.
Can Nitroglycerin be Combined with a PDE5 Inhibitor?
The best answer right now is that in most cases – no. The use of nitroglycerin and PDE5 is contraindicated. Using these medications together may result in a serious drop in blood pressure and adverse health effects. Some recent research has suggested that the actual incidence of adverse effects may not be that high, however most prescribers will only suggest using one or the other.
It is important to note that PDE5 inhibitors are very effective for many men who may not need an additional treatment. However for men looking for a medication that allows greater spontaneity, less interaction with food and alcohol, and no gastrointestinal side effects – nitroglycerin cream and gel may be a great option. Right now nitroglycerin cream can only be made by a compounding pharmacy however it may be available commercially in an FDA approved form in the future.
Articles
Nitrates and Erectile Dysfunction Meds? Increasingly Common, Mostly Benign (tctmd.com)
Onset and duration of action of sildenafil for the treatment of erectile dysfunction – British Journal of Clinical Pharmacology
Erectile Dysfunction: AUA Guideline (2018) – American Urological Association