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    I am a professional urologist and to make things clear I would like to explain the mechanism of male erection. Erection takes place when blood flows into the penis, provided the penis valves prevent the blood from flowing back during the erection. The blood flow into the penis starts as soon as the brain pulses a signal, which is delivered by nerves to penis blood vessels. Therefore, any obstacle on the way from the brain to the penis valves may result in erection failure. This occurs pretty often and is known as erectile dysfunction. The causes of erectile dysfunction are numerous; among them is diabetes, hypertension, valve defects, low testosterone level, atherosclerosis, psychiatric disorders and many others. Every case is individual of course, but treatment of any kind of erectile dysfunction starts with oral medications. You can't even imagine what in costs me to hold them in leash. azithromycin dose chlamydia Sildenafil is a potent vasoactive chemical that causes dilation of blood vessels throughout the body, including the penis. When used in combination with other medications that affect blood pressure, viagra (sildenafil) can contribute to an unsafe sudden drop. The best thing to do is check with your doctor and maybe try the medication in a controlled setting (doctor's office) to make sure it's safe. Read more If you're taking these meds in order lower your BP or in order to prevent angina, would probably want some sort of stress test first. If taking for AFib and no symptoms would want Holter monitor first. But, since both may cause GI upset so it would be hard to know which one may cause nausea if taking them together. Having stated this, it is my opinion that you may be taking a significant risk to your own life by starting such a medication without an in-person consultation with a medical professional. So, taking them in 6 hrs apart is a good precaution. Read more According to Medscape interaction checker, metoprolol may increase the blood level or effect of Viagra (sildenafil) due to reduced body clearance of the Viagra (sildenafil). I have many patients on Viagra (sildenafil) and Cialis taking similar meds! Read more See 1 more doctor answer POTS has a number of causes, and one can be the use of almost any anti hypertensive, including the ones you list. Besides, the time to prove Viagra's best possible effect for ED is a man with empty stomach and after a good mental and physical rest with full recharge of energy & ability. So careful monitoring is advised with this combination. Read more No adverse interaction here, but you are on meds for BP and cholesterol. So, because of the Postural Orthostatic part of the disorder, if you have high pressure lying down and low standing, its hard to find an agent that will help. Definitely need to consult your primary practitioner and get a referral to a specialist, usually a cardiologist. Read more Try taking either one separately and see which one works better for you.

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    Even if your high blood pressure (or hypertension) has caused erectile dysfunction (ED), you have every reason to be optimistic about the future and a healthy sex life. No one of them has been proven to work better than the others. ED is a common problem associated with high blood pressure, but there are many proven treatments you can try. But the time they take to start working and the duration of their effects vary. A doctor's firstchoice for treating erection problems is usually one of the pills called PDE5 inhibitors. That's something you may want to consider based on your sexual habits. They make it physically possible to get an erection when you are aroused. For example, does spontaneity matter to you, or do you usually plan sex ahead of time? Viagra starts working in about 15 to 30 minutes and its effects last about two to four hours. Levitra starts working in about 30 to 60 minutes and lasts four to five hours If erectile dysfunction pills are out of the question, or if pills haven't worked for you, don't worry. Alprostadil is another drug for erectile dysfunction. One brand, called MUSE, is an alprostadil pellet that you insert into the tip of your penis with an applicator. In combination with ED drugs, these 56 drugs can cause dangerous falls in blood pressure that could lead to a heart attack or stroke; a potentially harmful "overdose," even when taking the recommended amount; and decrease the effectiveness of the ED drugs themselves. The drugs include the usual suspects, such as nitrates for blood pressure. Taken in combination with Viagra, Cialis ior Levitra nitrates can lead to potentially lethal drops in blood pressure. But the list also includes some surprises -- household name drugs that shouldn't be taken with ED pills -- including Flomax, Provigil and grapefruit juice. Some drugs increase plasma concentrations of ED drugs, potentially leading to toxicity, and others reduce those concentrations, making the drugs ineffective.

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