Since being on blood pressure pills, my husband is having a problem getting an erection. Is there a connection?

Yes. Blood pressure tablets can sometimes cause erection failure in men and may affect some women also. If this happens, your husband should tell his doctor because a change in medication could solve the problem. Erectile dysfunction is more common with diuretics and beta-blockers and less likely with angiotensin II antagonists and doxazosin.

Everyone has heard about Viagra. My husband has a poor erection: will it help him?

Viagra is a truly wonderful drug, but it does not suit or help everyone with erection problems (known as erectile dysfunction or ED). In 8 out of 10 people it helps restore an erection in men. It is not an aphrodisiac, so the penis will still need normal stimulation to make Viagra work. Doses are 25, 50 and 100 mg, taken 1 hour before sexual foreplay, and its effects lasts for 4-6 hours. Heart patients may benefit from Viagra because heart disease, rather than the drugs used to treat it, is the most common cause of ED. Always get advice from your doctor and do not buy it on the Internet. It does not cause heart attacks (nor do other treatments), any more than might occur by chance. Before trying it, you should have a check-up at the doctor's, and you may be asked to do an exercise ECG. Viagra reacts with nitrates and nicorandil (see the section Treatment in Chapter 3). Oral nitrates and nicorandil must be stopped for 1 week before Viagra is used, and the nitrate tablets under the tongue or spray should not be used for 12 hours before or after Viagra. Nitrates plus Viagra can cause a dangerous fall in blood pressure. Otherwise, Viagra is a very safe and effective treatment, providing you are guided medically - do not experiment without a medical opinion.

A friend of mine had a heart attack after taking Viagra: it seems dangerous to me. What do media reports say?

There is no increased risk of a heart attack from Viagra - in fact there were fewer cases when Viagra was compared with a placebo (where there was no active tablet taken). Your friend probably took it without medical advice.

Does the effect of Viagra wear off the more you use it?

No. After a year, 87 out of 100 men who benefited from it, still did so.

What happens if I get angina during sex after taking Viagra?

Do not use a nitrate tablet or spray at the same time. Stop your activity and sit or stand up. The pain should gradually settle. A glass of whisky or brandy might be helpful. Do not try again until you have discussed the event with your doctor.

Are there other heart drugs that may react with Viagra?

Currently you are advised not to be on nicorandil (a potassium channel activator) or nevibolol (a beta-blocker) until research has reported that it is safe to do so.

Nitrates help my angina but I would like to try Viagra - what should I do?

Citrates are relatively weak angina drugs, and have no proven benefit in preventing heart attacks or sudden death. They are used only to help relieve pain and breathlessness. Alternatives exist, so you can ask for your medicine to be changed. For example, you could try felodipine or amlodipine as alternatives. Once the change has proved successful (two weeks should be enough time), you can then try Viagra. Your doctor may need to ask a specialist about this, but most people can manage without nitrates.

I have tried Viagra but it only partly works - how can I improve things?

Thirst of all don't despair. Viagra does not always work first time you try it - indeed some people need seven or eight attempts before it 'kicks in'. If it is not effective at 50 mg, try the 100 mg tablet. Only one tablet a day is advised and it should be taken on an empty stomach, and no smoking or alcohol is advised. It begins to work in 30 minutes, is at its peak after 1 hour and gives you 'a window of opportunity' for 4-6 hours. Remember that you have to be stimulated for it to work. Side effects are not common. Headache and flushing with occasional indigestion occur but are not usually severe enough to warrant stopping taking it.