On this page Jump to a section
- Key facts
- Is Viagra bad for your heart?
- Decision guide: what to do next
- Viagra and heart conditions: what the labels say
- Can Viagra or Cialis cause a heart attack or stroke?
- Does Viagra increase heart rate?
- Is sex safe for my heart?
- ED as an early warning sign of heart disease
- Is Cialis good for your heart? What research shows
- Safety checks before ED medication
- What each path includes
- If ED is the problem you want treated now
- Mendoxa plans and prices
- FAQ
- How we wrote this
- Sources and references
Key facts at a glance
- Label warning
- ED drugs should not generally be used when sexual activity is inadvisable because of heart statusViagra (sildenafil) label · DailyMed
- Recent heart attack
- Viagra: caution within 6 months (Viagra (sildenafil) label); Cialis: not recommended within 90 daysCialis (tadalafil) label · DailyMed
- Nitrates
- Contraindicated with sildenafil and tadalafil (Cialis (tadalafil) label)Viagra (sildenafil) label · DailyMed
- Heart attack reports
- Reported after approval; the label says it is not possible to determine whether Viagra caused themViagra (sildenafil) label · DailyMed
- ED and heart risk
- ED was linked to higher cardiovascular event risk in a 14-study meta-analysisVlachopoulos 2013 · PubMed
- Compounded status
- The Mendoxa compounded tablet is not FDA-approvedFDA compounding Q&A
Is Viagra bad for your heart?
The main checks are your cardiovascular status, the exertion of sex and drug interactions. The Viagra (sildenafil) label says: “There is a potential for cardiac risk of sexual activity in patients with preexisting cardiovascular disease.” It says ED treatment should generally not be used when sexual activity is inadvisable because of cardiovascular status.
Why is Viagra bad for the heart in some men? Sildenafil widens blood vessels: the Viagra (sildenafil) label reports transient supine blood pressure decreases in healthy volunteers (mean maximum 8.4/5.5 mmHg), “of little consequence in most patients,” but asks prescribers to consider whether men with heart disease “could be affected adversely by such vasodilatory effects, especially in combination with sexual activity.”
Read the sildenafil guide and Viagra, Cialis and blood pressure for blood-pressure detail from the Viagra (sildenafil) label and Cialis (tadalafil) label; ED and blood pressure covers the link from the other side.
Who should not take ED pills without a cardiology check
Use this order before starting ED pills.
- Symptoms during sex? Stop and seek medical attention; do not continue to test your tolerance (Cialis (tadalafil) label).
- Take or carry nitrates, or take riociguat? Sildenafil and tadalafil are contraindicated with these medicines; ask the prescribing clinician about your options (Viagra (sildenafil) label; Cialis (tadalafil) label).
- A condition in the label table, or advice to avoid exertion? Ask your treating clinician whether sex and ED treatment are appropriate now; a cardiology assessment may be needed (Viagra (sildenafil) label; Cialis (tadalafil) label).
- Stable heart status and no contraindicated medicine? Start an ED assessment with your complete history; the prescriber still needs to determine suitability (Viagra (sildenafil) label; Cialis (tadalafil) label).
Prepare for the visit: bring the date of any heart attack or stroke, recent blood-pressure readings, your diagnoses, and the names of all medicines and supplements. Include medicines used only occasionally. For the medication discussion, read ED and blood pressure and ED medication and nitrates.
Viagra and heart conditions: what the labels say
“Use with caution” and “not recommended” are different label instructions. The Viagra (sildenafil) label says there are no controlled safety or efficacy data in its listed groups and, “if prescribed, this should be done with caution.” The Cialis (tadalafil) label says its listed groups were excluded from clinical trials and the drug “is not recommended” for them until more information is available.
| Heart condition | Viagra (sildenafil) label, section 5.1 | Cialis (tadalafil) label, section 5.1 |
|---|---|---|
| Recent heart attack | “myocardial infarction … within the last 6 months”: no controlled data; “if prescribed, this should be done with caution” (Viagra (sildenafil) label) | “myocardial infarction within the last 90 days”: “not recommended” (Cialis (tadalafil) label) |
| Recent stroke | Stroke “within the last 6 months”: no controlled data; caution (Viagra (sildenafil) label) | “stroke within the last 6 months”: not recommended (Cialis (tadalafil) label) |
| Arrhythmia | “life-threatening arrhythmia within the last 6 months” (Viagra (sildenafil) label) | “uncontrolled arrhythmias” (Cialis (tadalafil) label) |
| Blood pressure | “resting hypotension (BP <90/50 mmHg) or hypertension (BP >170/110 mmHg)” (Viagra (sildenafil) label) | “hypotension (<90/50 mm Hg), or uncontrolled hypertension” (Cialis (tadalafil) label) |
| Angina | “coronary artery disease causing unstable angina” (Viagra (sildenafil) label) | “unstable angina or angina occurring during sexual intercourse” (Cialis (tadalafil) label) |
| Heart failure | “cardiac failure” (Viagra (sildenafil) label) | “New York Heart Association Class 2 or greater heart failure in the last 6 months” (Cialis (tadalafil) label) |
| Outflow obstruction | Aortic stenosis or idiopathic hypertrophic subaortic stenosis: “Use with caution” (Viagra (sildenafil) label) | Aortic stenosis or idiopathic hypertrophic subaortic stenosis “can be sensitive to the action of vasodilators” (Cialis (tadalafil) label) |
| Nitrates | Contraindicated with organic nitrates or nitrites “in any form” (Viagra (sildenafil) label) | Contraindicated with “any form of organic nitrate” (Cialis (tadalafil) label) |
Sources: Viagra (sildenafil) label, revised 12/2017; Cialis (tadalafil) label, cardiovascular section. Accessed Oct 23, 2026.
These are label categories, not a self-clearance checklist: passing a time window does not establish suitability. Bring your dates, diagnoses and medication list to the clinician reviewing your case.
Could Mendoxa ED care fit you?
Online ED visit · Prescription required · Independent licensed providers · Not available in California
Can Viagra or Cialis cause a heart attack or stroke?
Heart attacks and cerebrovascular events have been reported after Viagra use; those reports do not establish that Viagra caused them. The Viagra (sildenafil) label, section 6.2, lists myocardial infarction, sudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage and transient ischemic attack, and notes that most—but not all—patients had cardiovascular risk factors.
The Viagra (sildenafil) label states: “It is not possible to determine whether these events are related directly to VIAGRA, to sexual activity, to the patient's underlying cardiovascular disease, to a combination of these factors, or to other factors”. The Cialis (tadalafil) label also reports heart attack and stroke after approval with the same causation caveat.
Chest pain, dizziness or nausea during sex: stop and get medical help right away. Tell emergency staff when you last took sildenafil or tadalafil, and do not self-administer a nitrate after taking either drug (Viagra (sildenafil) label; Cialis (tadalafil) label). See ED medication and nitrates.
Does Viagra increase heart rate?
The available label studies do not show a meaningful resting heart-rate rise, but they do not predict your individual response. The Viagra (sildenafil) label heart-rate figures below came from a small intravenous pilot study, not an oral ED-tablet trial; the Cialis (tadalafil) label finding came from healthy men.
| Measure | Viagra (sildenafil) label | Cialis (tadalafil) label |
|---|---|---|
| Blood pressure, healthy men | Mean maximum supine decrease 8.4/5.5 mmHg, transient (Viagra (sildenafil) label) | No significant difference vs placebo; difference in mean maximal supine decrease 1.6/0.8 mm Hg (Cialis (tadalafil) label) |
| Heart rate | 8 men with stable ischemic heart disease, open-label uncontrolled pilot using intravenous sildenafil: 67 bpm at rest before vs 66.9 bpm after sildenafil (Table 3, Viagra (sildenafil) label) | “no significant effect on heart rate” in healthy men (Cialis (tadalafil) label) |
| Exercise with heart disease | 144 men with stable angina: exercise result “statistically non-inferior to placebo” (Viagra (sildenafil) label) | 23 men with stable coronary artery disease: mean total exercise time difference of 3 seconds vs placebo (Cialis (tadalafil) label) |
| With alcohol | — | 5 units or more can increase orthostatic signs “including increase in heart rate” (Cialis (tadalafil) label) |
Sources: Viagra (sildenafil) label, section 12.2; Cialis (tadalafil) label, sections 5.9 and 12.2. Accessed Oct 23, 2026.
These are separate studies with different populations, routes and methods. The figures cannot establish which drug is safer or predict the effects of a compounded combination.
Alcohol changes the picture: the Cialis (tadalafil) label warns that 5 or more units with tadalafil can raise heart rate and lower standing blood pressure. Read ED and alcohol and how much Viagra is too much.
Is sex safe for my heart?
For many people with stable heart disease, cardiology consensus treats sex as moderate exercise. The Princeton III consensus says “Sexual activity between couples in a longstanding relationship equates to approximately 3 Mets” and describes low-risk patients as those who “can generally perform exercise of modest intensity without symptoms.”
The same Princeton III paper lists high-risk profiles such as “unstable or refractory angina pectoris, uncontrolled hypertension,” where stabilization comes first. The American Heart Association also published a 2012 scientific statement on sexual activity and cardiovascular disease (Levine et al., Circulation); ask your cardiologist how it applies to you.
That is why the Viagra (sildenafil) label asks for a determination of underlying causes “following a complete medical assessment.”
ED as an early warning sign of heart disease
New ED can be a reason to check your heart, not just to treat erections. NIDDK lists “heart and blood vessel diseases, such as atherosclerosis, high blood pressure, and stroke” among ED causes and says “ED may be a symptom of another health problem.”
A meta-analysis of 14 cohort studies involving 92,757 participants (2013) linked ED with higher cardiovascular-event risk. That is an association, not a prediction that an individual with ED will have a heart attack. Bring new or worsening ED up at your health visit.
Mention blood pressure, cholesterol, diabetes and smoking at the visit; see ED and diabetes and can ED be reversed?
Is Cialis good for your heart? What research shows
Cialis is not approved to protect the heart, and research does not prove it does. The Cialis (tadalafil) label lists ED, BPH symptoms and both together as indications; heart protection is not one of them.
A 2017 retrospective study examined ED treatment and cardiovascular outcomes after a heart attack. It concerns PDE5 inhibitors as a class, not proof that Cialis itself protects the heart. Observational research cannot establish that taking a drug causes a cardiovascular benefit; do not start Cialis for heart protection (see the Cialis (tadalafil) label indications).
The nitrate warning still applies. The Cialis (tadalafil) label allows consideration of emergency nitrates only in a life-threatening situation after at least 48 hours, under close medical supervision with monitoring; this is not permission to combine them yourself. For sildenafil restrictions, see the Viagra (sildenafil) label. Compare sildenafil and tadalafil and read the tadalafil guide.
Safety checks before ED medication
- Sildenafil and tadalafil are contraindicated with organic nitrates or riociguat (Viagra (sildenafil) label; Cialis (tadalafil) label).
- An erection lasting more than 4 hours needs immediate medical care (Viagra (sildenafil) label; Cialis (tadalafil) label).
- Stop and seek care for sudden vision loss or sudden decrease or loss of hearing (Viagra (sildenafil) label; Cialis (tadalafil) label).
- Common adverse effects include headache and flushing with sildenafil, and headache, indigestion and back pain with tadalafil (Viagra (sildenafil) label; Cialis (tadalafil) label).
- The APOKYN (apomorphine) label contraindicates use with 5HT3 antagonists such as ondansetron and warns about nausea and fainting.
Also review alpha-blockers and blood-pressure medicines with your prescriber: both labels warn about additive blood-pressure lowering (Viagra (sildenafil) label; Cialis (tadalafil) label). Read how much Viagra is too much before changing how you take a prescription.
What each path includes
What each path includes depends on the question being answered. A heart assessment considers whether sexual activity is advisable (Viagra (sildenafil) label; Cialis (tadalafil) label); an ED assessment explores medical, sexual and medicine history and may include an exam or tests.
The Mendoxa online visit starts the ED-care conversation. Independent licensed providers review your history and medicines and may approve treatment, request more information or decline. Prescription required. An online intake does not establish that sex is safe for your heart; use the decision guide above to identify what to discuss with your treating clinician.
Review ED medication options or what Mendoxa ED care includes. The compounded Mendoxa tablet is not FDA-approved.
If ED is the problem you want treated now
Make the next step a review of your own history. In the online visit, share your heart conditions, blood-pressure readings and complete medicine list. Independent licensed providers determine whether Mendoxa ED care is appropriate; the cardiovascular warnings in the Viagra (sildenafil) label and Cialis (tadalafil) label are relevant to that discussion. Prescription required.
The tablet combines sildenafil, tadalafil and apomorphine; it is not FDA-approved. Ingredient references are the Viagra (sildenafil) label, Cialis (tadalafil) label and APOKYN (apomorphine) label; APOKYN is an injectable Parkinson’s treatment, and its label is not approval of this ED combination.
The Viagra (sildenafil) label and Cialis (tadalafil) label say safety and efficacy with other PDE5 inhibitors have not been studied and advise against such combinations. Discuss this limitation and FDA-approved alternatives with the provider before choosing a compounded combination.
Review the combination ED tablet guide before starting. If your heart clinician has given restrictions on sex or medicines, include those instructions in your intake.
Mendoxa ED plans and prices
The Mendoxa ED tablet is a compounded rapid-dissolve tablet with sildenafil (the active ingredient in Viagra), tadalafil (the active ingredient in Cialis) and apomorphine (APOKYN label). It dissolves under the tongue. A licensed clinician decides if it fits you and selects the strength. Compounded medicines are not FDA-approved.
| Tablets per month | 1-month total | Per tablet (1 month) | 3-month total | Per tablet (3 months) |
|---|---|---|---|---|
| 6 tablets / month | $129 | $21.50 | $329 | $18.28 |
| 10 tablets / month | $149 | $14.90 | $379 | $12.63 |
| 20 tablets / month | $179 | $8.95 | $449 | $7.48 |
The 3-month total covers three months at the monthly tablet quantity shown.
If prescribed · Cancel anytime · Available in 49 states (not California). Prices from the Mendoxa intake at try.mendoxa.co/f/ed on Oct 23, 2026. The intake always shows the current price.
Other safety questions: Viagra side effects, ED pills and glaucoma or vision loss and do statins cause ED.
Related reading: blood thinners and ED.
FAQ
Is Viagra bad if you have a heart condition?
It depends on the condition and how stable it is. The Viagra (sildenafil) label says ED drugs should not generally be used when sex is inadvisable because of your heart and lists recent heart attack, stroke, life-threatening arrhythmia, unstable angina, cardiac failure and resting blood pressure below 90/50 or above 170/110 as groups without controlled data; nitrates are contraindicated.
Can Viagra cause a stroke?
Strokes and brain bleeds have been reported after approval, but the Viagra (sildenafil) label states “It is not possible to determine whether these events are related directly to VIAGRA,” to sexual activity or to underlying disease. The Cialis (tadalafil) label lists stroke in its postmarketing reports with the same caveat and does not recommend Cialis within 6 months of a stroke.
Which is better for heart patients: Cialis or Viagra?
The Viagra (sildenafil) label and Cialis (tadalafil) label do not establish a heart-safety winner. Both are contraindicated with nitrates, and their cardiovascular cautions differ. The Cialis label requires at least 48 hours before nitrates can be considered for a life-threatening emergency, with close medical supervision and monitoring; that is not a self-dosing rule. Your prescriber needs to choose based on your history and medicines.
Can you take Viagra with clopidogrel?
The Viagra (sildenafil) label does not name clopidogrel, so the label alone cannot clear this combination for you. Its aspirin bleeding-time findings do not answer the clopidogrel question. Ask your prescriber to review clopidogrel, why you take it, and your full medicine list before using sildenafil.
Does Viagra increase heart rate?
The Viagra (sildenafil) label reports resting averages of 67 bpm before and 66.9 bpm after intravenous sildenafil in an uncontrolled pilot study of 8 men with stable ischemic heart disease; this was not an oral-tablet trial. The Cialis (tadalafil) label reports no significant heart-rate effect in healthy men. These findings cannot predict your individual response.
Can I get ED treatment online if I have heart disease?
You can start an online assessment; Independent licensed providers review your history and medicines and decide suitability. Prescription required. A condition flagged in the Viagra (sildenafil) label or Cialis (tadalafil) label may need assessment by your treating clinician before ED treatment. The Mendoxa compounded tablet is not FDA-approved.
Ready to see if the Mendoxa ED tablet fits you?
From $129/month if prescribed · Cancel anytime · Available in 49 states (not California)
How we wrote this
Written by the Mendoxa editorial team · Sources: DailyMed/FDA. Medical facts on this page come from the FDA-approved labels on DailyMed and Drugs@FDA; each drug name links to its label. We checked the cardiovascular warnings and postmarketing sections of the Viagra (sildenafil) label and Cialis (tadalafil) label, plus the APOKYN (apomorphine) label, on Oct 23, 2026. Label quotations retain the distinction between caution, not recommended and contraindicated. We identify study populations and routes, keep adverse-event reports separate from proof of causation, and use NIH/PubMed research for context. The AHA statement is cited by bibliographic record only. Ingredient labels describe approved products; they do not establish the safety or effectiveness of the Mendoxa compounded combination.
Updated Oct 23, 2026. This page is general information, not medical advice. A licensed clinician decides what fits you.
References
- DailyMed: VIAGRA (sildenafil citrate) tablet, film coated, label revised 12/2017. Accessed Oct 23, 2026.
- DailyMed: CIALIS (tadalafil) tablet, film coated, label revised 3/2026. Accessed Oct 23, 2026.
- DailyMed: APOKYN (apomorphine hydrochloride) injection, label revised 6/2022. Accessed Oct 23, 2026.
- FDA (Drugs@FDA): VIAGRA (sildenafil) prescribing information, NDA 020895. Accessed Oct 23, 2026.
- FDA (Drugs@FDA): CIALIS (tadalafil) prescribing information, NDA 021368. Accessed Oct 23, 2026.
- FDA: Compounding and the FDA, questions and answers. Accessed Oct 23, 2026.
- NIDDK: symptoms and causes of ED. Accessed Oct 23, 2026.
- NIDDK: diagnosis of ED. Accessed Oct 23, 2026.
- Nehra A, et al. The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease. Mayo Clin Proc. 2012;87(8):766–778 (PMC). Accessed Oct 23, 2026.
- Levine GN, et al. Sexual activity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2012;125(8):1058–72 (PubMed). Accessed Oct 23, 2026.
- Vlachopoulos CV, et al. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2013;6(1):99–109 (PubMed). Accessed Oct 23, 2026.
- Andersson et al. ED treatment and outcomes after myocardial infarction (2017), PubMed record. Accessed Oct 23, 2026.
- Mendoxa ED care (product, format, max 1 dose per 24 hours). Accessed Oct 23, 2026.
- Mendoxa ED intake: plan prices (term_options). Accessed Oct 23, 2026.
About Mendoxa
Mendoxa (mendoxa.co) is a US telehealth brand. Independent licensed providers (licensed clinicians in the LocumTele network) review each online visit, and prescriptions are filled by Rush Pharmacy, a licensed US pharmacy. Available in 49 states (not California).
- Prescription required. A licensed clinician reviews every visit and can say no. A prescription is not automatic.
- A compounded medicine is not an FDA-approved finished product (FDA compounding Q&A).
- Plans: 1 month or 3 months, from $129. If prescribed · Cancel anytime · Available in 49 states (not California).
Compounded medication prescribed only if a licensed U.S. clinician decides it is appropriate. Not FDA-approved as a finished product. Not available in California. This site is not for emergencies. Call 911 if you need urgent care.