by Erowid
April 2003
Despite the persistent and confusingly inaccurate reports in the national media that Ecstasy is either a "date rape drug" or a "sex drug", it is well known that for most men and women MDMA is not typically associated with actual intercourse. The two main reasons for this are that it blocks erection in a large portion of the male population and the feelings elicited in most people are more appropriate to cuddling than to sex.
Of course, everyone is different in their reaction. Some men and women do find the effects of MDMA erotic and choose to include sexual intercourse as part of their experience. Since the introduction of sildenafil (Viagra) in 1998, some ecstasy users have reported taking it to overcome the erectile issues presented by MDMA. Viagra is now well-known in U.S. and European sub-cultures as a remedy for stimulant-reduced erectile capacity. There is no data that we are aware of about how common it is to combine these substances, or what demographic is most likely to use the combination. It is rumoured to have first become popular among gay men, but is certainly now not confined to that demographic.
Health workers and interested individuals have expressed concerns about the use of Viagra in combination with MDMA. This use was not covered by the FDA approval research process for Viagra. In fact, neither the FDA nor NIDA require any evaluation of pharmacological interactions of new drugs with commonly-used recreational substances. While little to nothing is known about any specific interactions, there are several health concerns which could pose potential problems for those who combine these two substances:
Heart issues
Perhaps the most dangerous possible interaction between Viagra and MDMA is the theoretical risk that Viagra's vascular effects could interact dangerously with MDMA's heart-rate, blood pressure, and body temperature increasing tendencies. MDMA is a strong stimulant, increasing heart rate, blood pressure, and body temperature. Sildenafil, on the other hand, is a vasodilator and reduces blood pressure systemically. Although it is inappropriate to assume that a vasodilator 'cancels out' the effects of a stimulant, there is currently no indication that combining these two substances increase the cardiovascular risk of the other. Both alone provide substantial medical risks to those with heart conditions by themselves.
Priapism
The other major concern with this combination is possibly increasing the risk of penile injury from long lasting erection (called priapism). There are cases reported in the medical literature of sildenafil, by itself, resulting in priapism. It has been suggested that Ecstasy users might take unusually high doses of Viagra out of poor judgement or because they believe they need more to overcome the effects of the MDMA. It is possible that higher doses could be associated with increased priapism or other health risks. Also, there is speculation that there could be an interaction betwen MDMA and sildenafil because of MDMA's heavy 5HT (serotonin) activity.
Although there have been quite a few reports of men combining the use of ecstasy and Viagra, as of April 2003, there are no medical case reports published in the scientific literature for priapism resulting from the combination. There are two cases mentioned without details at ecstasy.org, but we have not been able to find any further information about this claim. There is a case report in which a doctor speculates that priapism could be associated with Ecstasy alone.
As of April 2003, it is unclear whether combining MDMA with sildenafil substantially increases the risk of priapism, but those who choose to take either or both of these substances should pay attention to potential problems and seek medical attention quickly if their erections last longer than a few hours. Priapism can cause permanent injury resulting in reduced ability to achieve erections in the future.
OFF-SITE RESOURCES
Ecstasy.org's Q & A about Viaga (undated, no author)
PubMed Search: Viagra & Priapism
Good Morning America on Ecstasy + Viagra Combination Sep 2002
TheBody.com on Club Drugs with Good List of References
REFERENCES#
Of course, everyone is different in their reaction. Some men and women do find the effects of MDMA erotic and choose to include sexual intercourse as part of their experience. Since the introduction of sildenafil (Viagra) in 1998, some ecstasy users have reported taking it to overcome the erectile issues presented by MDMA. Viagra is now well-known in U.S. and European sub-cultures as a remedy for stimulant-reduced erectile capacity. There is no data that we are aware of about how common it is to combine these substances, or what demographic is most likely to use the combination. It is rumoured to have first become popular among gay men, but is certainly now not confined to that demographic.
Health workers and interested individuals have expressed concerns about the use of Viagra in combination with MDMA. This use was not covered by the FDA approval research process for Viagra. In fact, neither the FDA nor NIDA require any evaluation of pharmacological interactions of new drugs with commonly-used recreational substances. While little to nothing is known about any specific interactions, there are several health concerns which could pose potential problems for those who combine these two substances:
Heart issues
Perhaps the most dangerous possible interaction between Viagra and MDMA is the theoretical risk that Viagra's vascular effects could interact dangerously with MDMA's heart-rate, blood pressure, and body temperature increasing tendencies. MDMA is a strong stimulant, increasing heart rate, blood pressure, and body temperature. Sildenafil, on the other hand, is a vasodilator and reduces blood pressure systemically. Although it is inappropriate to assume that a vasodilator 'cancels out' the effects of a stimulant, there is currently no indication that combining these two substances increase the cardiovascular risk of the other. Both alone provide substantial medical risks to those with heart conditions by themselves.
Priapism
The other major concern with this combination is possibly increasing the risk of penile injury from long lasting erection (called priapism). There are cases reported in the medical literature of sildenafil, by itself, resulting in priapism. It has been suggested that Ecstasy users might take unusually high doses of Viagra out of poor judgement or because they believe they need more to overcome the effects of the MDMA. It is possible that higher doses could be associated with increased priapism or other health risks. Also, there is speculation that there could be an interaction betwen MDMA and sildenafil because of MDMA's heavy 5HT (serotonin) activity.
Although there have been quite a few reports of men combining the use of ecstasy and Viagra, as of April 2003, there are no medical case reports published in the scientific literature for priapism resulting from the combination. There are two cases mentioned without details at ecstasy.org, but we have not been able to find any further information about this claim. There is a case report in which a doctor speculates that priapism could be associated with Ecstasy alone.
As of April 2003, it is unclear whether combining MDMA with sildenafil substantially increases the risk of priapism, but those who choose to take either or both of these substances should pay attention to potential problems and seek medical attention quickly if their erections last longer than a few hours. Priapism can cause permanent injury resulting in reduced ability to achieve erections in the future.
OFF-SITE RESOURCES
Ecstasy.org's Q & A about Viaga (undated, no author)
PubMed Search: Viagra & Priapism
Good Morning America on Ecstasy + Viagra Combination Sep 2002
TheBody.com on Club Drugs with Good List of References
REFERENCES#
- Mahmud A, Hennessy M, Feely J. Effect of sildenafil on blood pressure and arterial wave reflection in treated hypertensive men. J Hum Hypertens 2001 Oct;15(10):707-13