Health Advice



Viagra and any form of nitroglycerine do not mix!

By Keith Roach, M.D. on

DEAR DR. ROACH: My husband is taking Eliquis 5 mg (half a tab daily). He has had erectile dysfunction for 15 to 20 years and is 78 years old. Since we are in a new marriage, he obtained Viagra in Mexico. His cardiologist would not prescribe it. What precautions should he take or symptoms to look for when he starts taking it? He also takes hydralazine, metoprolol, Lipitor, and Isordil. -- J.B.

ANSWER: While I wish you both a happy marriage, he should absolutely listen to his cardiologist. This doctor is refusing to prescribe Viagra for a very good reason: It cannot be taken with any form of nitroglycerine.

Isosorbide mononitrate (Isordil) is a long-acting form of nitroglycerine. In combination with Viagra or similar medicines, your husband's blood pressure can drop into a very dangerously low level and stay that way a very long time. He should talk to his regular doctor or a urologist about other options (such as alprostadil) that can be safely taken along with nitroglycerinelike drugs.

DEAR DR. ROACH: During heat waves, is there an ideal indoor temperature for elderly people and people with heart conditions? I have a disabled brother with heart conditions, and for some reason he seems immune to the heat and doesn't turn on the AC. His caregivers sometimes find him sitting in a room that's 90 F! I would like to give instructions to his caregivers for setting the thermostat to a safe level. -- L.C.

ANSWER: The most comfortable indoor temperature varies greatly among individuals. The highest temperature that is safe for a population also varies, based on the area of the world and the temperatures people are used to. In Mediterranean countries, indoor temperatures up to 84 F (29 C) do not increase medical risk, whereas in northern continental cities, a maximum safe temperature of 74 F (23 C) has been identified by the World Health Organization. Most people feel most comfortable with indoor temperatures between 68 and 74 F (20-23 C). Humidity, air movement with wind or fans, and a person's medical condition -- thyroid disease in particular really changes a person's temperature regulation -- all have a role, so I can't give you a single number that is right for everyone. I agree that 90 degrees (32 C) is too hot.

DEAR DR. ROACH: I am currently dealing with LPR and taking omeprazole and Pepcid. If the reason for my LPR episode is weakening of the sphincter, how can the surge of acid stop without medication since medication only treats symptoms and does nothing to help the sphincter? -- E.M.

ANSWER: LPR stands for laryngopharyngeal reflux, which is when stomach contents, including stomach acid, go backward ("reflux") up the esophagus, all the way to the larynx and pharynx. This potentially causes damage to these structures. The major symptoms of LPR are voice changes, cough, throat clearing and a sense of something in the throat.

Initial treatment of LPR should be behavioral: avoiding triggers (like alcohol or chocolate); eating smaller meals; and allowing several hours between eating and exercise or sleep. For people who do not respond, anti-acid medicines are tried.


Omeprazole and other proton pump inhibitors effectively stop acid production in the stomach. Famotidine (Pepcid) and other H2 blockers reduce acid secretion incompletely. While neither of these stops the stomach contents from backing up, the damage to the tissues is much less and symptoms are decreased when there is less (or no) acid in the backed-up liquid. Another option is a medicine like Gaviscon Advance, which forms a mechanical blockage to reflux.

Treatment to stop reflux, such as surgery, has been tried in people who did not respond to antacid medications. Unfortunately, only 10% of the group who received surgery had relief of symptoms.


Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to or send mail to 628 Virginia Dr., Orlando, FL 32803.

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