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Erectile dysfunction (ED) may affect as many as 30 million men in the United States. People with ED experience an inability to get or keep an erection firm enough for sex.

You may be familiar with some of the more common treatments for ED, including lifestyle modifications, oral medications that include phosphodiesterase type 5 inhibitors (PDE5 inhibitors), and penis pumps.

A 2018 study also looked at the use of nitroglycerin gel or cream as a topical treatment for ED. Although results look promising, it’s important to note that nitroglycerin gel or cream isn’t approved by the Food and Drug Administration (FDA) to treat ED.

Here is what you need to know about nitroglycerin.

Language matters

In this article, we talk about the use of nitroglycerin. We use the term “men” throughout the article to reflect a term that has been used to describe gender people.

specificity is important when reporting on research participants and clinical findings, as we aim to create content that includes and reflects the diversity of our readers.

The studies and surveys referenced in this article did not include data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

A class of drugs called vasodilators widen the blood vessels and improve blood flow to the heart.

It can be applied under the tongue, under the skin, or on the skin. A drug called nitrate is used to prevent angina.

“The idea of treating ED with topical nitroglycerin is not new and was first described in the 1980s,” says Dr. Joseph Brito, a urologist at Yale New Haven Health, Lawrence + Memorial Hospital. Brito is also a member of Healthline’s clinical review network.

Brito says that nitroglycerin works by dilating the blood vessels, which is why it is used for angina sufferers.

The concept is the same for ED, but Brito says it may have a dual mechanism of action.

  • It helps blood flow.
  • It causes penile veins to be compressed and causes rigidity in the penis.

He says thatTopical nitroglycerin acts as a nitrogen donor to increase local levels of nitric oxide.

On the other hand, Brito says PDE5 inhibitors (like tadalafil and sildenafil) work at a later step in the chain by inhibiting the breakdown of cGMP.

That said, Brito points out that nitroglycerin gel or cream is currently not approved by the FDA to treat ED. Older studies have found that nitroglycerin gel can enhance blood flow to the penis, but this increased blood flow may not be enough to sustain an erection.

Brito points out that the American Urological Association guideline on ED published in 2018 (the most recent published guidelines) didn’t include topical nitroglycerin as a suggested treatment for men with ED.

The authors stated that the use of these treatments may preclude the use of other treatments that are known to be effective.

There isn’t much research related to nitroglycerin gel and ED treatment. However, the 2018 study mentioned above found that 23% of users with ED experienced improved erections using a 0.2% nitroglycerin gel. Those with mild ED experienced the most significant effects.

There’s another factor to consider: Nitroglycerin cream applied to the outside of the penis may transfer to your partner. Older reports of nitroglycerin use for ED have linked nitroglycerin gel use with an increased risk of headaches by both the person applying the gel and their partner.

Brito says that nitrolanin may have benefits over standard ED medications.

Brito says that the start of the drug is between 10 and 20 minutes, which is better than the time it takes to take an oral agent.

In fact, the 2018 study mentioned above found that 44% of people had an erection beginning within 5 minutes of application. About 70% of the men noticed an erection within 10 minutes.

The study included 232 men with ED who were randomized to either a placebo or a double-blind placebo. One trial used a gel that was 2% glyceryl trinitrate, while the other used a placebo.

Brito says that this may help with the issue of couples using oral agents.

“Brito says that unlike other ED treatments, nitroglycerin doesn’t need to pass through the gastrointestinal tract.”

He says that the medications are more effective when taken on an empty stomach. This requires more planning and can be difficult to plan for.

The FDA does not approve nitragin gel or cream to treat ED.

If you have questions about this treatment, you should talk to a doctor. A prescription is needed for a drug.

“Your doctor manages nitragin use. Don’t apply this treatment without being told.”

According to the 2018 study, the concentration studied was 0.2%, which Brito says likely explains why the effect was best for men with mild ED.

He points out that some studies used concentrations of 0.8% for people with more severe ED.

Brito says that people who have been prescribed nitroglycerin should apply a pea-sized amount to their penis.

“We have mentioned this before, but it is worth repeating that the FDA has not approved the use of nitroglycerin gel for ED. There isn’t a safe recommendation for the amount of medication to be used for the treatment. It is difficult to control an exact dose of a medication because it is not easy to measure.”

The strength of the nitrglycerin gels can be as high as 0.8%. The smaller doses are less than the 2% paste that is applied to the chest for chest pain. It is important to not mix up the two when applying to the penis.

If you apply a pea-sized amount, this is about 0.15 to 0.25 grams.

Nitroglycerin is certainly not for everyone. According to a 2018 research review, taking nitroglycerin-based medications with certain PDE5 inhibitors like Viagra is contraindicated. Using them together can result in a sudden and serious decrease in blood pressure and potentially death.

Brito says that a possible transmission to your partner can cause you to experience side effects, including low blood pressure.. This can cause headaches and congestion.

There are several treatments for ED.

If you have difficulty with an erection, talk to your doctor. Your doctor can help identify underlying causes and help you reduce symptoms.

Exploring ED treatments

If you have ED and would like to try nitroglycerin gel, talk with your doctor first. There are many medications that cause negative side effects if you use them with nitroglycerin gel too. While there are quite a few, some of the main ones are sildenafil (Viagra), aspirin, or ergotamine, which treats migraine.

Avoid using nitroglycerin gel if you have health conditions like anemia or hypotension. Using nitroglycerin can make these conditions worse.

Nitroglycerin gel side effects

Side effects can be caused by nitrglycerin gel. These effects include:

  • blurry vision
  • The mouth is dry.
  • feeling faint
  • There is a throbbing head.
  • low blood pressure.
  • nausea
  • rapid heart rate

You could also experience an allergic reaction if you apply the nitroglycerin. An allergic reaction could include redness, swelling, or itching.

If you experience these symptoms, stop using nitroglycerin gel. If you have symptoms that get worse, you should remove any excess and not touch the nitroglycerin with your hands.

“If you have trouble breathing or have a symptom that doesn’t improve after a few minutes, seek immediate medical attention.”

Does nitroglycerin work the same as Viagra?

Viagra and nitroglycerin work the same. Your body makes nitric oxide. The compound expands the blood vessels.

Viagra works to prevent PDE5 from causing blood flow to the penis. Viagra can make an erection stronger.

How do you apply nitroglycerin safely?

You can apply it anywhere. Before putting on gloves or covering your penis with plastic wrap, you should wear a protective covering. You can apply a dot to the head of your penis by squeezing a pea-sized dot on your finger.

“Your body will absorb the nitroglycerin in a rapid fashion. The gel shouldn’t affect your partner if enough time has passed.”

Can I use too much nitroglycerin?

“The benefits to using nitroglycerin gel are that it works faster than ED treatments. It doesn’t last very long in the body, usually only a few minutes. If you keep applying, it is possible you could use more than you need.”

It is difficult to say how much is too much and what the side effects are from using too much. It is important to talk with your doctor before applying a drug.

The FDA does not approve the use of nitroglycerin gel or cream for ED because of the effectiveness of the research.

It is important to talk with a doctor about any treatment options for ED. They can discuss lifestyle modifications, counseling, oral agents, penis pumps, surgery, and implants with you.