Nitroglycerin 0.4%, 0.6%, 0.8% Cream

Drug-Drug Interactions: Do not use nitrogycerin cream when taking medications containing sildenafil, tadalafil, vardenafil, or with any other ED medications. This includes Viagra, Cialis, and Levitra. Always tell your doctor about any other medications you are taking before starting a new treatment.

Nitroglycerin cream has been proven to effectively treat erectile dysfunction when applied topically before sexual activity. Onset of action for nitroglycerin topical is about 10-20 minutes, which is faster than the 30-minute to one hour wait with oral PDE5 inhibitors like sildenafil (Viagra). It works quickly so sexual activity can be spontaneous, instead of needing to plan at least an hour in advance.

Nitroglycerin is called a nitric oxide (NO) donor. Nitric oxide is a vasodilator and an important part of the biological process that helps maintain an erection. NO is able to relax smooth muscle and compress penile veins, which prevents venous return. Preventing blood from leaving the penis is essential for maintaining an erection. Nitroglycerin increases levels of NO to help with this process.

Nitroglycerin Topical Compared to Oral PDE5 Inhibitors

Compared to oral PDE5 inhibitors like sildenafil (Viagra) and tadalafil (Cialis), nitroglycerin cream produces fewer side effects. Sildenafil and tadalafil can produce headaches, congestion, painful erections, chest pain, and more. Part of the reason for these side effects is that peak drug concentration does not occur with oral PDE5 inhibitors until 1-2 hours after administration. With nitroglycerin cream, peak drug concentration occurs within an hour of application. That means that even though mild headaches may occur in some cases, the systemic side effects are less pronounced.

The absorption of PDE5 inhibitors can also be affected by food intake. The effectiveness of nitroglycerin topical is not altered by food intake, since it does not need to pass through the gastrointestinal system. Nitroglycerin cream allows for greater freedom and spontaneity in sexual activity, with a decreased incidence of side effects compared to PDE5 inhibitors.

Nitroglycerin Cream Use and Dosing

In studies it has been shown that a 0.2% nitroglycerin may be a minimally effective dose. This dose may be effective for patients with mild ED but not as effective for patients with moderate to severe ED. It is possible that for these patients a higher percentage dose of 0.4% or 0.6% will be more effective. A pea-sized amount (about 0.3mL) of nitroglycerin cream is applied to the tip of the penis and will start working in 10-20 minutes.

Research

Efficacy and Safety of MED2005, a Topical Glyceryl Trinitrate Formulation, in the Treatment of Erectile Dysfunction: A Randomized Crossover Study (Journal of Sexual Medicine)