Heart trouble and ED tablets: a guide for Las Palmas and Gran Canaria

Gran Canaria fills up every winter with people from the UK, Ireland, Scandinavia and the rest of northern Europe, and some of them pack heart or blood pressure tablets along with the sun cream. If you are one of them, the most useful question before any ED tablet is not which brand to pick but whether your heart and your current treatment allow it at all.

The facts below come from the Spanish product information (fichas técnicas, which Spain's medicines regulator AEMPS makes public in CIMA) for the four ED medicines and for the nitrates sold in Spain. The practical part, from duty pharmacies to hospitals, is at the end.

Your nitrate may go by a Spanish name

Nitrates are what make these tablets dangerous, and on a Spanish pharmacy shelf they won't look like the box you have at home. What to look out for:

• GTN spray: Trinispray.
• GTN tablets under the tongue: Cafinitrina, Solinitrina 0.8 mg.
• Nitrate patches: Nitroplast, Minitran, Epinitril, Trinipatch, Cordiplast, Dermatrans, Nitroderm TTS, or generic Nitrofix.
• Isosorbide mononitrate tablets: Uniket, Coronur Retard, Dolak Retard.
• GTN ointment for an anal fissure: Rectogesic. Its own leaflet rules out sildenafil, tadalafil and vardenafil.
• Poppers (amyl or butyl nitrite): the sildenafil and avanafil fichas name amyl nitrite specifically.

Riociguat (Adempas), a treatment for pulmonary hypertension, is on the same forbidden list. And a GTN spray you carry “just in case” but have never used still counts: on the day you need it, an ED tablet in your system would get in the way.

Chest pain after taking a tablet

Ring 112 straight away and tell the crew which tablet you took and when. Paramedics and emergency doctors often give GTN for chest pain, and that one piece of information changes what they can safely do. The Spanish product information gives these time frames:

With tadalafil, the interaction with GTN lasted more than 24 hours in a study and had gone by 48; within that window a nitrate would only be given under close medical supervision. With avanafil, the ficha flags the first 12 hours. With vardenafil 20 mg, GTN taken 1 and 4 hours later had a stronger effect, but not at 24 hours. The sildenafil ficha forbids the combination without giving a time.

Heart conditions that rule these tablets out

An old stent or a heart attack years ago, with a heart that is now stable, is not on these lists by itself. Whether a tablet is right for you then depends on how you are today and what you take, which is for your cardiologist or GP to judge.

Blood pressure medicines

Most of them can be taken alongside. Tadalafil was tested with amlodipine, enalapril, metoprolol, a thiazide diuretic and angiotensin receptor blockers, and later with up to four of them at once: in men whose blood pressure was well controlled the extra drop was minimal, and it was bigger in those whose blood pressure was not. Alpha-blockers such as doxazosin need more care; you should be stable on one before starting. Tadalafil with doxazosin is specifically not recommended; with other alpha-blockers it needs caution, especially in older men, beginning at the lowest dose and adjusting step by step.

It can work the other way round too. Some diuretics and beta-blockers have been linked to weaker erections. If you suspect that, raise it with your doctor rather than stopping a tablet that is protecting your heart.

The tablets we list, for a heart patient

• Cialis Generic: 5, 10 or 20 mg of tadalafil (a 40 mg version, twice the maximum, is also listed and we advise against it). It closes the door on nitrates for longest, up to 48 hours.
• Viagra Generic: 25, 50 or 100 mg of sildenafil. Shorter-acting, but every bit as incompatible with nitrates.
• Levitra Generic: 10 or 20 mg of vardenafil. Not an option with a long QT or heart rhythm drugs.
• Viagra Original: branded sildenafil, 100 mg only. That is the maximum dose, not the 50 mg the ficha suggests starting with.

A warning sign worth taking seriously

The European Association of Urology points out that erectile problems can be the first sign of narrowing arteries, sometimes years before the heart is affected. And the fichas ask doctors to check a man's cardiovascular health before prescribing, because sex itself is exercise. The American Heart Association regards sexual activity as reasonable for heart patients who are stable and can manage moderate exertion without symptoms.

Healthcare in Gran Canaria, for visitors and residents

On holiday. An EHIC, or a UK GHIC, gets you medically necessary state healthcare on the same terms as a local: health centres (centros de salud) and public hospital emergency departments. It does not work in private clinics, and prescriptions are not free. ED tablets are not funded by the Spanish system for anyone, so you would pay the full pharmacy price. Travel insurance that covers your heart condition is still worth having.

Living here. Once Spain's social security institute (INSS) recognises your right to public care, you apply at your centro de salud for the Canary Islands health service (SCS) health card and are given a GP (médico de familia). The GP can prescribe, check your heart first and, if needed, refer you to Urology at one of the two public hospitals in Las Palmas: Hospital Universitario de Gran Canaria Doctor Negrín or the Complejo Hospitalario Universitario Insular-Materno Infantil, depending on where you live.

Duty pharmacies. The Las Palmas pharmacists' college has a pharmacy finder (in Spanish) where you can filter for farmacias de guardia by town and date.

What visitors to Gran Canaria ask

Parcels to the islands

We have no shop or pharmacy in Las Palmas, or anywhere else in the Canaries. Orders travel by post or courier, and the islands add a step: the Canaries sit outside the EU VAT area (they have their own tax, IGIC), so parcels from mainland Spain or abroad go through customs clearance before delivery. See our delivery conditions; we don't promise timings.

Other cities: travelling with medicines in Málaga, premature ejaculation in Santa Cruz de Tenerife, heat and low blood pressure in Seville.

Sources: CIMA, the AEMPS medicines register (fichas técnicas for the four PDE5 inhibitors and for the nitrates named, Rectogesic included); European Association of Urology guidelines on male sexual health; American Heart Association statement on sexual activity and cardiovascular disease; BIFIMED (Spanish Health Ministry); Canary Islands health service (SCS); Las Palmas pharmacists' college; UK Government guidance on healthcare for visitors to Spain; Spanish Tax Agency (VAT territory). General information only: your doctor makes the call. In Spain, prescription-only medicines may not be sold online, and customs can hold a parcel that contains them. We do not check prescriptions: talk to your doctor before you order.