A 41-year-old man died of a stroke after taking generic Viagra with alcohol

• A man died after he took the maximum dose of sildenafil, a generic form of Viagra, with alcohol.
• An autopsy revealed that he had a stroke, and signs of long-standing high blood pressure.
• People need to be aware of the side effects that unprescribed sildenafil can cause, specialists said.

A man died from a stroke after he took a high dose of a generic form of Viagra — which probably wasn't prescribed — with alcohol, according to a report. 

The night before he got sick, the unnamed 41-year-old was staying in a hotel room with a "female friend" and is thought to have taken two 50 milligram sildenafil pills, a generic form of Viagra, and had some alcoholic drinks.

Forensic medicine specialists and a pathologist based in India described the case in the Journal of Forensic and Legal Medicine on March 3. 

Sildenafil works by inhibiting an enzyme found in the smooth muscle of one of the penis' erectile tissues, triggering a temporary rush of blood that causes an erection.

The Food and Drug Administration approved the popular blue pill for erectile dysfunction — which is when a person is unable to reach or maintain an erection until the end of sexual activity — in 1998, and it quickly became a blockbuster drug before generic forms were later made available. 

The specialists said they wrote the report to raise awareness of the risks associated with using sildenafil without medical advice. According the report, the man's friends and relatives said they weren't aware that he had a prescription for the drug. There are reports, for example from Korea, that people use the drug alongside alcohol recreationally.  

People need to know about the potential side effects of sildenafil to prevent more deaths, the case report authors said.

The usual dose of the drug for erectile dysfunction is 50mg once a day, but 25mg is recommended for first timers as well as those with liver, kidney or heart problems or those who take certain HIV medications, according to the original prescribing information for Viagra. 

The morning after the man took sildenafil, he developed a headache and started vomiting, the report states.

At first he declined to seek medical help, but his symptoms got worse and he was taken to hospital. Doctors declared him dead on arrival. 

The man died from a brain bleed

An autopsy later found that the man died from a brain bleed, a type of stroke. He also had signs of heart and kidney damage from longstanding high blood pressure; a fatty liver; and high levels of alcohol in his blood, the report authors said. 

According to the report, the man had an episode of high blood pressure two years before, but wasn't taking medication for it when he died. High blood pressure can increase the risk of strokes, whether or not a person takes Viagra.

How sildenafil and alcohol interact isn't well-established, with only a few reports of people having a brain bleed after taking it and drinking alcohol.

In this case and others it's not possible to determine whether the brain bleed was directly related to sildenafil, mixing the drug with alcohol, or other factors such as sexual activity or the patient's underlying health conditions such as high blood pressure.

Strokes were reported in less than 2% of people in clinical trials, according to Viagra's prescribing information, and it wasn't possible to prove the drug was the cause. Most of the people who had strokes had underlying health conditions that put them at risk of stroke, like high blood pressure.

A stroke that affects the eye, called a non arteritic anterior ischemic optic neuropathy (NAION), is listed in the prescribing information as a "rare" condition. People that experience sudden loss of vision in one or both eyes should stop using Viagra and seek medical care, it states.

More common side effects of sildenafil include: headache, flushing, heartburn, abnormal vision, back pain, muscle aches, rash, and dizziness. The drug can also enhance the effects of blood pressure medications, and drugs containing nitrates, which are used for chest pain.