Hey Dick,
Last Saturday, I got high, took a Viagra ('cause sometimes I get crystal-dick) and went to my favorite bathhouse for my weekly sex-capade. I had fucked around with a few guys and was feeling pretty fine . . . that is until the guy who was fucking me shoved a bottle of poppers under my nose. Afterwards, I got really dizzy and had to go home in a taxi. One of my friends told me that the reason I got dizzy was because of the poppers and Viagra. Also, my friend said that poppers are bad for me. What's up with that?
Dizzy in Denver

Dear Dizzy,
As you have found out, the combination of poppers and Viagra can be very dangerous, perhaps even deadly. When used at the same time, these drugs can drop your blood pressure. Low blood pressure can leave you feeling light-headed and dizzy and possibly cause you to faint or pass out. It could also cause heart or brain damage. You should consider yourself lucky.

"Poppers" are various kinds of nitrite or nitrate inhalants. Originally, they were made to treat certain heart problems. But in the gay community, they came to be used as sexual (and dance) stimulants. Some gay men inhale poppers to help relax the anal sphincter (butt hole) when they are getting fucked or fisted. Others find that orgasm is more intense with a quick whiff. When you inhale poppers, your blood vessels relax. This allows more blood to circulate through your body. Poppers used to be made of amyl nitrite. Congress banned the sale of some kinds of nitrites in 1990 because they were no longer the best heart medicines. Also, legislators found out that people were using them for fun and that they could be dangerous to a person's health. Popper manufacturers got around this ban by using different kinds of nitrites and calling them deodorizers, among other things. These products have never been tested on humans. So, their short and long-term medical risks are not known.

Poppers, HIV and STDs
The gay community has been looking at the effect of poppers on the immune system for years. Some studies show that poppers weaken the immune system. Other studies show a link between popper use and increased risk of getting HIV and STDs. Right now, no one really knows why this is. But there are a few good explanations.

• Poppers cause the blood vessels to dilate -- become more open. This makes more blood flow to vessel-rich areas like the anus. This could make it easier for HIV to get into the blood stream during anal sex.
• Some people use poppers to reduce the pain they feel with anal sex. If you use poppers to have long and hard butt sex beyond your normal limits, tears are more likely to happen. You might not feel a tear inside your butt. Even a tiny tear can be an opening for HIV or other bugs to get into your blood stream.
• As a group, gay men who use poppers might be having more anal sex or more sex partners. This means more opportunities to get exposed to HIV and other STDs.
  The truth is we aren't sure why popper users are more likely to get HIV and other STDs. But studies do show that there is a real connection.
  

Viagra risks
It is clear that poppers and other products that contain nitrites should not be mixed with Viagra. They should not be used within 24 hours of each other. Viagra works by increasing the flow of blood into the tissues of the penis. Contrary to popular belief, Viagra itself will not increase sex drive. So don't expect to get an instant hard-on unless you get turned-on! Also, it doesn't work for everybody.

Viagra works by inhibiting a certain chemical in the blood. Its' biggest effect is in the spongy tissue in the penis. When this chemical isn't around and you get turned-on, your penis will fill with blood. Like poppers, Viagra can lower blood pressure. So even without poppers, you might get dizzy when your brain doesn't get the blood it needs. Viagra can also cause other side effects like headaches, visual changes, and feeling "flushed."

If you are HIV positive, take protease inhibitors, and also use Viagra, you should decrease the amount of Viagra you take to 25 mg instead of the usual 50 mg dose. The same enzymes in your liver process Viagra and protease inhibitors. When used together, these drugs interact and the liver gets over loaded. It can't clear the drugs out of your body. This can result in too high a level of Viagra in your blood. The side effects can be serious, such as a sudden and severe drop in blood pressure, and, again, fainting, and worse. Too much Viagra can also cause a prolonged erection that could last for hours. Although this may sound like fun at first, a hard-on that lasts more than four hours can be really painful. It can also cause permanent damage to the penile tissue, leaving you a dick that may never inflate again.

If you are going to use poppers or Viagra, please remember these the Dog-terlines:

• Don't use poppers and Viagra together or within 24 hours of each other.
• Don't inhale poppers until your head explodes. Cut back on the amount you inhale. Or cut back on how often you inhale. Cutting back will reduce the chance of significant harmful effects.
• Know the limits of your anus! A bleeding butt hole is like putting out a welcome mat for HIV. If you are already HIV positive, you could also be more likely to give HIV to your partner.
• As always, make a sexual safety plan ahead of time. Have condoms and lube on hand. And use them!Editor's Note
  There was another warning from the people who make Viagra. The printed warning says that using cocaine with Viagra can be extremely dangerous or fatal. We contacted Pfizer, the manufacturers of Viagra, but they did not have any additional information on this issue. Until we know more, people should be very careful when using these drugs together.

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