What Happens When You Mix MDMA and Viagra?

First, an obligatory cautionary warning. Using any untested, unlicensed, or unapproved substance, especially in combination with another non-prescribed drug or alcohol, is always something to be wary of. This is a wise and attentive way to live one's life, and it is the basis upon which almost any doctor will offer advice. Remember, the medical profession shoulders the burden of alerting the public to possible harms, so it is by definition, conservative. Making psychedelics illegal doesn’t help either. “Prohibition doesn’t stop use, but it does stop research,” notes Erica Zelfand, ND, and the executive director of Right to Heal nonprofit in Portland, Oregon.  

The Pharmacology of MDMA 

A standard dose of MDMA (80-120 mg) increases the levels of feel-good chemicals – serotonin, norepinephrine, oxytocin, and dopamine – in the brain, which generally leads to amazing sensations of euphoria, increased sociability, and tactility. The amphetamine effects of MDMA constrict blood vessels, which can speed up heart rate, raise blood pressure, and lead to overheating for the 4-6 hours the drug is in the body. If you have hypertension or arrhythmia, this could be a concern. 

On its own, MDMA is a relatively safe substance. For 40 years, MDMA has been used by hundreds of thousands of people weekly at clubs, raves, and at home, yet there have been few reported Emergency Room, drug treatment center, or addiction service visits. While research shows that MDMA can bring on short-lived side effects, such as jaw clenching, nausea, sweating, chills, and blurred vision, they are typically mild and quickly fade, leaving no clear signal of increased cardiac risk. MDMA deaths are rare and often the result of ingesting a pill that has been tainted with fentanyl, meth, or another toxic contaminant. Other dangers include the fatal dehydration that occurs when people spend hours on overheated dance floors and fail to drink water, as well as overhydration, which has killed many more than heatstroke. 

Research also shows MDMA isn’t considered addictive. Clinical trials have found no signs of abuse or diversion, and it carries far less risk of dependence than classic stimulants. Nor is it known to cause drug-seeking behavior. Instead, MDMA is self-limiting: The more you take, the less magic you feel. Repeated use builds a tolerance, which is why experienced users tend to space out MDMA sessions to just a few times a year. 

Some researchers have pointed to an increase in promiscuous behavior and unprotected sex, but that’s not a pharmacological harm. It’s a behavioral issue. 

Viagra and Cialis

Standard doses of Viagra (sildenafil; 25-100 mg) and Cialis (tadalafil; 5-20 mg) work by relaxing (or dilating) blood vessels in the penis, increasing blood flow, which makes erections more possible when sexually stimulated. (Fun fact: Viagra was first developed as a medication to lower blood pressure. It wasn’t great at doing that, but men kept noticing one other pesky side effect. Pharma companies noticed it too, and gleefully rebranded it as a fix for erectile dysfunction.)

So What About Combining the Two? 

While MDMA raises heart rate and blood pressure, sildenafil lowers blood pressure. The two do not act synergistically, which is a good thing because the two substances don’t potentiate each other.  

But they don’t have equal and opposite effects across the entire cardiovascular system.  

“I view risk on a spectrum,” says Seth Mehr, MD and founder of Cascade Psychedelic Medicine in Portland, OR. “If you are a healthy man who can tolerate moderate exercise and you have no heart disease or other risk factors, then taking an average dose of MDMA is relatively safe. But, if you're 80 and have had a heart attack or arrhythmia and you’re on another stimulant like Ritalin or Vivance, that’s riskier. Knowing your body and the rare side effects of both drugs will enable you to make a more informed decision. That’s the definition of informed consent.” 

There’s one other factor to consider: MDMA is called the “love drug” or the “hug drug,” but it’s not called the “sex drug.” And for a good reason: It enhances emotional connection, but it doesn’t enhance erections. 40% of men report they can’t get hard on MDMA. And of those who do get erections, a large percentage can’t ejaculate. So, while MDMA is great for cuddle puddling, it’s less great when it comes to squelching. Personally speaking, MDMA makes my penis feel uniquely irrelevant – it’s easier to just enjoy the waves of warm, unconditional love and save the sex for the day after.

Or, as Dr. Zelfand puts it: “There are so many other ways to share love and deepen intimacy on MDMA. Do you really need an erection?” 

Wait! What About Women? How Does Molly Affect Their Sexual Response?

There is almost no information about women's sexual response to MDMA (and other drugs) because most clinical studies have small sample sizes, underrepresent women, and rarely include sexual function as a primary outcome. The scant existing data suggest that while MDMA can increase sexual desire and satisfaction, it may also delay orgasm or impair lubrication and doesn’t reliably enhance sexual arousal in controlled settings.

According to Stephanie Karzon-Abrams, a neuropharmacologist based in Los Angeles, women may experience MDMA differently than men due to a constellation of factors, including metabolism, hormonal fluctuations, body composition and genetics, and a dangerous drop in blood sodium levels, known as hyponatremia.

Metabolism: Women generally metabolize more slowly than men, which means they process and eliminate MDMA at a slower rate. This can result in the drug staying in the system longer, leading to more intense effects or prolonged side effects.

Hormonal Fluctuations: Women’s hormones oscillate throughout their menstrual cycles, and estrogen can influence the levels of serotonin and dopamine in the brain. This is why during certain phases of the cycle like ovulation, women might be more sensitive to MDMA and feel bigger emotional responses. 

Body Composition: Women tend to have a higher percentage of body fat than men. Since MDMA is lipophilic, or fat-soluble, it may accumulate in fat cells and be released more slowly. This can result in delayed onset or longer-lasting effects, making women more susceptible to both MDMA’s positive and negative effects.

Genetics: Specific genes, like 5-HTTLPR (which influences serotonin transport) and COMT (which affects dopamine metabolism), may differ between the sexes, influencing how MDMA interacts with serotonin and dopamine systems in the brain. Genetic differences could explain why women have stronger emotional and physiological responses to MDMA, including anxiety or more pronounced mood changes.

Hyponatremia: MDMA can cause the body to retain water, leading to a dangerous drop in blood sodium levels. Young women ages 15-35 are at a significantly higher risk of experiencing severe hyponatremia, which can cause brain swelling, seizures, and death. 

While Viagra or Cialis are not prescribed for women, it’s important to remember that MDMA affects everyone differently, and not least of those differences have to do with gender. The takeaway here is simple: MDMA isn’t a one-size-fits-all experience. Whether combined with a pharmaceutical like Viagra or taken on its own, the safest path lies in knowing your body, respecting its limits, and remembering that intimacy on MDMA is about more than just erections and orgasms.

##

Joe is the author of Modern Psychedelics, The Handbook of Mindful Exploration. 

💌 If you loved this email, forward it to a psychonaut in your life.

Editorial Process

DoubleBlind is a trusted resource for news, evidence-based education, and reporting on psychedelics. We work with leading medical professionals, scientific researchers, journalists, mycologists, indigenous stewards, and cultural pioneers. Read about our editorial policy and fact-checking process here.