Malegra DXT Plus—doing so can be dangerous or even life-threatening. Anyone taking the following types of nitrates: Nitroglycerin (sublingual tablets, sprays, patches) Isosorbide dinitrate (Isordil) Isosorbide mononitrate (Imdur) Amyl nitrite / Butyl nitrite ("poppers") These are often prescribed for: Angina (chest pain) Heart failure Coronary artery disease Malegra DXT Plus contains: Sildenafil – a PDE-5 inhibitor Duloxetine – an SNRI antidepressant Sildenafil and nitrates both lower blood pressure. Taking them together can cause: Sudden, severe hypotension (dangerously low blood pressure) Fainting Heart attack Stroke Death in extreme cases Malegra DXT Plus and manufacturers warn against combining sildenafil with any nitrate drug. Malegra DXT Plus is absolutely contraindicated (should never be used) in anyone: Currently using nitrates Using recreational poppers Recently taken nitrates (within the last 24–48 hours) Talk to a doctor about alternative ED treatments that are safer with your heart condition. If you're on nitrates, your doctor may recommend non-sildenafil-based approaches, like: Lifestyle changes Testosterone therapy (if deficient) Psychotherapy or couples therapy (if relevant) Nitroglycerin (sublingual/tablet/patch) Isosorbide dinitrate / mononitrate Amyl or butyl nitrite ("poppers") Let me know if you'd like help identifying ED-safe alternatives for someone with heart disease or nitrate use.