Malegra DXT Plus should never be taken with nitrates because of a dangerous interaction that can cause severe and potentially life-threatening low blood pressure. Here’s why: How the interaction works: Malegra DXT Plus contains sildenafil, a PDE5 inhibitor. Sildenafil relaxes blood vessels to increase blood flow to the penis. Nitrates (like nitroglycerin, isosorbide mononitrate) are also vasodilators, used for heart conditions like angina. When taken together, their combined effect can cause sudden, severe drops in blood pressure, which can lead to: Dizziness or fainting Heart attack Stroke Shock or even death in extreme cases Key points: The dapoxetine in Malegra DXT Plus does not contribute to this interaction; it’s specifically the sildenafil component. Even small doses of nitrates, including patches, sprays, or sublingual tablets, can trigger this reaction. If a man is taking nitrates for chest pain, alternative ED treatments must be discussed with a doctor. In short: The combination of Malegra DXT Plus and nitrates can drop blood pressure dangerously, so they must never be taken together.