When PDE5 inhibitors for treating Erectile Dysfunction (ED) fail, pairing them with treatments like vacuum erection devices or medications such as alprostadil might significantly improve results. Studies suggest that combining treatments not only boosts effectiveness but also remains safe, with minimal side effects.
In this article, you will explore several combination treatments for ED, understand how they work, and discover if they might be suitable for your specific needs.
| 🔑 Key Takeaways ➤ Combining PDE5 inhibitors with vacuum erection devices (VEDs) has significantly improved ED in men who did not respond to PDE5 inhibitors alone. ➤ Pairing PDE5 inhibitors with alprostadil, whether as an injection, gel, or urethral insert, has led to better erections and higher satisfaction compared to using either treatment separately. ➤ Low-intensity shockwave therapy (LiST) combined with daily tadalafil has shown stronger improvements in ED scores over time compared to tadalafil alone. ➤ The combination of tadalafil and tamsulosin has not only improved erectile function but also helped relieve urinary symptoms, benefiting men with both conditions. ➤ Testosterone therapy combined with sildenafil has been effective for men with ED and low testosterone, improving sexual function and satisfaction. |
1. PDE5 Inhibitors and Vacuum Erection Devices (VEDs)
Using PDE5 inhibitors along with vacuum erection devices (VEDs) can be an effective choice if PDE5 inhibitors alone haven’t worked for you. One study tested whether this combination helps men who did not respond to PDE5 inhibitors by themselves. They wanted to see if adding a VED could boost treatment results.
The study included men who tried PDE5 inhibitors alone but did not see good results. After using the combined treatment, most men saw a noticeable improvement.
For instance, 79% of the men who couldn’t previously achieve erections good enough for sexual activity could now successfully have intercourse after combining the two treatments. Similarly, overall scores measuring erectile function rose significantly, from an average score indicating poor function to much better levels.
One important thing is safety. Only one patient reported mild penile pain from using the device, but the discomfort went away on its own within a few days.
2. PDE5 Inhibitors and Alprostadil
Combining PDE5 inhibitors with alprostadil might help you achieve better results. This approach showed promising outcomes in several studies that tested different ways of using alprostadil, such as injections, topical gels, or treatments placed directly in the urethra.
One study showed clear improvements when PDE5 inhibitors were combined with alprostadil compared to using either treatment alone. Specifically, men had higher scores in the International Index of Erectile Function (IIEF), a survey that measures how well ED treatments work.
Simply put, the combination therapy seemed to work better, providing better erections and improving sexual performance—even when one method alone wasn’t enough.
| 📚 Related Study Another study supported that when PDE5 inhibitors were used with a vacuum device, men’s erectile function improved dramatically. Smaller yet meaningful improvements also came from adding daily tadalafil, shockwave therapy, folic acid, metformin, or medications for blood pressure (angiotensin-converting enzyme inhibitors). This combination approach especially helped men who previously saw little benefit from PDE5 inhibitors alone. For men who experienced ED after prostate surgery or who had low testosterone, combining therapies brought noticeable improvements. Importantly, combining these therapies didn’t lead to more side effects, suggesting this approach is safe. |
3. Low‐intensity Shockwave Therapy and Tadalafil
Combining low-intensity shockwave therapy (LiST) with daily tadalafil could help if you have severe ED. One recent study tested how effective this combined therapy is, compared to taking tadalafil alone.
They studied 48 men with severe ED. Half of the men got real shockwave treatments three times a week along with daily tadalafil pills. The other half received fake (sham) shockwave treatments plus tadalafil. So, did the real therapy make any difference?
The results showed promising improvements. After one month, men using the real shockwave therapy plus tadalafil had higher ED scores—12.1 points compared to 10.2 in the placebo group. After three months, the gap grew even wider, reaching 12.9 versus 10.8 points. Even a 2-point difference matters when it means better sexual function and quality of life.
However, the success rate during sexual encounters didn’t show a big difference between groups. Still, by three months, more men who got the real therapy reached a significant improvement in overall ED. Importantly, nobody reported side effects, meaning the combined treatment was safe.
4. Tadalafil And Tamsulosin
Another helpful combination could be tadalafil and tamsulosin. In one research, combining tadalafil (5 mg daily) and tamsulosin (0.4 mg daily) improved ED symptoms noticeably. Men using this treatment saw their ED scores rise significantly—from about 9 points up to around 17.6 points on IIEF-5.
Even if men had other health issues like metabolic syndrome, the combination therapy still helped improve their ED to similar levels as men without these health conditions.
Furthermore, the treatment also relieved urinary symptoms, such as difficulty passing urine, in both groups equally. Both groups had comparable scores for ED—16.3 points for those with metabolic syndrome and 17.7 points for those without. Importantly, no serious side effects were reported.
5. Testosterone and Sildenafil
Sometimes men who undergo treatments like bone marrow transplants can experience ED. When traditional erectile dysfunction medications alone don’t work, combining two therapies might offer relief. A helpful approach involves testosterone along with sildenafil.
One study looked at men who faced severe ED after receiving bone marrow transplants. These men also showed low testosterone levels, a condition that can worsen ED. To help, doctors gave them testosterone injections once a month, along with sildenafil tablets one or two times weekly.
After six months, the results were very encouraging. All eight patients in the study showed improved erectile function. Before treatment, these men struggled significantly, but after combining testosterone and sildenafil, they reported better sexual performance, stronger libido, and improved satisfaction.
Additionally, the study confirmed the combination was safe, with no serious side effects reported.
Wrap Up
Finding the right treatment for ED can sometimes feel challenging. However, combining therapies opens new doors and provides fresh hope when standard treatments fall short.
Whether it’s PDE5 inhibitors paired with vacuum devices or alprostadil or even adding low-intensity shockwave therapy or testosterone, these combinations can deliver better results safely. But remember, not every combination suits everyone equally.
Frequently Asked Questions
Are there risks with combination therapies?
Yes. Side effects can increase when treatments are combined, and some combinations lack long-term studies. Always consult a doctor before trying new therapies.
Can testosterone therapy help with ED?
If low testosterone is the cause of ED, hormone therapy may help, especially when combined with PDE5 inhibitors. However, it is not a solution for all cases.
Does diet and lifestyle impact ED?
Absolutely. Regular exercise, a healthy diet, and avoiding smoking or excessive alcohol can improve ED and overall sexual health.
Can ED be a sign of other health problems?
Yes. ED can be an early warning sign of heart disease, diabetes, or high blood pressure. If you have ED, talk to a doctor to check for underlying conditions.
Sources
- Canguven, O., Bailen, J., Fredriksson, W., Bock, D., & Burnett, A. L. (2009). Combination of vacuum erection device and PDE5 inhibitors as salvage therapy in PDE5 inhibitor nonresponders with erectile dysfunction. The Journal of Sexual Medicine, 6(9), 2561-2567. https://doi.org/10.1111/j.1743-6109.2009.01364.x.
- Moncada, I., Martinez-Salamanca, J., Ruiz-Castañe, E., & Romero, J. (2018). Combination therapy for erectile dysfunction involving a PDE5 inhibitor and alprostadil. International Journal of Impotence Research, 30(5), 203-208. https://doi.org/10.1038/s41443-018-0046-2.
- Mykoniatis, I., Pyrgidis, N., Sokolakis, I., Ouranidis, A., Sountoulides, P., Haidich, A.-B., van Renterghem, K., Hatzichristodoulou, G., & Hatzichristou, D. (2021). Assessment of combination therapies vs monotherapy for erectile dysfunction: A systematic review and meta-analysis. JAMA Network Open, 4(2), e2036337. https://doi.org/10.1001/jamanetworkopen.2020.36337.
- Kalyvianakis, D., Mykoniatis, I., Pyrgidis, N., Kapoteli, P., Zilotis, F., & Hatzichristou, D. (2024). The effect of combination treatment with low-intensity shockwave therapy and daily tadalafil on severe erectile dysfunction: A double-blind, randomized, sham-controlled clinical trial. The Journal of Sexual Medicine, 21(6), 533-538. https://doi.org/10.1093/jsxmed/qdae038.
- Sebastianelli, A., Morselli, S., Spatafora, P., Liaci, A., Gemma, L., Zaccaro, C., Vignozzi, L., Maggi, M., McVary, K. T., Kaplan, S. A., Chapple, C., Gravas, S., Serni, S., & Gacci, M. (2021). Outcomes of combination therapy with daily tadalafil 5 mg plus tamsulosin 0.4 mg to treat lower urinary tract symptoms and erectile dysfunction in men with or without metabolic syndrome. Minerva Urology and Nephrology, 73(6), 836-844. https://doi.org/10.23736/S2724-6051.20.04099-0.
- Chatterjee, R., Kottaridis, P. D., McGarrigle, H. H., & Linch, D. C. (2002). Management of erectile dysfunction by combination therapy with testosterone and sildenafil in recipients of high-dose therapy for haematological malignancies. Bone Marrow Transplantation, 29(7), 607-610. https://doi.org/10.1038/sj.bmt.1703421.