Sildenafil + Tadalafil (combo)

This tablet combines two PDE-5 inhibitors: 50mg sildenafil and 20mg tadalafil. The idea is to merge the strengths of both, the fast onset of sildenafil and the long duration of tadalafil.

In practice that means it kicks in quickly and then stays available over a long window. Both compounds work through the same mechanism.

Both components block the enzyme PDE-5 and so keep the vessel-relaxing messenger in the penis up for longer. Sildenafil gets the effect going fast, tadalafil holds it over many hours. Here too: it only amplifies the natural response and does not replace arousal.

One tablet already contains both compounds in a fixed dose. It is taken as a single dose, about 30 to 60 minutes before.

• At most once a day.
• With some gap from fatty food, as that delays the sildenafil part.
• Because two compounds come together, ease in carefully rather than combining with anything else right away.

For the exact fixed combination there is no large dedicated approval study; the data base comes from the two individual compounds. Sildenafil (Goldstein, 1998) and tadalafil (Brock, 2002) are each very well evidenced, and their action principles and profiles are known from those studies.

The studies on both components are in the source block below.

The same hard rule applies as for the single substances, here even doubly: never combine with nitrates. Heart nitrates (e.g. nitroglycerin) and "poppers" (amyl nitrite) together with PDE-5 inhibitors can crash blood pressure dangerously. Through the tadalafil part the risk exists over an especially long window.

Caution with alpha-blockers and cardiovascular disease. With pre-existing conditions or other medication, clear it with a doctor first.

Store the tablets dry, at room temperature and protected from light, out of reach of children. Keep the original packaging closed and mind the expiry date.