The product labeling for tadalafil now states that caution be advised when PDE5-I are coadministered with α-blockers. Patients should be stabilized on α-blockers prior to the initiation of PDE5-I therapy for ED or LUTS and physicians should discuss with patients the potential for PDE5-I to augment the effect of α-blockers on their blood pressure. The only contraindication to

all three PDE5-I is the use of nitrates.32 Dual therapy with an α-blocker and PDE5-I has also been explored to verify if combination therapy would be superior to α-blocker therapy alone for LUTS. An early Inhibitors,research,lifescience,medical pilot study by Kaplan and associates33 demonstrated that combination click here alfuzosin and sildenafil was superior to monotherapy for treating LUTS and ED. Patients were given alfuzosin, Inhibitors,research,lifescience,medical 10 mg, daily, sildenafil, 25 mg, daily, or both. Improvement of IPSS was significant with all three treatments but greatest with combination (−24.1%) compared with alfuzosin

(−15.6%) and sildenafil (−16.9%) alone (P < .03). IIEF improved greatest with Inhibitors,research,lifescience,medical combination therapy (58.6%) compared with alfuzosin (16.7%) and sildenafil (49.7%) alone (P = .002).33 Bechara and colleagues34 assessed the safety and efficacy of tamsulosin 0.4 mg/d versus tamsulosin 0.4 mg/d plus tadalafil 20 mg/d in 30 men with LUTS. A randomized, double-blind, crossover study was performed at a single institution. Each randomized group received tamsulosin or tamsulosin plus tadalafil for 45 days, and then switched to the other treatment regimen for the following 45 days. Although both groups had improvements in IPSS and IPSS-QoL compared with baseline (P < .001), the combination group Inhibitors,research,lifescience,medical had greater improvement (mean IPSS: tamsulosin alone 12.7 vs tamsulosin/tadalafil 10.2; P < .05) and Inhibitors,research,lifescience,medical IPSS-QoL (mean IPSS QoL: tamsulosin alone 2.3 vs tamsulosin/tadalafil 1.6; P < .05). IIEF was better in the arm receiving tadalafil (mean IIEF: tamsulosin alone 16.9 vs tamsulosin/ tadalafil 23.2; P < .001),

but there were no differences in improvements seen in both uroflowmetry Qmax (mean Qmax [mL/s]: tamsulosin alone 11.7 vs tamsulosin/tadalafil 12.5; P > .05), and PVR (mean PVR [mL]: tamsulosin alone 24.8 vs tamsulosin/tadalafil 21.3; P < .05).34 These studies and others demonstrate the efficacy of combination PDE5-I and α-blockers for the treatment of LUTS, else especially in men who also have ED.35,36 Urodynamics and PDE5-I The acute effects of PDE5-I have been assessed using uroflowmetry as a marker of drug effect on BPH tissue. Two studies assessed maximum and average flow rates in men given sildenafil either 30 or 120 minutes before uroflowmetry. The maximum and average flow rates were significantly higher in the sildenafil-treated groups compared with those who did not receive medication.