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NEVER combine PDE5 inhibitors with nitrates. This combination causes severe, potentially fatal hypotension. There is no safe dose or timing window.Combination with alpha-blockers can cause severe symptomatic hypotension. If co-prescribing is necessary, start PDE5 inhibitor at lowest dose and ensure patient is stable on alpha-blocker first.Strong CYP3A4 inhibitors significantly increase PDE5 inhibitor plasma levels, raising risk of adverse effects. Dose reduction required: max sildenafil 25mg/48h, max tadalafil 10mg/72h.Additive blood pressure lowering effect. Not contraindicated but requires monitoring, especially on initiation. Patient should be informed of potential for dizziness.Moderate to heavy alcohol use amplifies vasodilation and orthostatic hypotension risk. Limit to 1-2 drinks when using PDE5 inhibitors.Upload Your Latest Panel
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Nitrates
CONTRAINDICATEDNitroglycerin (Nitrostat, Nitro-Dur)Isosorbide mononitrate (Imdur)Isosorbide dinitrate (Isordil)Amyl nitrite (poppers)Nitroprusside
Alpha-blockers
CAUTIONTamsulosin (Flomax)Doxazosin (Cardura)Terazosin (Hytrin)Alfuzosin (Uroxatral)Silodosin (Rapaflo)
HIV Protease Inhibitors (CYP3A4 inhibitors)
CAUTIONRitonavir (Norvir)Indinavir (Crixivan)Saquinavir (Invirase)Lopinavir/ritonavir (Kaletra)KetoconazoleItraconazole
Antihypertensives
MONITORAmlodipineMetoprololLisinoprilHydrochlorothiazide
Alcohol
CAUTIONCommon supplements below (L-Citrulline, Zinc, Vitamin D, Pycnogenol) have no known pharmacokinetic interactions with PDE5 inhibitors at standard doses.
Yohimbine / Yohimbe barkhigh risk
Unpredictable and highly variable blood pressure effects. Can cause severe hypertension or hypotension, anxiety, tachycardia, and panic attacks. Especially dangerous combined with antidepressants (MAOI interaction) or cardiovascular medications.High-dose L-Arginine (above 3g)moderate risk
Oral L-arginine is rapidly degraded by arginase before reaching circulation. High doses cause GI distress without proportional benefit. L-Citrulline is a superior precursor with better bioavailability and less redundant mechanism overlap.Upload a blood panel to see your values alongside these recommendations.
Total Testosterone
Low testosterone is present in 25-40% of men with ED. Identifies treatable hormonal cause.Baseline, then annually or when symptoms changeOptimal: 400-700 ng/dL (functional range)
Free Testosterone
SHBG can be elevated, making total testosterone misleading. Free testosterone reflects bioavailable hormone.Same draw as total testosteroneOptimal: 15-25 pg/mL
DHEA-S
Adrenal androgen precursor. Low DHEA-S is common after age 40 and compounds hormonal ED.Baseline, then annuallyOptimal: 200-400 mcg/dL (age-dependent)
Prolactin
Elevated prolactin suppresses LH and testosterone. Can be caused by pituitary adenoma. Important to rule out before starting treatment.Baseline (especially if libido is primary complaint)Optimal: Under 15 ng/mL
Lipid Panel
Dyslipidemia causes endothelial dysfunction and atherosclerosis, directly impairing penile blood flow. ED is often the first sign of cardiovascular disease.AnnuallyOptimal: LDL under 100 mg/dL, HDL above 50, Triglycerides under 100
HbA1c
Diabetes and insulin resistance are major causes of ED via both vascular and neuropathic mechanisms. Up to 75% of diabetic men develop ED.Annually or with metabolic workupOptimal: Under 5.7% (non-diabetic)
TSH
Both hypothyroidism and hyperthyroidism cause ED. Thyroid function should be evaluated in all men with unexplained ED.Baseline, then as clinically indicatedOptimal: 1.0-2.5 mIU/L (functional range)
Medical Disclaimer
Erectile dysfunction can indicate serious cardiovascular conditions. See a doctor for proper evaluation before starting or changing any treatment.
These protocols are for educational purposes only. This is not medical advice. Always consult a licensed healthcare provider before taking any medication or supplement.
Avelor does not sell supplements or accept affiliate commissions. All content is independently researched.