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Sildenafil + alprostadil is an investigational combination pharmacotherapy for men with difficult-to-treat erectile dysfunction (ED) who have failed monotherapy with either agent alone. The combination pairs oral sildenafil, a small-molecule phosphodiesterase type 5 (PDE5) inhibitor that acts on the nitric oxide (NO)/cGMP pathway, with intracavernosal alprostadil injection (prostaglandin E1), a small molecule that elevates cyclic AMP (cAMP) in cavernosal smooth muscle. These two agents work via complementary and synergistic mechanisms to promote penile smooth muscle relaxation and erection. The combination was studied in a randomized, single-blind clinical trial (NCT00507286) sponsored by the Keogh Institute for Medical Research in Australia. There is no proprietary brand name for this specific combination; both components are generic drugs used off-label in combination.
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