Overview
The goal of this clinical trial is to evaluate whether daily dosing with tadalafil 5 mg combined with on-demand sildenafil 100 mg can improve erectile function in men with erectile dysfunction (ED) who do not respond to PDE5 inhibitor alone.
The main questions it aims to answer are:
- Does the combination of daily tadalafil and on-demand sildenafil lead to a greater improvement in erectile function (measured by the IIEF-EF domain) compared with on-demand sildenafil alone?
- Is the combination therapy safe and well tolerated in this patient population?
Researchers will compare:
- Group A: Daily tadalafil 5 mg plus on-demand sildenafil 100 mg
- Group B: Daily placebo plus on-demand sildenafil 100 mg
to determine whether the combination regimen provides superior improvement in erectile function and patient satisfaction.
Participants will:
- Undergo baseline assessment including medical history, physical examination, and laboratory tests.
- Be randomly assigned to one of the two treatment groups.
- Take the assigned medications for 12 weeks.
- Complete follow-up evaluations at 4, 8, and 12 weeks, including:
International Index of Erectile Function (IIEF-15) questionnaire Erection Hardness Score (EHS) assessment Reporting of any adverse effects
Eligibility
Inclusion Criteria:
- Sexually active male.
- History of ED for ≥6 months.
- Erectile function domain of IIEF-15 score \<17.
- Documented failure to respond to PDE-5I \[definition of non-responder patients are patients with ED who don't respond to maximum dose of PDE-5I on ≥4 occasions in spite of accurate timing and good sexual stimulation\].
- Stable sexual relationship ≥ 6 months.
Exclusion Criteria:
- Penile anatomical deformities or Peyronie's disease.
- Pelvic surgery or radiation.
- Active malignancy or severe systemic illness.
- Previous penile surgery of any kind, such as penile prosthesis, penile lengthening, penile cancer surgery, penile plication or grafting.
- Contraindication to PDE5i (High risk cardiac patients, patients on nitrates, hypotension).
- Using other treatments for ED e.g., Intra-cavernoasl prostaglandin injection therapy.