PDE5 Inhibitors and Alpha-Blockers May Help Men with ED and LUTS

Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) become more common as men get older. New research suggests that taking a combination of two drugs may benefit these men more than taking one drug alone.

Both ED and LUTS can be difficult to deal with. ED happens when a man can’t get or keep an erection firm enough for sex. It’s a frustrating situation that often makes men feel inadequate and anxious. One of the leading causes of ED is poor blood flow to the penis. Blood is what makes a rigid erection. Without good blood flow, an erection will either be weak or it won’t happen at all.

LUTS is associated with benign prostatic hyperplasia (BPH), otherwise known as an enlarged prostate. When a man has BPH, his prostate gland grows inward. This can squeeze the urethra, the tube that helps urine flow out. With added pressure on the urethra, many men with BPH/LUTS have trouble urinating.

For men who can take medications, treatment for ED often starts with pills called phosphodiesterase type 5 (PDE5) inhibitors like Viagra, Levitra, and Cialis. These drugs help relax muscle tissue in the penis, which allows more blood to flow in.

LUTS may be treated with alpha-blockers, which relax muscles and relieve pressure on the urethra, making it easier to urinate.

Since both ED and LUTS are common in older men, scientists have investigated whether combining PDE5 inhibitors and alpha-blockers might help. Past research has had mixed results. So researchers from Capital Medical University in Beijing, China reviewed and analyzed some of the medical literature on the subject.

They searched medical databases for studies involving PDE5 inhibitors and alpha-blockers for treatment of ED and BPH/LUTS. They only included randomized controlled trials in their analysis, which are often considered the “gold standard” methodology for medical research.

For their study, they analyzed seven trials that, combined, involved 515 patients. Overall, they found that patients who took a combination of a PDE5 inhibitor and an alpha-blocker had better results on ED and LUTS assessments than those who took a PDE5 inhibitor alone. Adding an alpha-blocker to PDE5 inhibitor therapy appeared to help alleviate both ED and LUTS.  

How does adding an alpha-blocker help? The researchers explained that because alpha-blockers relax muscle tissue, they help PDE5 inhibitors do their job. Also, since alpha-blockers can relieve the urinary symptoms of LUTS, men can feel better about their lives, which may help them sexually.

However, the authors added that only seven studies were analyzed. They recommended more research using high-quality randomized controlled trials to get a better sense of how this drug combination can be used to treat men with ED and BPH/LUTS.

The study was first published online last month in the Journal of Sexual Medicine.


The Journal of Sexual Medicine

Yan, Huilei MD, et al.

“The Efficacy of PDE5 Inhibitors Alone or in Combination with Alpha-Blockers for the Treatment of Erectile Dysfunction and Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis”

(Full-text. First published online: March 13, 2014)


Mayo Clinic

“Alpha blockers”

(February 1, 2014)