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Sildenafil should be used cautiously in men on alpha blockers such as doxazosin (Cardura), terazosin (Hytrin), and tamsulosin (Flomax). There have been occasional reports of low blood pressure in men who have taken the two classes of drugs simultaneously and therefore it is recommended that there be at least a span of 4-6 hours between the ingestion of sildenafil and alpha blockers.
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Nutritional Supplements: nutritional supplements including the amino acid arginine, bioflavonoids, zinc, Vitamin C, Vitamin E, and flaxseed meal have been used to improve erectile function. In addition, certain ED patients with low levels of the hormone dehydroepiandrosterone (DHEA) showed improvement in erectile function after receiving supplemental doses of DHEA. However, because the long-term safety of DHEA is not known, most experts do not recommend its use.
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With respect to neurological causes, involvement of any nerve group, either central or peripheral, may lead to erectile dysfunction. Cerebral diseases lead to decreased sexual interest, possibly through over-inhibition of spinal centres. Among patients with spinal cord injury, 95% of those who have upper motor neuron lesions are capable of reflexogenic erections, 25% of patients who have lower motor neuron lesions are capable of psychogenic erections, and more than 90% of patients who have incomplete lesions of either kind retain their erectile function.21 Direct injury to the cavernosal nerve and blood supply commonly occurs during therapy for prostate cancer; erectile dysfunction is present to some extent in 80% of patients so treated, whether by surgery or external beam radiation therapy.22
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