Sildalist

Two erectile dysfunction medicines in one tablet

Sildalist packs sildenafil 100mg and tadalafil 20mg into a single tablet — the two best-known oral medicines for erectile dysfunction, where a man struggles to get an erection hard enough for sex or to keep it. Both are PDE5 inhibitors. Each one loosens the muscle in the walls of the penile arteries, letting blood fill them once a man is aroused, though arousal has to come first. Packs hold 10 to 270 tablets.

If you would rather take one ingredient at a time, sildenafil and tadalafil are each sold separately.

How and when to take it

Swallow one tablet with a glass of water around an hour before sex, which suits both halves: sildenafil works from 30 minutes to four hours after the dose, and tadalafil wants at least half an hour. Leave a full day between tablets, because taking another one sooner adds nothing and only raises the chance of side effects. A rich, fatty meal slows the sildenafil down, so after a heavy dinner the tablet may take longer to show. Heavy drinking is a poor match: it brings on headache, dizziness and a racing pulse, drags blood pressure down and can work against the erection itself. Keep the strips somewhere dry, out of the heat.

How long it keeps working

The sildenafil side wears off within hours. Tadalafil hangs around far longer: a 20mg dose taken when it is needed can still be active 36 hours later, so a tablet swallowed in the evening may help the next morning.

Side effects and what to watch for

Headache, a flushed face, a stuffy or runny nose and indigestion are the usual ones, along with backache or sore muscles the day after a tadalafil dose. They pass on their own. An erection that will not go down and lasts four hours or more needs urgent treatment — the tissue can be damaged. Sudden loss of vision, or chest pain, also needs urgent attention, and rarely a reaction makes the tongue or throat swell and breathing difficult.

Interactions that matter

Nitrate medicines for angina (tablets, sprays and patches) and the recreational drug amyl nitrite, known as "poppers", are the firm exclusion: with either ingredient they can drop blood pressure to a dangerous level, so the two are never used together. Ketoconazole, itraconazole and ritonavir slow the liver's clearance of both ingredients, so blood levels climb. Alpha-blockers, whether taken for the prostate or for blood pressure, add to the dip.