I am looking for the best medical therapy for a moderate Peyronie’s case (no ED, age 30, healthy) and have questions about a combination Dr. Levine once proposed (PDE5 e.g. Sildenafil 25mg daily, L-arginine 500 mg twice daily, pentoxyfiline 400 mg thrice daily). 1. L-Arginine is known to be a precursor to nitric oxide. Why is that not contraindicated with Sildenafil (“no nitrics”) 2. Pentox says it should not be combined with substances that lower the blood pressure. Any problem with Sildenafil?

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At this time, there is no FDA approved, non-surgical treatment for Peyronie’s disease, but several treatment options have been proposed, Dr. Levine’s three-armed, non surgical therapy includes pentoxifylline 400mg 3 times per day, L-arginine 1000mg twice per day, or L-citrulline 750mg twice daily. The second arm includes intralesional verapamil injections every 2 weeks, and the third arm is daily traction therapy, which is recommended to be used three hours or more daily, at two hour intervals. L-arginine is a nitric oxide donor and has been shown in its own right to potentially improve erections in patients with mild ED, because it is not a potent systemic nitric oxide donor, it has not been contraindicated to be used with a PDE5 inhibitor. Nitroglycerin on the other hand, does have powerful systemic effects which can cause profound lowering of blood pressure when a PDE5 inhibitor such as sildenafil is in the bloodstream as it would result in sustained low blood pressure. Pentoxifylline, similarly, is a nitric oxide donor, but has not been shown to have a contraindication when used in concert with a PDE5 inhibitor.

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