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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