What Is Combination Therapy for Erectile Dysfunction?

Combining ED treatments can boost results. Discover how BlueChew’s dual PDE5 combos work better together.

Key Takeaways

• Combination therapy means using two (or more) treatments at once to boost erection success.
• Studies show that combination approaches often work better than a single therapy.
• Options include medications, hormones, devices, and lifestyle strategies.
• The ultimate combo? BlueChew’s custom chewable PDE5 inhibitor plans.

At BlueChew, we know erectile dysfunction treatment isn’t a one-size-fits-all solution. Some men respond great to a single medication, while others need a little extra support. That’s why we offer unique combination therapies—custom compounded sublingual medications that combine two PDE5 inhibitors (medications that boost blood flow to the penis) to fit your goals.

Why use combination therapy? Research shows that using more than one approach to treat erectile dysfunction can make a real difference—especially for men who don’t fully respond to a single therapy.

Below, we’ll dive into what combination therapy is, the different types to be aware of, and why BlueChew’s MAX Combo solutions may be the perfect fit for you.

What Is Combination Therapy?

Combination therapy for erectile dysfunction means using two or more ED treatments at the same time. Instead of putting all your hope in one pill, shot, or device, you stack treatments that work in different ways—so you’re tackling erection issues from multiple angles.

Think of it like training for a marathon: running helps, but pairing it with strength training, sleep hygiene, and nutrition gives you the best chance to win.

For erections, that might look like medication + lifestyle changes, medication + devices, or even two PDE5 inhibitors together.

Popular Combination Therapies for Erectile Dysfunction

1. Medication + Lifestyle Changes

Taking medications clinically shown to improve erections (such as a PDE5 inhibitor) while also improving diet, exercise, and sleep often leads to better results. In fact, research shows that men who paired medications with aerobic exercise had better erection scores than those on medications alone.

Certain diets, particularly the Mediterranean diet, have also been shown to improve erectile function. While research into individuals with obstructive sleep apnea and erectile dysfunction has shown the most significant improvements in erections when they combined specialized sleep therapy with medications.

Based on the research, lifestyle changes combined with erectile dysfunction medications can positively impact your erections.

2. Medication + Testosterone Therapy

For some men who don’t respond to PDE5 inhibitors alone, hormone therapy can help improve erections, particularly testosterone therapy. Testosterone is the hormone closely tied to a healthy sex drive and erections.

A systematic review found that testosterone replacement in men with low testosterone levels can enhance the effectiveness of PDE5 inhibitors and improve overall sexual satisfaction.

Based on the research, testosterone therapy plus PDE5 inhibitors often outperforms either treatment solo—restoring both desire and function.

3. Medication + Vacuum Erection Devices (VEDs)

Vacuum erection devices (VEDs) work by creating suction to pull blood into the penis, and a constriction ring helps keep it there. When you add a PDE5 inhibitor into the mix, you’re improving blood flow chemically and mechanically, which can make a noticeable difference.

Studies show that combining medications with VEDs leads to better erectile outcomes than using either option alone. Other research confirms this combo can improve erection quality and boost sexual satisfaction.

Based on the evidence, using a VED alongside PDE5 inhibitors can help men achieve firmer, more consistent erections.

4. Medication + Shockwave Therapy

Shockwave therapy (LiSWT) uses low-intensity sound waves to stimulate new blood vessel growth and improve blood flow to the penis. When combined with PDE5 inhibitors, the two treatments may work even better—improving erectile function in the short term and potentially supporting long-term vascular health.

Clinical reviews have found that pairing LiSWT with PDE5 inhibitors can improve erectile outcomes compared to medication alone and may even help men who don’t fully respond to PDE5 therapy.

5. Medication + Psychotherapy

Performance anxiety is one of the biggest erection killers—and it can impede the effects of even the strongest PDE5 inhibitor. Pairing medication with psychotherapy, particularly cognitive-behavioral therapy (CBT) may help break the cycle of stress, worry, and erectile dysfunction.

Research shows that men who combined CBT with ED medications reported better erectile function and higher satisfaction than those using medication alone.

Based on the evidence, addressing both the mind and the body often leads to better results than treating either one on its own.

6. Two PDE5 Inhibitors Together

One of the most promising approaches to combination therapy for erectile dysfunction involves using two PDE5 inhibitors—typically tadalafil (long-acting) and sildenafil or vardenafil (fast-acting). This strategy combines sustained coverage with rapid onset for more consistent erections, improved confidence, and higher satisfaction.

Research supports the benefits: a 2014 study found that men who combined tadalafil and sildenafil achieved stronger erections and greater sexual satisfaction without additional side effects. A recent 2024 study reported that men previously unresponsive to erectile dysfunction treatment with one medication alone experienced significant improvements in erectile rigidity and function when combining medications.

Why BlueChew Leads the Pack

BlueChew takes the guesswork out of combination therapy with two custom-compounded options designed for real-world results. MAX and VMAX.

MAX combines sildenafil and tadalafIl for a rapid onset and long-lasting coverage—perfect for men who want flexibility and dependable performance anytime.

VMAX pairs vardenafil and tadalafil, delivering a powerful balance of potency and staying power with a smoother side-effect profile.

With MAX and VMAX, BlueChew delivers dual-action performance that’s fast, long-lasting, and built for real life—so you can stay ready, confident, and in control anytime the moment strikes.

Final Thoughts

When one medication doesn’t fully deliver, combination therapy can.

By strategically pairing short-acting and long-acting PDE5 inhibitors, BlueChew’s MAX and VMAX give you the best of both worlds—rapid onset, extended coverage, and enhanced confidence.

Clinical studies show that combining tadalafil with another PDE5 inhibitor like sildenafil or vardenafil can lead to stronger erections and higher satisfaction.

With these innovative sublingual erectile dysfunction medications, you’re not just improving your sexual performance—you’re expanding the possibilities.

Whether it’s a date night or an entire weekend away, BlueChew helps you stay ready, steady, and in control of your performance.

How To Get Erectile Dysfunction Medications from BlueChew

Interested in taking your erections up a notch? BlueChew has got you covered.

BlueChew makes it easy to get an erectile dysfunction medication that fits your needs. Select a plan, complete an online intake, and you’re done. A medical provider will review your information and, if appropriate, prescribe your plan, which will be shipped directly to your door.

No doctor appointments or patient support charges make it a stress-free experience.

With plans starting as low as $25 per month, BlueChew can fit into anyone’s budget. Plus, there’s no commitment—you can easily cancel or switch plans anytime.
Click here to explore all plan options for treatments at BlueChew.

FAQs

What is combination therapy for erectile dysfunction?

Combination therapy means using two or more treatments together to improve erection quality and sexual performance. This could include pairing medications, hormone therapy, devices, or even lifestyle changes. BlueChew’s approach focuses on combining two PDE5 inhibitors for stronger, longer-lasting erections.

Why would someone combine two ED medications?

Some men don’t get their best results from one medication alone. Combining two PDE5 inhibitors—such as tadalafil with sildenafil or vardenafil—can enhance erection firmness, duration, and satisfaction. Research shows this combination can deliver greater benefits without increasing side effects.

Is it safe to combine erectile dysfunction medications?

When prescribed and monitored by a licensed provider, combination therapy can be safe and effective. It’s important not to mix or adjust medications on your own—your BlueChew provider determines the best combination and dosage for your needs.

How do BlueChew MAX and VMAX fit into combination therapy?

MAX and VMAX are BlueChew’s custom-compounded combination formulas. MAX combines sildenafil (fast-acting) and tadalafil (long-lasting) for flexible, all-day performance. VMAX combines vardenafil (potent and precise) with tadalafil for stronger rigidity and staying power. Both are sublingual for faster absorption and reliable results.

Will I experience more side effects with combination therapy?

Not necessarily. Studies show that combining PDE5 inhibitors doesn’t increase side effects compared to using one medication alone. In fact, lower doses of each ingredient may help minimize issues like flushing, headache, or nasal congestion.

References

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2. Maio G, Saraeb S, Marchiori A. Physical Activity and PDE5 Inhibitors in the Treatment of Erectile dysfunction: Results of a Randomized Controlled Study. The Journal of Sexual Medicine. 2010;7(6):2201-2208. doi:https://doi.org/10.1111/j.1743-6109.2010.01783.x
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4. Li Z, Fang Z, Xing N, Zhu S, Fan Y. The Effect of CPAP and PDE5i on Erectile Function in Men with Obstructive Sleep Apnea and Erectile dysfunction: a Systematic Review and meta-analysis. Sleep Medicine Reviews. 2019;48:101217. doi:https://doi.org/10.1016/j.smrv.2019.101217
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6. Alhathal N, Elshal AM, Carrier S. Synergetic Effect of Testosterone and Phophodiesterase-5 Inhibitors in Hypogonadal Men with Erectile Dysfunction: A Systematic Review. Canadian Urological Association Journal. 2012;6(4):269-274. doi:https://doi.org/10.5489/cuaj.11291
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This article is for informational purposes only and does not constitute medical advice. The content provided here is not a substitute for, and should never be relied upon as, professional medical advice. Always consult your doctor to discuss the risks, benefits, and appropriateness of any treatment. BlueChew offers compounded medications prescribed solely for the treatment of erectile dysfunction and sexual performance enhancement. Compounded medications are not FDA-approved.