Contents
Erectile dysfunction (ED) is a condition that affects millions of men worldwide, impacting not only physical intimacy but also mental well-being and self-confidence. (Leslie, 2024) Over the past two decades, phosphodiesterase type 5 inhibitors (PDE5is) have revolutionized ED treatment, offering reliable solutions that enhance blood flow to the penis and facilitate erections. However, as research advances, it’s becoming clear that combination treatments may be the best option for optimizing efficacy, speed, and the overall experience of taking ED medications.
Rugiet is adopting combination ED treatments, offering next-generation ED medications that include a combination of PDE5is and apomorphine—an approach that is redefining performance enhancement.
PDE5 Inhibitors for Erectile Dysfunction
PDE5s work by slowing or stopping the action of an enzyme found in the body known as phosphodiesterase 5. This leads to increased blood flow to the penis when a man is aroused, allowing for a more satisfactory erection. (Dhaliwal A, 2023)
The introduction of sildenafil (Viagra) in 1998 marked a turning point in the management of ED. Soon after, other PDE5 inhibitors like tadalafil (Cialis) and vardenafil (Levitra) entered the market, offering variations in duration and onset time to cater to different patient needs (Huang, 2013). Patients would choose between these medications, opting for the “weekend pill” (tadalafil) for its 36-hour effectiveness, or vardenafil or sildenafil for a less-spontaneous, more targeted treatment duration. (Huang, 2013)
While PDE5s have proven to be very effective for many men over the years, they are not a one-size-fits-all solution. Some men respond differently to these medications and will experience delayed onset times, inconsistent results, or require additional stimulation to achieve and maintain an erection. While PDE5s can increase blood flow to the penis when the user is already aroused, they can not cause or stimulate mental arousal. One study even suggests that monotherapy (using one medication) to treat ED doesn’t lead to results for 30-40% of patients. (Munk, 2019)
This has led to a growing interest in combining different PDE5is or integrating other medications to enhance performance and reliability.
Combination ED Treatments: How Do They Work?
Researchers and clinicians have explored the benefits of combining different PDE5 inhibitors or using them alongside other pharmacological agents. The reasoning for combination therapy is simple: by leveraging multiple mechanisms of action, men can experience improved efficacy, faster onset times, and longer effects. (Cui, H, 2015)
Most research suggests that these combination treatments can have a significant impact on erectile function, improving treatment for those with severe ED or those struggling to adequately get and maintain an erection with one medication. (Cui, H, 2015) (Sullivan, JF, 2021)
So how does combination therapy work if you are combining the same ingredients? It’s important to recognize that different PDE5s have some key differences. For example, sildenafil is known for its relatively fast onset but shorter duration (4–6 hours), while tadalafil offers a longer duration of action (up to 72 hours) but can sometimes take longer to reach peak effectiveness. (Gong, 2017)
Combining these medications can lead to a more balanced and adaptable treatment, allowing users to benefit from both quick onset and longer results.
Because PDE5s can only help with performance enhancement when a man is already aroused, researchers have targeted medications that may help with the psychogenic aspects of ED. One example is apomorphine, a dopamine agonist that stimulates the brain's reward and arousal centers, making it a powerful complement to traditional ED medications. (Hagemann, 2003)
The Next Level: Rugiet’s Advanced ED Therapy
Rugiet takes combination therapy to the next level by offering unique medications that target PE and ED. Our flagship product, Rugiet Ready, is a sublingual (under the tongue) tablet that includes two PDE5 inhibitors (sildenafil and tadalafil) and apomorphine. This innovative approach addresses both the mental aspects of arousal and the physical, ensuring your brain and body are both primed for better sex.
1. Faster Onset and Increased Efficacy
One of the primary advantages of Rugiet’s formula is its rapid absorption. Traditional oral ED pills can take anywhere from 30 to 60 minutes to become effective, as they must pass through the digestive system before entering the bloodstream. (Le, 2024) Rugiet's dissolvable formulation ensures that active ingredients are absorbed sublingually, allowing for significantly faster onset times—often within 15 minutes. Read more about the benefits of sublingual medications.
Additionally, including two different PDE5 inhibitors provides a more balanced duration time of 24-36 hours. Whether you need a treatment option that will get you hard fast or help you last longer, Rugiet's blend may be exactly what you’re looking for.
2. Enhanced Arousal via Dopamine Stimulation
Unlike standard ED medications that focus solely on increasing blood flow to the penis, Rugiet incorporates apomorphine, a dopamine receptor agonist that activates the pathways involved in sexual desire and motivation. (Hagemann, 2003)
Many men with ED experience anxiety or a lack of natural arousal, which can impact the effectiveness of PDE5 inhibitors alone. Rugiet’s formula ensures a more holistic approach, promoting both physiological and psychological readiness for sexual activity.
3. Convenient and Discreet Usage
Rugiet’s dissolvable tablet format eliminates the need for swallowing pills with water, making it more convenient and discreet than traditional oral medications. This ease of use is particularly beneficial for men who want spontaneity in their intimate lives.
The Future of ED Treatment
Fortunately, ED treatment has evolved beyond having to pick between the “weekend pill” or the “for-right-now” pill. Combination ED treatments offer men a better option for targeting their sexual performance. With treatment options like Rugiet, more men can benefit from improved mental and physical arousal, leading to better sexual experiences for themselves and their partners.
Citations
Leslie SW, Sooriyamoorthy T. Erectile Dysfunction. [Updated 2024 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/
Dhaliwal A, Gupta M. PDE5 Inhibitors. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549843/
Huang, S. A., & Lie, J. D. (2013). Phosphodiesterase-5 (PDE5) Inhibitors In the Management of Erectile Dysfunction. P & T : a peer-reviewed journal for formulary management, 38(7), 407–419.
Munk, N. E., Knudsen, J. S., Comerma-Steffensen, S., & Simonsen, U. (2019). Systematic Review of Oral Combination Therapy for Erectile Dysfunction When Phosphodiesterase Type 5 Inhibitor Monotherapy Fails. Sexual medicine reviews, 7(3), 430–441. https://doi.org/10.1016/j.sxmr.2018.11.007
Cui, H., Liu, B., Song, Z., Fang, J., Deng, Y., Zhang, S., Wang, H., & Wang, Z. (2015). Efficacy and safety of long-term tadalafil 5 mg once daily combined with sildenafil 50 mg as needed at the early stage of treatment for patients with erectile dysfunction. Andrologia, 47(1), 20–24. https://doi.org/10.1111/and.12216
Sullivan JF, Campbell KJ, Lipshultz LI. Combination Therapies for Erectile Dysfunction—A Synergy of Modalities Holds the Key. JAMA Netw Open. 2021;4(2):e2037292. doi:10.1001/jamanetworkopen.2020.37292
Gong, B., Ma, M., Xie, W., Yang, X., Huang, Y., Sun, T., Luo, Y., & Huang, J. (2017). Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis. International urology and nephrology, 49(10), 1731–1740. https://doi.org/10.1007/s11255-017-1644-5
Hagemann, J. H., Berding, G., Bergh, S., Sleep, D. J., Knapp, W. H., Jonas, U., & Stief, C. G. (2003). Effects of visual sexual stimuli and apomorphine SL on cerebral activity in men with erectile dysfunction. European urology, 43(4), 412–420. https://doi.org/10.1016/s0302-2838(03)00002-2
Jennifer Le. Merck Manuals. November 2024. Drug Administration. https://www.merckmanuals.com/home/drugs/administration-and-kinetics-of-drugs/drug-administration
