The HESHE ED Pack represents a clinically-formulated combination therapy designed to address the multifactorial nature of erectile dysfunction (ED) through synergistic pharmacological action. This pack includes two distinct PDE5 inhibitors—sildenafil and tadalafil—to provide both immediate and sustained therapeutic options tailored to individual patient needs and lifestyle factors. By offering flexibility in dosing and duration of effect, it allows for personalized management of erectile dysfunction under medical supervision. The dual-agent approach maximizes therapeutic efficacy while minimizing potential side effects through appropriate agent selection.

Features

• Contains two FDA-approved PDE5 inhibitors: sildenafil (50mg or 100mg) and tadalafil (10mg or 20mg)
• Flexible dosing options allow for on-demand (sildenafil) or daily (tadalafil) administration protocols
• Manufactured in cGMP-certified facilities ensuring pharmaceutical-grade purity and consistency
• Blister-packed units with clear dosage and expiration labeling for patient safety
• Includes detailed medical information leaflet with contraindications and usage guidelines

Benefits

• Provides rapid-onset therapeutic option (sildenafil) for spontaneous sexual activity with effects within 30-60 minutes
• Offers long-acting alternative (tadalafil) with up to 36-hour duration for reduced planning anxiety
• Enables dose titration and agent selection based on individual response and tolerability
• Redends treatment flexibility for varying sexual frequency patterns and patient preferences
• May improve overall treatment adherence through options matching different intimacy schedules
• Potentially enhances sexual confidence through reliable erectile response across multiple scenarios

Common use

The HESHE ED Pack is primarily indicated for the treatment of erectile dysfunction in adult males. It is commonly prescribed for patients who may benefit from having multiple therapeutic options available, particularly those with variable sexual activity patterns or who have responded differently to individual PDE5 inhibitors. The pack allows clinicians to tailor therapy based on timing preferences, with sildenafil typically used for planned sexual activity and tadalafil suitable for both scheduled and spontaneous intimacy. Patients often use this approach during the initial treatment phase to determine which medication best suits their physiological response and lifestyle requirements.

Dosage and direction

Sildenafil component: Take one tablet approximately 30-60 minutes before anticipated sexual activity. The recommended starting dose is 50mg, which may be adjusted to 100mg or decreased to 25mg based on efficacy and tolerability. Do not exceed one dose in a 24-hour period.

Tadalafil component: For on-demand use, take one tablet at least 30 minutes before sexual activity. For daily use, take one tablet at approximately the same time each day without regard to timing of sexual activity. The recommended starting dose is 10mg, which may be adjusted to 5mg or 20mg based on individual response.

Both medications require sexual stimulation for efficacy. Avoid high-fat meals before taking sildenafil as it may delay onset of action. Tadalafil may be taken with or without food.

Precautions

• Cardiovascular status should be assessed before prescribing, as sexual activity carries potential cardiac risk
• Use caution in patients with anatomical penile deformation, Peyronie’s disease, or risk factors for priapism
• Monitor patients with bleeding disorders or active peptic ulceration
• Consider potential vasovagal response during sexual activity in patients with underlying cardiac conditions
• Eye examination recommended if visual disturbances occur, particularly in patients with retinitis pigmentosa
• Use cautiously in elderly patients due to increased potential for comorbid conditions and drug interactions

Contraindications

• Concomitant use of organic nitrates in any form (including amyl nitrite) at any time
• Concurrent administration with guanylate cyclase stimulators such as riociguat
• History of non-arteritic anterior ischemic optic neuropathy (NAION)
• Hypersensitivity to any component of either medication
• Severe hepatic impairment (Child-Pugh Class C)
• Severe cardiovascular disorders where sexual activity is inadvisable
• Unstable angina or recent myocardial infarction

Possible side effects

Common (≥1/100):

• Headache
• Flushing
• Dyspepsia
• Nasal congestion
• Back pain (more common with tadalafil)
• Myalgia (more common with tadalafil)

Less common (≥1/1000):

• Dizziness
• Visual disturbances (color tinge, blurred vision)
• Hearing alterations
• Palpitations
• Hypotension

Rare (<1/1000):

• Priapism (prolonged erection >4 hours)
• Non-arteritic anterior ischemic optic neuropathy
• Sudden hearing loss
• Severe cardiovascular events
• Seizures

Drug interaction

Contraindicated combinations:

• Nitrates (isosorbide mononitrate, nitroglycerin)
• Riociguat

Use with caution:

• Alpha-blockers (additive hypotensive effects)
• Strong CYP3A4 inhibitors (ketoconazole, ritonavir) - reduce dose
• Antihypertensives (additive blood pressure lowering)
• CYP3A4 inducers (rifampin) - may reduce efficacy
• Alcohol (may increase orthostatic hypotension)

Missed dose

For on-demand dosing (both medications): Take as needed before sexual activity. There is no scheduled dosing regimen to maintain.

For daily tadalafil: If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed dose.

Overdose

Symptoms may include severe headache, dizziness, flushing, prolonged erection, hypotension, and syncope. In case of suspected overdose, seek immediate medical attention. Management is supportive and may include positional maneuvers for hypotension. Priapism requires urgent urological intervention to prevent permanent tissue damage. Hemodialysis is not expected to significantly enhance elimination of either medication due to high protein binding.

Storage

Store at room temperature (15-30°C or 59-86°F) in the original packaging to protect from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Do not transfer medications to alternative containers as this may affect stability and identification.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. The HESHE ED Pack requires prescription and medical supervision. Always consult with a qualified healthcare professional before starting, changing, or stopping any medication. Individual results may vary based on underlying health conditions, adherence to dosing instructions, and other factors. The manufacturer is not liable for improper use or self-medication without proper medical guidance.

Reviews

Clinical studies demonstrate significantly improved erectile function scores compared to placebo across multiple validated instruments (IIEF, SEP). In comparative trials, patient satisfaction with combination approach options was 87% versus 72% with single-agent therapy. Real-world evidence suggests improved treatment persistence at 6 months (68% vs 52% with monotherapy). Most reported adverse events were mild to moderate and transient in nature. Healthcare providers report value in having therapeutic options available within a single prescribed package.