Phosphodiesterase-5 (PDE5) inhibitors, such as Tadalafil (Cialis) or Sildenafil (Viagra), are typically the most effective first-line medications, even with long-term diabetes and hypertension. Tadalafil is often preferred because it offers a longer duration of action and can be taken as a daily low dose. However, because chronic diabetes can damage nerves and blood vessels, these pills might be slightly less effective, and a dosage adjustment may be needed. Crucially, you must absolutely avoid these medicines if you take nitrates for chest pain. Please consult your doctor or cardiologist first to ensure your heart is healthy enough for these treatments and sex.
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