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But, the growing number of patients with no or low response to PDE5I, and the potential of adverse reactions have prompted the development of safer and more effective treatments ( Figure 1 Drug therapy: Phosphodiesterase 5 inhibitors Phosphodiesterase 5 (PDE5) is highly expressed in vascular smooth muscle and it is the most common PDE subtype in penile smooth muscle

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However, the potential for increased bleeding risk due to additive antiplatelet effects from both curcumin and cilostazol, coupled with potential pharmacokinetic interactions (CYP inhibition) that could increase cilostazol exposure, requires careful clinical consideration