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In those patients already taking an optimized dose of PDE5 inhibitor, alpha-blocker therapy should be initiated at the lowest dose. Stepwise increase in alpha-blocker dose may be associated with further lowering of blood pressure when taking a PDE5 inhibitor. buy cialis online without a prescription cold sweats mirtazapine (Remeron)Erection of the penis is initiated by the relaxation of smooth muscle in the corpus cavernosum, one of a pair of sponge-like regions in the penis. When aroused, nitric oxide is released from nerve endings and endothelial cells in the corpus cavernosum. Nitric oxide activates the enzyme guanylate cyclase resulting in increased synthesis of cyclic guanosine monophosphate (cGMP) in the smooth muscle cells of the corpus cavernosum. The cGMP triggers smooth muscle relaxation, increasing blood flow into the penis, resulting in erection.
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