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Combination protocols (very effective) PT-141 + PDE-5 Inhibitor PT-141: 0.51 mg SQ Tadalafil: 510 mg PO Use together for synergistic effect Common side effects Use PT-141 for immediate performance Shockwave for long-term vascular remodeling Common side effects (dose-dependent) Nausea (most common) Facial flushing Headache Mild BP elevation (transient) Injection site irritation How to reduce nausea Start low (0.5 mg) Avoid fatty meals pre-dose Consider ondansetron 4 mg PRN (if needed Contraindications / cautions Who Should Avoid PT-141 Uncontrolled hypertension Significant cardiovascular instability History of severe nausea with melanocortins Avoid daily chronic use (on-demand)

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