Stop Both Medications Immediately and Seek Emergency Care
You should NOT use Motrin (ibuprofen) or hydrocortisone cream for your current symptoms—these will not help and may delay necessary treatment. Your symptoms of persistent penile firmness, discoloration, and variable size after combining tadalafil and sildenafil suggest possible priapism or a serious adverse reaction requiring immediate medical evaluation.
Why This is an Emergency
The combination of tadalafil and sildenafil is explicitly contraindicated. The FDA label for tadalafil clearly states: "The safety and efficacy of combinations of tadalafil and other PDE5 inhibitors or treatments for erectile dysfunction have not been studied. Inform patients not to take tadalafil with other PDE5 inhibitors" 1. You have created an unsafe drug interaction by taking both medications together.
What You're Experiencing
Your symptoms—persistent firmness, discoloration, and size changes—raise concern for:
- Ischemic priapism: An erection lasting >4 hours that requires emergency treatment. The 2022 AUA/SMSNA guideline emphasizes that priapism "requires not only treatment of acute episodes" but immediate intervention to prevent permanent damage 2.
- Severe vasodilation effects: Combining two PDE5 inhibitors amplifies blood pressure drops and vascular effects, potentially causing tissue ischemia or other complications.
Why Your Proposed Treatments Won't Work
Ibuprofen (Motrin): This is an anti-inflammatory pain reliever. It has no mechanism to reverse PDE5 inhibitor effects, resolve priapism, or address penile vascular complications. While one study showed tadalafil with aspirin didn't increase bleeding risk 3, this doesn't apply to your situation—you need reversal of drug effects, not anti-inflammatory action.
Hydrocortisone cream: This topical steroid treats skin inflammation and conditions like phimosis. There is zero evidence it works for drug-induced penile complications. One study specifically debunked the myth that topical corticosteroids help with penile adhesions 4, and there's no mechanism by which it would address your vascular/erectile tissue problem.
What You Must Do Now
If your erection has lasted >4 hours: Go to the emergency department immediately. The FDA label warns: "An erection that won't go away (priapism). If you get an erection that lasts more than 4 hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis, including the inability to have erections" 1.
If symptoms are present but <4 hours: Contact your healthcare provider urgently today. Describe exactly what medications you took, when, and at what doses.
Stop all PDE5 inhibitors immediately: Do not take any more tadalafil, sildenafil, or related medications.
Critical Pitfalls to Avoid
- Don't wait to see if it resolves: Ischemic priapism causes permanent erectile tissue damage within hours. The guideline emphasizes that "lasting damage can happen to your penis, including the inability to have erections" if not treated promptly 2.
- Don't try home remedies: Neither over-the-counter medications nor topical treatments will reverse this drug interaction.
- Don't minimize discoloration: Color changes suggest compromised blood flow, which is a medical emergency.
Why Combining These Drugs is Dangerous
Both medications work through the same mechanism (PDE5 inhibition), creating additive and potentially dangerous effects. Studies on PDE5 inhibitor safety specifically note they should not be combined 5, 6. The combination amplifies:
- Hypotensive effects (dangerous blood pressure drops)
- Prolonged smooth muscle relaxation in penile tissue
- Risk of priapism and tissue ischemia
Seek immediate medical evaluation. Your symptoms require professional assessment and potentially urgent intervention—not over-the-counter medications.