Objective To evaluate which vasoactive agents have synergistic effects on the cavernosal smooth muscles of rabbits and rats when the agents are combined with sildena®l. Materials and methods Relaxation responses of cavernosal smooth muscle to single agents (phentolamine, moxisylyte, sodium nitroprusside, forskolin, vasoactive intestinal peptide, VIP, papaverine and sildena®l) in the rabbit, and prostaglandin-E 1 and sildena®l in the rat, and to combinations of each agent plus sildena®l, were assessed in vitro. The response to sildena®l of the rabbit strips with and without incubation with L-arginine (1 mmol/L) for 20 min was also evaluated. The effective concentrations for a half-maximal response of single agents and combination solutions were compared. Results All single agents induced concentrationdependent relaxation of the rabbit and rat cavernosal smooth muscles. There was signi®cant synergism on rabbit cavernosal smooth muscle when the sildena®l was combined with forskolin, sodium nitroprusside, VIP or phentolamine.There was also signi®cant synergism with sildena®l plus prostaglandin-E 1 in rat cavernosal muscles. There were no synergistic effects of combinations of sildena®l plus moxisylyte, papaverine or L-arginine.Conclusions These results suggest potentially effective combined therapies of sildena®l and intraurethral or intracavernosal prostaglandin-E 1 , intracavernosal forskolin or VIP, or oral phentolamine for patients with erectile dysfunction who have no success after monotherapy with these agents.