Niacin and PDE5 inhibitors

One of the supplements that has helped me a lot has been niacin (B3). It seems to reduce most of my symptoms somewhat but importantly it reduces my pain so much that it sometimes eliminates it completely.

The relief can happen quite fast after taking the supplement (how fast NAD+ synthesis from niacin happens?) and niacin apparently causes some vasodilation so I decided to try PDE5 inhibitors (Sildenafil) and it appears that it also reduces my pain levels.

Last few times when I have had tingling in my arms, I have taken Sildenafil and the tingling has mostly disappeared after a while. I noticed that there was a recent thread about PDE5 inhibitors and neuropathy so linking it here.

Does anyone have suggestions what treatments/supplements/drugs I could try if these two seem to help (at least so far)? Perhaps Tadalafil later as it has a lot higher half-life?

@ChookityPop might be interested.


Senior Member
I have also had some improvement with Niacin, but sometimes experienced over dilation.

I think my vessels fluctuate between dilation and constriction so it’s really hard to take one medication for one thing as I’m swinging between both.

I did have some luck for a while with ritalin (it was great for my back muscle pain due to it seeming to balance the dilation out) but it pooped out.

I have been wondering if combining the two (niacin and ritalin) would be helpful but I also feel like it might be a nasty combo so haven’t gone there yet. There is a possibility of taking strattera too but again I’m just not sure.
I don't have pain, thus I don't know of anything that'd work for it in my case. However, other ways of forming NAD+ include NMN and NR. The viagra you mentioned also worked by increasing NO and l-arginine and l-ornithine also increase NO. Some things to consider talking to your doctor about.


Senior Member
Brisbane, Australia
There's a body of research to suggest that just nitric oxide (NO) donors in general are beneficial for diabetic neuropathy and that includes the PDE inhibitor and nitrates family. Where nitrates are concerned, you would get longer benefit from using the controlled release forms rather than sublinguals. A Randomized, Double-Blind Study of the Effects of a Sustained Release Formulation of Sodium Nitrite (SR-nitrite) on Patients with Diabetic Neuropathy. (2018) The effect of transdermal nitroglycerin on pain control in diabetic patients with peripheral neuropathy (2015)