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If One of These Drugs Isn't Effective for Erectile Dysfunction, Can I Try Another?
CORRESPONDENCE Ivan Borrello: borreiv@jhmi.edu
Intracavernosal administration of alprostadil (Caverject) has reported success rates of 67 to 85 percent and has been used in the treatment of erectile dysfunction for several years.11 When injected directly into the corpus cavernosum, alprostadil (prostaglandin E1) acts on the arteriolar smooth muscle cells, causing them to relax and produce an erection, usually within several minutes. Its mechanism of action is to stimulate an increase in the levels of intracellular cyclic nucleotides that cause relaxation. The usual dose is between 5 and 40 µg per injection. The current average wholesale price ranges from about $86 for six of the 5-mg doses to approximately $163 for six of the 40-µg doses.12 Patients usually start at 2.5 µg and titrate up in 5-µg increments for effect, with a maximum dose of 60 µg. No more than three injections per week are recommended, with a minimum period of 24 hours between injections.13 Initial dosing and required adjustments should be carried out in the physician's office.
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A new study is showing that recreational use of Viagra is growing rapidly in men under 45 years of age. From 1998 to 2002, the use of Viagra in men under forty-five tripled, says the study, which looked at 5 million insured American males. What this study indicates is that Viagra is being used as a recreational drug, not as a drug to treat a medical condition. Thus, it belongs more in the category of pot, crack, heroin, or meth rather than being a medicinal pharmaceutical.
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The survey did not ask volunteers if a doctor had diagnosed either of the disorders, only about related symptoms, which is a weakness, said Dr. Thomas Pollm?cher, the director of mental health at Ingolstadt Hospital, Germany.
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"It is essential that healthcare clinicians get that message across."
Myth #1: Erectile dysfunction is strictly a physical problem.
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Penile pain (11 to 32 percent) and minor urethral discomfort are the most common reported adverse effects of transurethral administration, with dizziness (2 percent) and symptomatic hypotension (3 percent) being the most serious.16 As with transcavernosal alprostadil, the transurethral form of the drug is contraindicated in patients with an abnormally formed penis, those having conditions that predispose them to priapism, those with a known hypersensitivity to alprostadil and those who have been advised for medical reasons to avoid sexual intercourse. Because it is a smooth muscle relaxant, transurethral alprostadil should not be used during sexual intercourse with a pregnant woman.16
The study authors focused on 12 patients who had been diagnosed with chronic obstructive pulmonary disease and were suspected of having PAH. Throughout the study, right heart blood pressure was tracked among all 12 patients by inserting a thin plastic tube into the pulmonary artery -- a procedure known as cardiac catheterization. Cardiac blood pressure was measured at rest and just after all the patients cycled for three minutes.
Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Smoking, being overweight, and avoiding exercise are possible causes of ED.
If the veins in the penis cannot prevent blood from leaving the penis during an erection, an erection cannot be maintained. This condition is known as a venous leak. Venous leakage may occur with vascular disease, but it also can occur as a result of poor muscle relaxation of the penis. Difficulty with smooth muscle relaxation of the penis can occur with diabetes or with Peyronie's disease, a condition that results in the buildup of scar tissue of the sheath (tunica albuginea) surrounding the erection tissue (corpora cavernosa). Venous leak also can occur when neurological diseases or high levels of anxiety are present because these conditions can prevent adequate smooth muscle relaxation.
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Is saying "no" to sex really an option?
In addition to healthy blood circulation, the male sex hormone testosterone is important for erections and for sex drive. Men with erectile dysfunction may have low testosterone levels.
What Should I Do If I am Having Problems Achieving/Maintaining an Erection?
Talk therapy: During therapy, a licensed and trained mental health care professional helps you identify and work through issues related to depression. Types of talk therapy include couples therapy, individual therapy, and group therapy.
The average wholesale price of alprostadil for transurethral administration ranges from $118.50 for six of the 125-µg suppositories to $143.25 for six of the 1,000-µg suppositories.12 Dosage is initially 125 to 250 µg, with adjustment up or down as indicated. However, in the study cited above,15 few patients responded to less than 500 mg. The treating physician should determine the minimal effective dose. The drug is available in 125-, 250-, 500- and 1,000-µg suppositories. More flexibility is available with this form of alprostadil because it can be used twice in a 24-hour period.16
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