Erectile Dysfunction

METHODS: The study included 625 patients, 26-85 years old, with ED. Four intracavernous injection protocols were used: protocol 1, papaverine plus phentolamine; protocol 2, prostaglandin E(1); protocol 3, papaverine, phentolamine, and prostaglandin E(1); and protocol 4, atropine sulfate, papaverine, phentolamine, and prostaglandin E(1). A positive response was defined as an erection sufficient for penetration. Patients for whom the basic protocol failed were successively switched to the more advanced protocols until a positive response was achieved. RESULTS: A positive response was achieved by 415 (66.4%) of the 625 patients given protocol 1; 75 (36) of the remaining 210 patients give protocol 2; 98 (72.6%) of the 135 patients given protocol 3; and 22 (59.5%) of 37 patients given protocol 4. All four protocols failed in only 15 patients (2.4%). At the 3-year follow-up visit (n=610), 349 had achieved coitus, 65 (10.6%) without an injection and 202 (33.1%) with an injection. Eighty-two patients sometimes performed coitus without an injection. Sixty-three patients (10.3) abandoned the program because of marital or health problems; 198 asked to be switched to Viagra during the follow-up period, and 120 returned to the program. CONCLUSIONS: Overall, our progressive treatment yielded a high positive response rate (97.6%), with 57.2% achieving successful coitus on follow-up. The main advantage of the program is that is spares patients who are responsive earlier from using more complex, painful, and costly drugs.

The above article is useful because it states that vasoactive drugs in different combinations are effective for ED. Our purpose is to be the solution for urologists who have patients that require intracavernosal injections. For patients who don’t respond to Viagra or to whom Viagra is contraindicated, the Tri-mix/Quad-mix is a viable alternative. We have worked with a number of urologists to formulate combinations that offer the lowest effective dose for their patients.

Case Study:

Mr. S. has been using Viagra without satisfactory results. He has been to his regular physician to see if there is any other alternative for his erectile dysfunction. His physician stated that he was not aware of any non-conventional therapies for Mr.S. Desperate for an answer, Mr.S. telephoned our compounding pharmacist to see if there was something he can try. The compounding pharmacist referred Mr.S to an urologist who has extensive knowledge on intracavernosal injections. Through working one on one with the urologist, the compounding pharmacist formulated a tri-mix (phentolamine/papaverine/PGE1) injection for Mr.S. Happy with his results, Mr.S has been refilling his prescription on a regular basis.

Examples of products we are currently doing in accordance to the requests of practicing urologists:

  1. Viagra RDT (Rapid Dissolve Tablets)
    1. Dissolves in less than a minute unlike the conventional tablet which can take up to several hours to absorb
    2. We can add other medications to this tablet to work synergistically with sildenafil (e.g. phentolamine or apomorphine)
    3. Can be flavored to be disguised as a breath mint for patients who want to be discreet
  2. Topical creams
    1. Topical testosterone or other hormone cream that are just as effective as injection
  3. Intracavernosal injections (trimix, quadmix etc.)
    1. Customized ratios of PGE/phentolamine/papaverine for each patient
  4. Urethral inserts
    1. Can contain combinations of antibiotic/glucocortical steroid (e.g. nitrofurantoin/hydrocortisone)
  5. Tablet titurates
    1. Sublingual tablets that absorb even faster
    2. Can be customized to contain any medication (e.g. apomorphine/sildenafil) that needs to have an almost immediate effect
    3. Can be flavored to be disguised as a breath mint for patients who want to be discreet
  6. Irrigation solutions for localized infections
    1. DMSO bladder irrigation
    2. DMSO 50%
    3. Sodium bicarbonate
    4. Gentamicin
  7. Verapamil injections for Peyronnies disease
  8. Vacuum erection pumps (we have many different brands to choose from)

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