Erectile Dysfunction

Intracavernosal Injections

An intracavernous injection, according to the American Urologic Association, is the most effective non-surgical treatment for ED. Injections into the penis, unlike oral medications, triggers an automatic erection. Injection can be done by the individual 5 minutes prior to sexual activity and should last for no more than 1 hour. Injection is considered second line to be used if oral therapy fails. Compounds that can be injected include alprostadil, papaverine, and phentolamine.

Bi-Mix: Papaverine + Phentolamine

Bi-Mix was first introduced by a study in 1985 that showed a success rate of 71% amongst 250 patients that were given 1mg of phentolamine mixed with 30mg of papaverine. In 1987, 2 more studies were published. One study showed that phentolamine mixed with papaverine had a 72.9% success rate verse 20% with papaverine alone. In another study, papaverine mixed with phentolamine was examined for a follow up of 26 months. Only 13% of the patients failed to respond to therapy.

Tri-Mix: Papaverine, Phentolamine, Alprostadil

Tri-Mix is a compounded medication the combine's papaverine, phentolamine and alprostadil in one vial to achieve maximum efficacy, lower incidence of pain, and lower cost per dose. Studies have been done that have shown the efficacy of all three agents combined into one formulation. Combination therapy was first introduced in 1991 by Bennett and his colleagues who demonstrated a success rate of TriMix of 92% in 116 patients. Tri-Mix is often reserved for patients who fail alprostadil (PGE-1), fail Bi-Mix or for patients with severe penile pain from prostaglandin E1. Since Tri-Mix uses lower doses of alprostadil, penile pain often subsides

Quad-Mix: Papaverine, Phentolamine, Alprostadil, Atropine

Quad-Mix includes the addition of atropine which may work synergistically to cause smooth muscle relaxation in the penis. In a study conducted by Israilov and colleagues, 13 patients that failed tri-mix had a positive response to quad-mix. Seven (53.8%) of the patients responded successfully with the addition of atropine.

Apomorphine

Apomorphine is a drug that triggers the hypothalamus in the brain. It promotes the production of dopamine, a chemical that helps develop erections. This is different from other erectile dysfunction medications that affect muscles and blood vessels in the penis. Apomorphine is available in capsules or sublingual tablets..