Comparison of a Mixture of
Papaverine, Phentolamine and
Prostaglandin E(1), with Other Intracavernous Injections

Meinhardt, W.; Nijeholt, A.A.B. Lycklama à; Kropman, R. F.; Vermeij, P.; Zwartendijk, J.

doi:10.1159/000475407

Cited by 13 publications

(4 citation statements)

References 5 publications

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“…Three-drug (alprostadil, papaverine and phentolamine), [71][72][73][74] 4-drug (alprostadil, atropine, papaverine and phentolamine )[75.7 6 ] and even 6-drug (atropine, dypridamole, ifenprodil, papaverine, piribedil and yohimbine) [77] combinations have reportedly been used with success in home selfinjection programmes. Although superior efficacy has been claimed with these combination treatments for ED, they have yet to be thoroughly evaluated in comparative studies.…”

Section: Combination With Other Erectogenic Agentsmentioning

confidence: 99%

Intracavernous Alprostadil

Lea¹,

Bryson²,

Balfour³

1996

Drugs & Aging

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Intracavernous alprostadil (synthetic prostaglandin E1) is a vasodilating agent which acts by relaxing the smooth muscles of the corpus cavernosum and by increasing the diameter of cavernous arteries; this leads to erection. Following intracavernous administration, alprostadil is either locally metabolised or rapidly cleared from the penis into the systemic circulation where it is extensively metabolised by the lungs. Studies suggest that long term use of intracavernous alprostadil may increase penile blood flow, although the clinical relevance of this is not currently known. In men with erectile dysfunction (ED), short term trials have shown that intracavernous alprostadil is superior or equal, in inducing erections, to other intracavernous agents such as papaverine, the combination of papaverine plus phentolamine, linsidomine and topical nitroglycerin (glyceryl trinitrate). Intracavernous alprostadil induced erections in around 70% of patients with ED of various origins in short term studies. 49 to 84% of patients accept the offer of joining self-injection programmes and 13 to 60% of these patients withdraw from such programmes for a variety of reasons. At therapeutic doses, intracavernous alprostadil is well tolerated. The most common adverse event of transient penile pain occurred in around one-third of patients and in 11% of injections, causing 3 to 5% of patients to withdraw from self-injection programmes. Potentially serious adverse events such as priapism and fibrosis occurred in 4 and 8% of patients. Overall, available data suggest that the efficacy of intracavernous alprostadil is superior or equal to that of other erectogenic agents which are in use. Furthermore, the drug is well tolerated especially with regard to serious adverse events. Thus, although further research is necessary to confirm its use in combination with other agents, alprostadil appears likely to become the intracavernous agent of choice for the management of erectile dysfunction.

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Section: Combination With Other Erectogenic Agentsmentioning

confidence: 99%

Intracavernous Alprostadil

Lea¹,

Bryson²,

Balfour³

1996

Drugs & Aging

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“…Those patients not responding to oral medication or with contraindications for the drug should still be offered ICI. The clinical efficacy and the safety of prostaglandin E1 (PGE1), standard combinations of papaverine/phentolamine (P/P) or triple‐mix of these agents in severe cases of ED has been reported over the last two decades, and they are all commercially available in Europe [2–4]. Some authors even suggest using ICI combined with oral drugs to increase their overall efficacy, or to enable the dose and thus the side‐effects of either agent to be reduced [5,6].…”

Section: Introductionmentioning

confidence: 99%

In vitro viability of human cavernosal endothelial and fibroblastic cells after exposure to papaverine/phentolamine and prostaglandin E1

et al. 2005

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phentolamine or the respective triple-mix of these agents for 30 min. Viable cells were counted and cell metabolic activity measured in these cultures 48 h after drug exposure. RESULTSThere was a significant dose-dependent decrease in the viable cell count after exposure to papaverine-containing formulations, probably because of the low pH of this substance. This cytotoxic effect was more pronounced in endothelial than in fibroblastic cells, and was not apparent in the PGE1 groups. The relative increase in cell metabolic activity in cultures affected by a moderate cytotoxic effect indicated a regenerative process. CONCLUSIONThese comparative results in endothelial and fibroblastic cell cultures suggest that the endothelium rather than the interstitium of the corpus cavernosum is more sensitive to side-effects produced by intracavernosal injection therapy with papaverine. Thus, unfavourable consequences on the function of the endothelial layer might be as important as the risk of interstitial fibrosis. As these effects were not detected for PGE1 this drug should be preferred to papaverine in clinical practice.

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“…Papaverine or papaverine-containing combinations such as the double and the triple mix have been shown to carry a greater risk of priapism. 11,12 However, the risk of priapism is present with all types of ICIs and occurred in our series with PGE1 alone. Nevertheless, the incidence of priapism fell sharply after the institution of PGE1 monotherapy as the treatment of choice in 1989.…”

Section: Discussionmentioning

confidence: 54%

The incidence and management of priapism in Western Australia: a 16 year audit

et al. 2003

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The objective of the study was to conduct a retrospective audit of patients who presented with priapism in Western Australia during the years 1985-2000. We searched the records of the teaching hospitals in metropolitan Perth and those of the Keogh Institute for Medical Research for the diagnostic code for priapism. A total of 82 episodes of priapism in 63 patients occurred over this 16 year period. In all, 62 episodes occurred after intracavernosal injections (ICI) and 20 were due to other causes. Treatment of priapism included simple aspiration of blood, intracavernosal injection of a-adrenergic agents and surgical shunt procedures. Priapism occurring outside the setting of ICI was more likely to require surgery; seven of 20 episodes. After ICI therapy, eight of 62 episodes required shunts. The use of prostaglandin E1 as the drug of choice in ICI therapy in 1989 led to a fall in the incidence of ICI-induced priapism. Priapism is a major side effect of ICI therapy and an uncommon, although important, side effect of other conditions. The incidence of priapism has fallen with the introduction of prostaglandin E1 monotherapy as the favoured drug for ICI therapy of erectile failure.

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Comparison of a Mixture of Papaverine, Phentolamine and Prostaglandin E(1), with Other Intracavernous Injections

Cited by 13 publications

References 5 publications

Intracavernous Alprostadil

Intracavernous Alprostadil

In vitro viability of human cavernosal endothelial and fibroblastic cells after exposure to papaverine/phentolamine and prostaglandin E1

The incidence and management of priapism in Western Australia: a 16 year audit

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