Oral Treatment of Erectile Dysfunction with Apomorphine SL

Altwein, Jens E.; Keuler, F. U.

doi:10.1159/000051001

Cited by 41 publications

(24 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Treatment with apomorphine is contraindicated in patients in whom sexual activity is inadvisable (those with unstable angina, severe heart failure, recent infarction) and in patients who are allergic or intolerant to the drug. 36 The clinical use of apomorphine has been largely disappointing owing to its lack of efficacy at the recommended doses. It is no longer considered a true alternative to sildenafil, and its use is limited to patients in whom sildenafil is contraindicated.…”

Section: Symptomatic Treatmentsmentioning

confidence: 99%

Core document on erectile dysfunction: key aspects in the care of a patient with erectile dysfunction

Brotons¹,

Campos²,

González-Correales³

et al. 2004

Int J Impot Res

View full text Add to dashboard Cite

The aim of this Core Document of the Spanish Consensus on Erectile dysfunction (ED) is to offer guidance to the nonspecialist physician in the management of patients with ED. ED is one of the most frequent chronic health problems in men older than 40 y of age and may also act as a sentinel symptom for other important underlying diseases. Its etiology can be classified into organic, psychogenic, or mixed. In most cases, the underlying cause of ED is usually a chronic health problem (such as diabetes, hypertension, atherosclerosis, and so on) or an adverse drug effect. The initial step in the management is to assess erectile function in patients with risk factors for ED. Once ED has been established, a detailed sexual, medical, and social history, including a review of medications used, is the most important aspect of a patient's assessment. Generally, examination should be limited to the cardiovascular, neurological, and urogenital systems. Fasting glucose and blood lipid profile should be performed in every man with ED, and free testosterone levels in men older than 50 y or if hypogonadism is suspected; other diagnostic tests are optional and should be requested on an individualized basis. In many cases, the most likely cause of ED can be identified based on the above information. Therapeutic intervention should be patient-oriented and based on the expectations and wishes of the patient and his partner, who should be included in discussions whenever possible. Basic interventions common to any type of ED include sexual counseling, lifestyle modifications, treatment of associated medical conditions, and switching to alternative drugs with lower risk of ED. In certain cases, an etiologic treatment may be performed (sex therapy, revascularization surgery, and hormonal therapy). Most patients with ED will benefit from symptomatic treatments; first-line therapy may be prescribed by physicians who are not specialists in ED, and includes oral agents such as inhibitors of phosphodiesterase type 5, currently considered the drugs of choice for initial treatment of ED. Intracavernous drugs are the second-line therapy, and surgical treatments, such as implantation of penile prostheses, are reserved for urologists/ andrologists who specialize in ED. Referral may be appropriate where indicated by age, clinical findings, or the patient's request.

show abstract

Section: Symptomatic Treatmentsmentioning

confidence: 99%

Core document on erectile dysfunction: key aspects in the care of a patient with erectile dysfunction

Brotons¹,

Campos²,

González-Correales³

et al. 2004

Int J Impot Res

View full text Add to dashboard Cite

show abstract

“…Apomorphine [3] acts as a central initiator of erection and enhances pro-erectile stimuli. The erectogenic effects of apomorphine arise from improved central neural signaling specific to penile vascular response.…”

Section: Discussionmentioning

confidence: 99%

An Open-Label, Randomized, Flexible-Dose, Crossover Study to Assess the Comparative Efficacy and Safety of Sildenafil Citrate and Apomorphine Hydrochloride in Men with Erectile Dysfunction

et al. 2008

View full text Add to dashboard Cite

Introduction: We report the methodology and results of a study that compared a dopaminergic agonist, apomorphine, with a phosphodiesterase type-5 inhibitor, sildenafil, in terms of efficacy, tolerability, satisfaction and patient preference. Patients and Methods: This was a 20-week open- label, randomized, flexible-dose, crossover study to assess the comparative efficacy and safety of sildenafil and apomorphine. One sequence group received treatment with sildenafil followed by apomorphine and the other sequence group received treatment with apomorphine followed by sildenafil. The primary efficacy variable was the measurement of the score of the erectile function domain (the sum of questions 1–5 and 15) of the International Index of Erectile Function (IIEF) questionnaire. The secondary efficacy variables were: the responses to the Global Efficacy Assessment Questions; the score of the responses to all the questions of the IIEF questionnaire; the index score of the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, and the event log variables. Resultsand Conclusions: A marked increase in the mean IIEF score was observed after treatment with sildenafil, compared with a small increase following treatment with apomorphine. The mean baseline and final scores before and after treatment with sildenafil were 13.9 ± 5.2 and 24.1 ± 5.2, while the corresponding mean scores before and after treatment with apomorphine were 14.2 ± 5.1 and 16.8 ± 6.2. The comparison between treatments showed a statistically significant difference in favor of sildenafil. Furthermore, sildenafil was found to be significantly superior to apomorphine in all the other secondary variables, produced a high level of patient satisfaction, and a significantly larger number of patients indicated their preference for sildenafil compared to apomorphine.

show abstract

“…By avoiding first pass metabolism through this route of administration, apomorphine avoids any significant interaction with food or other drugs. Unfortunately, it shows only 15% of effectiveness among patients with minor dysfunctions and may cause nausea and vomiting [17].…”

Section: Apomorphinementioning

confidence: 99%

The blue pill (sildenafil) and its descendants: an overview

Krzanowski

Dąbkowska

Wujec

et al. 2017

Current Issues in Pharmacy and Medical Sciences

View full text Add to dashboard Cite

Erectile dysfunction (ED) is the inability to develop and/ or maintain an erection necessary to have a successful sexual performance [1]. It has been diagnosed in an increasing number of men around the world [2]. According to the sexuality study conducted by Professor Izdebski, 1 out of 10 men in Poland suffers from ED. The problem is found among men of any age, however, 60% of all patients are between 40 and 60 years old, thus in their prime, and, hence, still have the desire to fully enjoy life. Moreover, among men older than 60, ED occurs in more than 50% of the population [3]. Unfortunately, out of 1.5 million men suffering from ED, only 15% seek medical help. Not only are the effects of ED detrimental to a man's self-esteem, but they also have a negative influence on his partner and his sexual relationships. Still, in spite of a growing awareness within society, the problem remains perceived as embarrassing, which leads patients to treat themselves on their own, delaying a visit to their doctors even up to several years. Indeed, 16% of all patients only decide to seek professional help more than 4 years after the first symptoms are observed [4]. THE MECHANISM OF ERECTIONWhile flaccid, a penis is controlled by the sympathetic nervous system responsible for involuntarily reactions. Through the effect of adrenaline, vascular smooth muscles and the trabeculae of the corpus cavernosum are shrunk, and the flow of blood is low. As a result of sexual arousal (mechanical or psychogenic), the activity of the sympathetic nervous system decreases, while sympathetic neurons from the NANC group (nonadrenergic, noncholinergic) prevail and release nitric oxide -NO, which stimulates relaxation of the corpus cavernosum smooth muscle and produces erection. The compounds which are additionally released by these neurons, for instance, adenosine or vasoactive intestinal peptide (VIP), also result in an increased production of NO in the endothelium cells. NO connects with "guanylyl cyclase receptors", which conditions the production of highly energetic cyclic guanosine monophosphate (cGMP), which lowers the calcium ion concentration (Ca 2+ ) in muscle cells. As a consequence, vascular smooth muscles relax and the flow of blood is increased, which results in the stiffening of a penis and erection. After ejaculation, a penis returns to its flaccid state. The erection recedes due to the effect of phosphodiesterase type 5 enzyme (phosphodiesterase type 5, PDE-5), which causes the decomposition of cGMP [5,6].

show abstract

Oral Treatment of Erectile Dysfunction with Apomorphine SL

Cited by 41 publications

References 22 publications

Core document on erectile dysfunction: key aspects in the care of a patient with erectile dysfunction

Core document on erectile dysfunction: key aspects in the care of a patient with erectile dysfunction

An Open-Label, Randomized, Flexible-Dose, Crossover Study to Assess the Comparative Efficacy and Safety of Sildenafil Citrate and Apomorphine Hydrochloride in Men with Erectile Dysfunction

The blue pill (sildenafil) and its descendants: an overview

Contact Info

Product

Resources

About