Dose Evaluation Study of Alprostadil in Erectile Dysfunction

Abstract

ABSTRACT: Intracavernous injection of vasoactive drugs is an important therapeutic advance for the treatment of erectile dysfunction. Namely three drugs used alone or in combination have gained clinical acceptance: papaverine, papaverine and phentolamine, and alprostadil.Since the first reports on the use of alprostadil in 1987, investigators of many countries published studies reporting the efficacy of alprostadil in inducing erections with tolerable local side‐effects. Based on his personal experience, methodology, and support to the patients who entered a self‐injection program, the author performed a formal dose evaluation study in 116 patients who self‐injected alprostadil for treatment of erectile dysfunction.Of the 296 patients seen during the years of 1988 to 1992 and who were eligible for self‐injection of alprostadil to maintain their capacity for intercourse, only 116 patients were entered in the selfinjection program. Their ages were between 27 and 69 years old (average 53). One hundred eleven (94.8%) have elected a dose equal or inferior to 20 mcg of alprostadil as the minimal dose producing complete and functional erections. The optimal dose range is decided for each patient based on his satisfaction and tolerance and includes erections of 1 to 2 hours long, without adverse systemic or local reactions. The side effects were minimal (16 cases = 13.78%). They were hematoma (12), prolonged erection (2), fibrosis with penile curvature (1), and dizziness (1). The results are similar to others related in previous literature.The author believes that intracavernous injection of vasoactive drugs is an important instrument to deal with impotence and alprostadil is the drug of choice for the self‐injection program. Longterm use of alprostadil and its effects, social acceptability, and its adoption by national health authorities are, according to the author, issues that need to be addressed.