erectile dysfunction medicine

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Erectile Dysfunction (ED) affects more than 18 million men in the U.S alone. Most of these men are over 40 years old, although it can strike you no matter what your age may be. ED is sometimes an unfortunate side effect of a disease. Men who have diabetes, decreased testosterone levels, high blood pressure, an enlarged prostate, may get ED. Smoking, alcohol misuse, or certain medications can also cause ED. It can even be the result of every day pressures such as anxiety or stress. Fortunately, no matter what the cause, Erectile Dysfunction can be successfully treated.

While some men respond well to oral ED treatments such as Viagra or Cialis, others have uncomfortable or even dangerous side effects to these medications. In those cases, custom compounded medications can be used successfully to treat ED.

ED Medications Available

Injections

One erectile dysfunction medicine we offer at Dr. Quinn Weight Loss Clinic comes in the form of injections. The injectable medications we use, including Papaverine, Phentolamine, Alprostadil (Prostaglandin E1) the three of which are also called Trimex, as well as Atropine, Chlorpromazine, and/or Forskolin can either be administered individually or in combination. While an injectable ED medication may sound intimidating or even painful, the treatment involves very little discomfort and is an easy and very effective way to treat ED.

Dr. Quinn offers 2 services that can be used alone or in combination with other treatment modaliites—the P-Shot and GainsWave. Dr. Quinn is one of only a handful of physicians in the state of Michigan to be certified to perform both procedures.

Oral ED Medications

Viagra (Sildenafil)

Another medicine we use to help patients address ED is Viagra. This is available as an oral tablet ranging from 25 mg to 100 mg. A starting dose of 50 Mg taken about one hour prior to sexual intercourse has been recommended8. Viagra has been reported as a safe and efficacious treatment for ED, however, it is ineffective in approximately 27 to 35% of the population and has been associated with a variety of adverse effects including headache, flushing, dyspepsia, and adverse interaction with nitrates and inhibitors of cytochrome P450 enzymes. Viagra should not be taken in conjunction with nitrate therapy.

Cialis (Tadalafil)

Cialis is another oral tablet we offer, ranging from 5 to 20 mg. The recommended tadalafil starting dose for most men is 10 mg, taken as needed before sexual activity (but not more than once daily). The dose may be increased to 20 mg or decreased to 5 mg, per its efficacy and the man’s personal tolerance of the drug. Cialis’s 36-hour effectiveness earned it the nickname, “The Weekend Pill”; like sildenafil, tadalafil is recommended as an ‘as needed’ medication. Cialis is the only one of the three that is also offered as a once-daily medication.

Additional Information Regarding Tri-mix

General Information

Tri-mix is administered as a penile self-injection, typically considered to be the most powerful class of anti-erectile dysfunction agents. While the components of Tri-mix are, on there own, indicated for a vast number of different conditions (papaverine, phentolamine, PGE1 monographs), the practice of bringing them together in concert to treat erectile dysfunction has become commonplace in sexual medicine and is now considered to be the go-to treatment if conventional PDE5 inhibitors are contraindicated or nonresponsive. and is now considered the go-to treatment if a patient is not responsive to conventional PDE5 inhibitors such as Viagra or Cialis.

Indications

Tri-Mix is indicated in the treatment of erectile dysfunction in males. Tri-Mix contains three drugs from complimentary classes designed to act synergistically, mixed into a sterile injection. They are:

Papaverine: A drug that causes blood vessels to expand (vasodilator); it produces an erection by allowing for increased blood flow to the penis. Papaverine interacts with adenylate cyclase resulting in increased cyclic adenosine monophosphate (cAMP) production, ultimately resulting in increased erectile capacity by relaxation of penile smooth muscle. This drug was one of the first effective therapies for erectile dysfunction administered by penile injection. Papaverine works by inhibiting phosphodiesterase non-specifically, there are also multiple other mechanisms by which this drug acts to improve erectile capacity.

Phentolamine: When injected into the penis, it induces an erection by relaxing and dilating the blood vessels of the penis, as well as by elevating cardiac output.

Phentolamine is classified as an Alpha-Adrenoceptor Antagonists. Noradrenaline effects the smooth muscle tone of the penile tissues by keeping the corpora cavernosa in a contracted state. By blocking the functional noradrenaline receptors, the Alpha-Adrenoceptor, erectile response can be achieved. Phentolamine competes with endogenous norepinephrine for the Alpha1-Adrenoceptor and Alpha2-Adrenoceptor. Phentolamine has similar binding capacities to both receptors. The current literature suggests that this is the main mechanism by which phentolamine exerts its physiological effects. Phentolamine also blocks 5-HT receptors, inducing the release of histamine from mast cells. Some studies also show that NOS activation could possibly be involved in another mechanism, inducing increased vasodilation.

The Alpha-Adrenoceptor Antagonist of phentolamine is considered to be complex. The non-selective receptor blocking action interacts with adrenergic nerves in a complex fashion. Phentolamine action on adrenergic nerves has not been fully established. It is thought that there might be counteracting regulation on pre-and post-junctional nerves.

Prostaglandin E1 (Alprostadil): A potent hormone-like substance that induces erection by relaxing the penis’s blood vessels and dilating cavernosal arteries-dilation of the cavernosal arteries is accompanied by increased arterial inflow velocity and increased venous outflow resistance allowing for more blood into the penis and less blood out.

Prostaglandin E1 is administered intracavernosally. This drug is prescribed as a second-line treatment, after oral PDE5 inhibitors have been ineffective for treatment of erectile dysfunction. Currently the body of medical literature demonstrates that 40 to 70% of erectile dysfunction patients respond to treatment with prostaglandin E1. The failure to respond to prostaglandin E1 has not been established. The demonstration that prostaglandin E1 with S-nitrosoglutathione in combination is more effective than prostaglandin E1 alone may shed light on the lack of efficacy in some patients .

Medications to activate alternative relaxant pathways in addition to by prostaglandin E1 may be necessary in patients who fail to respond to prostaglandin E1. Relaxation of smooth muscle is a critical component of erectile capacity. Additional agents to work in combination with prostaglandin E1 might have significant therapeutic benefits. Prostaglandin E1 with S-nitrosoglutathione or other erectile dysfunction medications, might have advantages in the treatment of male erectile dysfunction.

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