China
Africa
Explore chapters and articles related to this topic
Penile augmentation
Published in Jani van Loghem, Calcium Hydroxylapatite Soft Tissue Fillers, 2020
Ideally, the penis should be erect during the procedure to minimize contour irregularity as the product can be administered evenly throughout the entire length of the penis. Trimix injection (a mix of papaverine, phentolamine, and prostaglandin E1) is recommended as most patients will be able to achieve an erection without physical and emotional stimulation. The patient must be screened for recent use of PDE5 inhibitors, as Trimix in conjunction with these medications may lead to priapism. Patients must be instructed to avoid use as the procedure date approaches.
Hypogonadism, erectile dysfunction, and infertility in men
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Pierre-Marc G. Bouloux, Shalender Bhasin
Several formulations of alprostadil are commercially available (e.g., CaverJect, Pfizer, New York, NY, USA; Prostin VR, Pfizer; and Edex, Auxilium, Chesterbrook, PA, USA). In addition, a combination of phentolamine, papaverine, and alprostadil is also available (Trimix).
Erectile Dysfunction in Older Adults with Diabetes
Published in Medha N. Munshi, Lewis A. Lipsitz, Geriatric Diabetes, 2007
Although injection therapy was widely used for years, alprostadil (Caverject, Edex) became the first approved therapy when it received FDA approval in 1995. Alprostadil is a synthetic compound identical to prostaglandin El (PGE1). It works by increasing intracellular cyclic adenosine monophosphate, leading to vasodilation. The dosage ranges from 2.5 to 20 mcg. Studies have shown that over 80% of men achieve erections adequate for sexual activity with alprostadil therapy (27). The combination of papaverine and phentolamine, known as bimix, was used extensively prior to the approval of alprostadil. For those who do not have success, PGE1 can be added. This mix, referred to as trimix, has reported response rates of up to 80% (28). The most common side effects with this form of therapy are pain when injecting and the development of painless, fibrotic nodules. Various studies report a highly variable rate of this complication, ranging from 1.5% to 60%, depending on the frequency and duration of therapy and how nodules are identified (29). Priapism is the most worrying side effect. Although rare, it has been reported and is more likely to occur early in the course of therapy on exceeding the optimal dose for therapy either accidentally or purposely in the hope of a better response. Priapism is quite painful and requires immediate treatment to prevent damage to the corpus cavernosa. Despite high rates of success with ICI, follow-up studies have shown that half of patients who had a good response to therapy discontinued treatment by one year (30,31).
A review on pharmacological options for the treatment of erectile dysfunction: state of the art and new strategies
Published in Expert Opinion on Pharmacotherapy, 2023
Mattia Longoni, Alessandro Bertini, Nicolò Schifano, Emanuele Zaffuto, Paolo Maggio, Rossi Piercarlo, Sara Baldini, Giulio Carcano, Gabriele Antonini, Andrea Salonia, Francesco Montorsi, Federico Dehò, Paolo Capogrosso
Phentolamine is a nonselective α-adrenergic antagonist that decreases arterial resistance and promotes vasodilatation by inhibiting smooth muscle cell contraction [75]. The commercial preparation of Bimix, approved for clinical use in some European countries, contains papaverine hydrochloride (15 mg/mL) and phentolamine mesylate (0.5 mg/mL) in 2-mL vials [61]. The combination of these two drugs has shown the same efficacy and equal rate of prolonged erection compared to PGE1 30 μg alone, whereas it caused significantly less injection pain (15% vs 35%, p < 0.05) [76]. The addition of alprostadil (Trimix) provides the highest efficacy rates, reaching up to 92% [77,78]. This three-drug combination has similar adverse effects as alprostadil monotherapy, although fibrosis is more common when a higher dose of papaverine is used (5–10%) [77]. Noteworthy, hypotension could potentially occur with higher concentrations of the compounds [53]. In a randomized clinical trial, the combination of papaverine 17.64 mg + phentolamine 0.58 mg + PGE1 5.8 μg had a twofold efficacy rate compared to PGE1 40 μg monotherapy (50% vs 22%), with very low pain (12.5% vs 22%) due to the reduced dose of alprostadil being used [79]. Therefore, Trimix could be a suitable option for patients who underwent radical pelvic surgery as pain or tenderness after PGE1 is accentuated by an underlying cavernous nerve injury [53,63]. Unfortunately, no commercially marketed preparation for Trimix is available, due to the low stability of the combined agents.