Urology

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What is Erectile Dysfunction?

ED is a common physical condition that is estimated to affect more than 18 million men in the U.S. alone. The majority of these men are over 40 years old, however it can affect men of all ages. ED occurs when a man has the inability to maintain a firm erection during or before sexual intercourse.

While some men respond well to oral ED treatments such as Viagra or Cialis, others do not respond to these treatments or have uncomfortable or even dangerous side effects to these medication. In those cases, custom compounded medication can often be used successfully to treat ED.

Here at Family Pharmacy, we specialize in the compounding of numerous medications used to treat erectile dysfunction.

Common ED symptoms:

  • Difficulty achieving an erection
  • Difficulty maintaining an erection
  • Decreases desire for sexual arousal

Causes of Erectile Dysfunction:

Erectile Dysfunction can be caused by a number of physical and psychological factors.

  • Low Testosterone
  • High Cholesterol level
  • High blood pressure
  • Obesity
  • Some prescription medications
  • Use of tobacco, alcohol, or illegal drugs
  • Prostate cancer treatment
  • Surgeries or injuries involving the spinal cord or pelvic area
  • Medical conditions like heart disease, metabolic syndrome, multiple sclerosis, diabetes, atherosclerosis or clogged blood vessels, Parkinson’s disease, Peyronie’s disease.
  • Depression
  • Anxiety
  • Stress
  • Mental health conditions
  • Relationship problems

The usual problems of ED occur in of the following three ways:

  1. Transient and occasional- If a man’s inability to get or hold an erection happens only occasionally, it should not be cause for concern.
  2.  Gradual and Persistent- A physical cause is probably the underlying reason for gradual and persistent erectile dysfunction.
  3. Abrupt and Persistent- ED that is abrupt but happens on a regular basis probably has  a psychological basis.

Oral ED Medications:

Sildenafil (Viagra)– Most effective when taken one hour prior to sexual activity. Effective for up to 6 hours.

Vardenafil (Levitra,Staxyn)– Also effective when taken 1 hour prior to sexual activity. Effective for up to 7 hours.

Tadalafil (Cialis)– Taken with or without food about 1-2 hours before sexual activity. Effective for 36 hours. Can be taken in a small dose daily or a larger dose as needed.

Avanafil (Stendra)– Taken with or without food 15 to 30 minutes prior to sexual activity depending on the dose. Lasts up to 6 hours.

When are oral medications not appropriate?

When patients are taking certain medications including Nitrate drugs such as Minitran, Nitro-Dur, Nitrostat, as well as isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil)

Also, patients with very low blood pressure, severe liver disease and kidney disease that requires dialysis.

Injectable ED ingredients:

  • BiMix: A combination of Papaverine & Phentolamine
  • Super BiMix: A highly concentrated version of the standard BiMix Injection
  • TriMix: A combination of Papaverine, Phentolamine & Prostaglandin E1
  • Super TriMix: A highly concentrated version of the standard TriMix injection.
  • QuadMix: Super TriMix with Atropine added
  • Super QuadMix: A highly concentrated version of the standard QuadMix injection
  • Custom Combinations and concentrations are available

PapaverineA smooth muscle relaxant and vasodilator. The primary pharmacological action is as a non-specific vasodilator of the arterioles and capillaries.

Phentolamine- May provoke a reflex, increasing sympathetic outflow and the release of  neurotransmitters. Often used in combination with other ED agents to enhance efficacy.

Prostaglandin E1 (Alprostadil)- Binds with PGE receptors, and the resultant relaxation response in the smooth muscle is mediated by cAMP. Alprostadil has also been used in combination with other agents, such as papaverine, and the combination was superior to  only alprostadil.

Atropine- A non-selective muscarine agonist that functions by competitively binding to muscarine receptors, a class of acetylcholine receptor involved in the contraction and relaxation of smooth muscle and epithelial tissue throughout various parts of the body.

Possible Side Effects:

  • Penile pain
  • Dizziness
  • Headache
  • Bruising at site of injection
  • Prolonged erection (< 4 hours)

Injection Administration:

Step 1: Getting Set Up

  1. Assemble the following:
  2. Proper hygiene is important. Wash your hands using an anti-bacterial soap and keep the penis clean.
    • medication vial
    • alcohol pads
    • syringe
    • sharps container
  3. Keep the erectile dysfunction mix cold by returning the bottle to the refrigerator, or by placing the bottle in a cup of ice, while gathering all other materials.

Step 2: Setting up the syringe

  1. Wipe the rubber top of the vial with an alcohol pad.
  2. After removing the cap of the needle, pull the plunger back to the desired dosage, filling this volume with air. Use a new needle and syringe each time.
  3. Insert the needle through the rubber top and inject air into the vial
  4. Turn the vial with needle and syringe inserted upside down. Pull back on the syringe plunger in a slow and steady motion until the desired dosage is achieved.
  5. Tap the side of the syringe to allow any air bubbles to float towards the needle. Avoid having these air bubbles in the syringe when self-injecting by first injecting out the collected bubbles that may form.
  6. Remove the needle from the bottle.

Step 3: Select and Prepare the site for injection

  1. Avoid the midline of potential for injury to the urethra (6 o’clock; for urinary passage) and the penile arteries and nerves (near 12 o’clock)
  2. Avoid any visible veins or arteries on the surface.
  3. The proper location for injection is at 9-11 and 1-3 o’clock positions, between the base and mid-portion of the penis. (see diagram)
  4. Grasp and pull the head of the penis toward the side of your leg with the index finger and thumb (use the left hand if right handed). Position the penis firmly against your thigh to keep it from moving during the injection. While maintaining light tension, select a site for injection.
  5. Clean the site with an alcohol pad.

Step 4: Inject Erectile Dysfunction Mix and Apply Compression

  1. With a steady and continuous motion, penetrate the skin with the needle at a 90 degree angle. The needle should then be advanced to the hub. Slight resistance is encountered as the needle passes into the proper position within the erectile tissue
    (corporeal body).
  2. Inject the mix over approximately 10-20 seconds. Withdraw the needle from the penis and apply compression to the injection site for approximately 1 minute. Several minutes of compression may be requires to avoid bleeding, especially if you are an aspirin user.
  3. Discard the needle in your sharps container.

Note: If you get a large black and blue mark on the side of the penis after you inject, you have not penetrated the corpusum. Remove the needle and start over using a new needle and syringe to inject the other side.

If you twist the penis, you may inject the urethra. You may notice a drop of blood or clear liquid coming from the tip. Remove the needle and start over using a new needle and syringe to inject on the other side.

When is ED injection treatment an appropriate option?

  • –Oral medications were not effective.
  • –Oral medications caused significant side effects such as headaches, dizziness, diarrhea, upset stomach, stuffy nose or facial flushing.
  • –For men who have had surgery with damage to the nerves going to the penis, the oral medications are not likely to have a significant effect as they would require intact nerves that are functioning.
  • –Penile injections may be effective since the injection does not work through the use of intact nerves but instead the medication is being delivered directly to the penile tissues.

Start restoring your confidence today!

ED injections include:

table1

* Testosterone creams are available in multiple strengths ranging from 1-200mg/ml

ED Lozenges include:

table2

ED Booklet_FP2B01_111814 (1)-1

 

 

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