Effectiveness Of Alprostadil For Erectile Dysfunction (ED)

It is no surprise that every adult craves for a quality sex life at any given age. Healthcare providers also believes that a healthy libido is a sign of great health and fitness. According to a prospective study conducted in 1,000 men over a period of 10 years, investigators suggested that men who reports higher frequency of orgasms have a 50% lower mortality rate (1). Unfortunately, some sexual disorders such as erectile dysfunction can greatly compromise the quality of sex life in men. Thanks to scientific advancements and medical technology, there are so many options today that can help in managing the ED symptoms in men.

What Is Alprostadil?

Alprostadil is a transurethral medication and a well-established option to address ED in men. It is synthetic form of Prostaglandin E1 (or PGE1) and can be introduced in the system via intraurethral application via suppository or intracavernous injection. Once peak levels are achieved in the blood, the drug exert its action by dilating the vessels to allow pooling of blood in the intracavernous sinuses.

1. Alprostadil As Intraurethral Drug: Urethra is a tube or canal that is present inside the penis and carries semen and urine to the exterior at the time of ejaculation or urination respectively. Alprostadil is available in the form of prefilled applicators (made up of plastic). Before engaging in sexual intercourse, about 1.25 inch of applicator is introduced at the tip of penis and a pellet of Alprostadil is pushed inside the urethra. Once administered, the drug is rapidly absorbed and distributed into the surrounding tissues.

Advantages Of Urethral Medications

• The drug promotes the flow of blood towards the penis.
• Alprostadil reaches its peak levels within minutes and successful erection is achieved within 5 to 10 minutes.
• Very effective for patients who are experiencing erectile dysfunction secondary to radical prostatectomy.
• In most cases, the drug is covered by insurance.

Limitations Of Urethral Medications

Being less efficacious is a drawback of Alprostadil in solid form. According to latest estimates, only about 30-40% patients report satisfactory results with the Alprostadil use (3). This is mainly because the major part of drug is absorbed into the blood stream and only very little amount goes inside the penis which means that sufficient drug levels are not achieved in the required area.

2. Alprostadil By Intracavernous Route:

As compared to the intra-urethral administration, penile injections are found far more effective and well tolerated. According to latest estimates, more than 80% patients report satisfactory results (3). This option is highly effective in individuals who are not responsive to other traditional therapies due to various systemic or local indications. Study conducted by Dinsmore and associates suggests that Alprostadil is a viable option in men with advanced diabetic neuropathy, spinal cord injury, vascular disease, erectile dysfunction secondary to radical prostatectomy or tobacco/alcohol abuse etc. (2)

Several clinical studies that Alprostadil therapy is also excellent for men who are less responsive to monotherapy with Viagra (or other phosphodiesterase inhibitors) and are not looking for a surgical solution.

Here are some limitation to the Alprostadil by Intracavernous route of administration:

• Patients are less complaint to the use of Alprostadil injection as it is more painful as compared with other penile injections.
• The response to the active drug vary from person to person. A significant percentage reports unsatisfactory results.
• The risk of adverse effects or complications is high in certain susceptible individuals. This includes priapism, fibrosis and severe penile pain that compromises the quality of sexual intercourse.

Cautions And Concerns With Alprostadil Use

• Do not use more than once per 24 hours.
• Under normal circumstances, the effect of drug lasts for about 1 hour. Speak to your doctor on emergent basis if erection lasts more than 4 hours or is associated with severe pain or other disturbing symptoms.
• Do not take Alprostadil if you ever had a reaction or allergic response to this drug.
• If you have a penile implant, Alprostadil is not for you.
• Individuals with a history of blood disorders, Peyronie's disease, active penile infection, history of priapism or those who are on chemotherapeutic or blood thinning medications should not use Alprostadil.

There is ample evidence that men who engages in regular sexual activity tends to live a longer and healthier life. Therefore it is very important to look for drugs and solutions that can effectively manage your erectile dysfunction symptoms over a long period of time. Refer to your doctor to learn if Alprostadil can help address your ED symptoms.

References

1. Smith, G. D., Frankel, S., & Yarnell, J. (1997). Sex and death: are they related? Findings from the Caerphilly cohort study. Bmj, 315(7123), 1641-1644.

2. Dinsmore, W., Lopes, T. M., Potempa, A. J., Piha, J., & Costa, P. (2014). Intraurethral alprostadil in the management of erectile dysfunction: a reappraisal of the clinical evidence.

3. Hatzimouratidis, K., & Hatzichristou, D. (2014). How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment. Current diabetes reports, 14(11), 1-10.

4. Hanchanale, V., & Eardley, I. (2014). Alprostadil for the treatment of impotence. Expert opinion on pharmacotherapy, 15(3), 421-428.