ERECTILE RESPONSE TO TRANSURETHRAL ALPROSTADIL, PRAZOSIN AND ALPROSTADIL-PRAZOSIN COMBINATIONS |
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Authors: | CRAIG A. PETERSON ALAN H. BENNETT WAYNE J.G. HELLSTROM FRAN E. KAISER JOHN E. MORLEY KERRY J. NEMO HARIN PADMA-NATHAN VIRGIL A. PLACE J. JOSEPH PRENDERGAST PETER Y. TAM EMIL A. TANAGHO LESLIE K. TODD JOHN C. VARADY NEIL GESUNDHEIT |
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Affiliation: | From the Department of Clinical Research, VIVUS, Inc., Menlo Park, Department of Urology, University of Southern California, Los Angeles, The Male Clinic, Santa Monica, Pacific Medical Research Services, Atherton and Department of Urology, University of California, San Francisco, California, Division of Urology, Albany Medical College, Albany, New York, Department of Urology, Tulane University, New Orleans, Louisiana, and Division of Geriatric Medicine, St. Louis University School of Medicine and Geriatric Research Education and Clinical Center, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri. |
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Abstract: | PurposeTransurethral alprostadil has been shown to be efficacious in many men with erectile dysfunction. We compared transurethral alprostadil and prazosin alone, and in combination to treat this disorder.Materials and MethodsIn this double-blind, placebo controlled study the erectile responses to transurethral alprostadil, prazosin and alprostadil-prazosin combinations were assessed in 234 men 26.8 to 8.15 years old with complete organic erectile dysfunction. Patients self-administered a random sequence of 7 doses in the clinic in 4 weeks. The erectile response was assessed using categorical and visual analog scales.ResultsFull penile enlargement or rigidity was achieved by 165 of the 234 men (70.5%) after at least 1 active dose of medication. The most effective alprostadil dose (500 micro g.) resulted in full penile enlargement or rigidity in 51.8% of administrations, whereas the most effective prazosin dose (2,000 micro g.) and placebo resulted in a similar response in 12.7 and 2.7%, respectively (p <0.001). The 500/2,000 micro g. alprostadil/prazosin combination, which resulted in full enlargement or rigidity in 58.9% of doses, was only slightly better than the most effective dose of alprostadil alone (500 micro g.). However, combinations of 125/500 and 250/500 micro g. alprostadil/prazosin were more effective (p <0.01) than 125 and 250 micro g. alprostadil given alone, respectively. The most common side effect of therapy was penile pain, which rarely led to study discontinuation. Hypotension most commonly developed at the higher alprostadil-prazosin combination.ConclusionsTransurethral alprostadil and alprostadil-prazosin combinations produced erections in men with complete organic erectile dysfunction. This combination therapy may be an option in patients who do not respond to transurethral alprostadil alone. |
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