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Archive for the ‘Erectile Dysfunction’ Category

If you are not comfortable with the injection therapy used to treat ED, don’t worry, there are alternatives. Intraurethral Gels are another method that many patients may be happier using. Here is an overview of what you need to know about this method. Talk to your doctor if you think it’s something that you would want to try.

The same medications used in injection therapy to treat ED (alprostadil, papaverine, and phentolamine) are all available in gel form for intraUrethral application. Prior to intercourse, the easy to apply gel is inserted into the urethra. IntraUrethral gels are a great alternative for those who are not willing or cannot inject the medications with a needle to treat erectile dysfunction.

Like the injections, the medication should take effect within 10-15 minutes. An erection that lasts for approximately 60 minutes will occur if this form of treament is effective for you.

Are there any side effects for the partner?

Unless your partner is allergic or responsive to the medications used within the gel (experience minor vaginal itching or burning), there have been no reported instances of negative side effects for the partner.

Ensuring your success.

Occassionally but rarely the men using this medication do not get the desired results. If this medication does not work for you, please inform our pharmacists so that they may discuss with you the proper technique of injecting. If this still does not work, we will consult with your physician in regards to alternative medication combinations that may be more effective.

The most commonly prescribed ED therapy – ED oral pills, called PDE-5 Inhibitors, are only effective in 60% of men with ED. Just because one method does not work for you, doesn’t mean there aren’t other methods that can help. Intracavernosal injections take advantage of the latest scientific discoveries in order to help you and your partner restore sexual intimacy in a discreet, convenient, and most importantly, effective manner.

What is Injection Therapy?

Intracavernosal injection treatments were first discovered in the 1980s when it was found that certain drugs could be injected into the penis to stimulate an erection. This discovery not only led to a greater understanding of how an erection happens, but also offered an effective treatment for men with ED. To have this effect in a very controlled way, the drug should be delivered directly into the erectile penis. The most effective way of doing this is by an injection.

How does it work?

Intercavernosal injections will be injected into one of the two corpus cavernosum that run the length of the penis. Avoid visible blood vessels. With each use of the injections, alter the side of the penis, and vary the site of injection. Injection therapy normally uses drugs that will relax the blood vessels feeding blood into the penis allowing the blood flow to increase. At the same time, relaxation of the muscle layers surrounding the erectile penis allows them to expand preventing the flow of blood out of the penis, and helping to maintain an erection.

If this sounds complicated to you, dont worry, there are various injections systems available to help you to prepare and inject your treatment. Injection therapy is usually dispensed as a dry sterile power and diluent, which needs to be mixed before use. It is important that you take time to learn how to administer your injection. Your doctor, nurse, or specialist can help you with this. Most patients find that performing the injection is fairly easy and not painful.

If needed, there are various systems available to assist you with the injection process. At Pallimed, we recommend the Owen Mumford brand Autoject El which is a simple solution for self-injection. Autoject injects the needle to a pre-set depth and delivers the contents of the syringe. It comes equipped with an external indicator which provides confirmation that the full dose has been delivered.

If you are interested or have any questions please give us a call. We are happy to help you. You can reach us at 781-937-3344.

If you don’t think pills, injections, or other methods are suitable for you, Vacuum Therapy might be it! Here’s how it works and what you need to know about it. Even if you are comfortable with using pills or injections, try this out anyway, maybe you’ll find it even more efective!

Along with prescription pills and injections, Vacuum Therapy is one of the most effect ways to treat ED. Vacuum Therapy is one of the safest ways to deal with impotence and has a 84-95% success rate of producing and maintaining an erection.

Because it does not require you to take any drugs, there are no risks of interactions with other medications or harmful side effects. Vacuum Therapy is sometimes recommended as a compliment to oral or injectable regimens.

How does it work?

A pump is used to create a vacuum around the penis which draws in blood and creates a firm erection within minutes. A penile ring is slipped over the base of the penis and the pump is removed to allow for full sexual intercourse to take place. The ring maintains an erection and must be removed within 30 minutes.

Where do I get it?

At Pallimed Solutions, we offer two types of vacuum therapy systems – The Rapport™ Classic and the Rapport™ Rings both made by medical device manufacturer specialists Owen Mumford.

The Rapport™ Classic is the conventional vacuum therapy system which consists of a tube, pump, and rings. The Rapport™ Rings are for men who need help maintaining their erections and do not require a pump to form the inital erection.

Both products are available without a prescription, but it is recommended to ask your doctor or healthcare professional for medical advice before initiating any form of ED therapy.

Cortisol hormone is a hormone that people produce naturally and is required to sustain life. It is frequently referred to as the “stress hormone”, since its levels increase during times of stress. It is released from the pituitary gland, which is located under the hypothalamus. The hypothalamus is the area of the brain that is responsible for many actions, including body temperature, blood volume and osmolarity (how many solutes are in the blood), and hormone regulation. The pituitary gland acts on the regulations of the hypothalamus and secretes many hormones, including adrenocorticotropin hormone (ACTH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), gonadotropin-releasing hormone (GnRH), thyroid hormones, prolactin, among others.

ACTH is the hormone responsible for triggering the release of cortisol from the adrenal gland. LH, FSH, and GnRH are all involved in the reproductive cycle in both men and women. In men, they stimulate sperm production and regulate the body temperature to keep the sperm viable. In women, it controls egg maturation and stimulates ovulation once every 28 days. These hormones are very tied into one another. If one is produced in excess, the body devotes more energy into making that one hormone more, and the other hormones less. The body even starts making the other hormones into the one it needs most in an attempt to conserve energy and resources (resources being metabolites and amino acids that are needed for cell metabolism and survival).

Cortisol is affected by many things, external and internal. External sources of stress can include car accidents, work/school stress, and other people bringing stress into our lives. Internal factors can include an interruption of the balance of other hormones, such as those previously listed or certain radio graphical lab tests can cause errors in the metabolism of cortisol, which can result in low cortisol levels. Also, if the patient is taking exogenous steroids (hydrocortisone, methylprednisolone, prednisone, etc.), the body will stop making its own steroids. If the patient then suddenly stops taking them, neither the adrenal gland nor the pituitary gland can react quick enough to start producing the amount of steroid that the body requires. This is the reason that these hormones, when taken exogenously, are tapered down over the course of a couple days. This allows the body to start increasing the secretion of cortisol slowly, and by the time the exogenous steroids are stopped, the body is back to making its own steroid.

All of these hormones play an essential role in the body, and among the other hormones. If one is unbalanced, then the others will follow suit. Pallimed Pharmacy has pharmacists that are specifically assigned to address these problems, and to counsel patients on what is going on with their bodies, and how to fix them. Whether you have too much hormone, or not enough, Pallimed Pharmacy is here to help.

Obesity is linked to erectile dysfunction (ED) in ways that scientists do not understand. It has been cited that erectile dysfunction could be a predictor of cardiovascular disease. It has also been noted that lack of exercise, obesity or even being overweight, and cigarette smoking all contribute to erectile dysfunction. For many, lifestyle changes can greatly improve ED symptoms if the patient maintains a healthy lifestyle. For most however, these changes are difficult to implement and maintain. In a study of male health professionals, it was shown that men that are actively engaged in exercise and diet modifications with nutritionists showed more benefits then men who only had written instructions. The arm that had the nutritionists lost more weight and lowered their BMI by more points than the control arm. Men with comorbidities like diabetes were excluded from the trial.

Besides the obvious body image issues that overweight or obese men have regarding erectile function, it has been shown that losing weight and exercising can improve the symptoms of erectile dysfunction. However, it may not be realistic for all men. Even knowing of the link between cardiovascular health and erectile function, one would think that this would be an excellent motivator to start living a healthier lifestyle, but like many other medical conditions, many men would like pharmacological therapy because it may fit into their current lifestyle better. Pharmacists and health care practitioners alike should push for more lifestyle modifications before pharmacological therapy. Also, research on which insurance plans offer rebate incentives for gym memberships would be a useful tool. Many gyms offer personal training sessions and/or nutrition support, which may be what is needed to keep people on track with their diet and exercise plan. And if insurance plans recognize this, then the patient on that plan should be rewarded.

                When people are seeking treatment for something, many are often inclined to find a natural route for treatment. For some conditions, dietary supplements are a safe and effective treatment. However, not all conditions can be safely treated by dietary supplements.

Recently, there have been advertisements for “dietary supplements” that can be used to treat erectile dysfunction and other sexual dysfunctions. Some men will purchase these dietary supplements online without consulting their health providers first. Not only can taking any type of medications be dangerous without consulting a healthcare professional first, these “dietary supplements” that claim to be used to treat erectile dysfunction can be particularly dangerous. These dietary supplements have not been approved by the FDA so there is no guarantee regarding the purity, safety, or efficacy of them. One of the potential problems with these dietary supplements are that some of the ingredients may be very similar to prescription medications used to treat erectile dysfunction such as sildenafil.

Taking dietary supplements with ingredients that are similar to sildenafil can be very dangerous for unknowing consumers. Prescription erectile dysfunction drugs can have very dangerous drug interactions with other medications such as nitrates. To make things riskier, nitrates are often taken by people who have hypertension or high cholesterol, and hypertension and high cholesterol are risk factors for erectile dysfunction. This means that there is a probable chance that those taking nitrates could seek treatment for erectile dysfunction and face a potentially deadly interaction.

Recently the FDA did a chemical analysis of the dietary supplement Zimaxx and found that one of the active ingredients contained sildenafil which is the active ingredient in prescription Viagra. They also tested another product and found an analog of vardenafil which is the active ingredient in the prescription product Levitra. There was no mention of these being the active ingredients on the product labeling of these dietary supplements. The FDA has also recently taken action against the dietary supplements 4EVERON and Libidus from entering the United States.

It’s always important to be cautious when taking any new type of medication. Even over-the-counter medications should be discussed with your pharmacist or provider to ensure the use of them are safe and effective for you.

-Laura Somers

Reference:

FDA warns consumers about dangerous ingredients in “dietary supplements” promoted for sexual enhancement. Pharmacist’s Letter/Prescriber’s Letter 2006;22(9):220906

The effects of some conditions such as cardiovascular disease and diabetes on increasing the risk of developing erectile dysfunction is well studied. It has been determined that the reason diabetes and cardiovascular problems lead to erectile dysfunction is because those conditions affect the human vasculature. If blood vessels are not in good working order, the blood is not able to get to the penis to form or maintain an erection.

Recently, it has been discovered that arsenic exposure can lead to cardiovascular disease by having a negative effect on blood vessels. The proposed connection between arsenic exposure and damage to blood vessels  comes down to a substance called nitric oxide. Nitric oxide is a substance in the body that is responsible for the relaxation of smooth muscle, including the smooth muscle that comprises blood vessels. Arsenic exposure has been shown to decrease the activity of nitric oxide. Nitric oxide also plays an important role in forming and maintaining an erection, so when there is dysfunction with nitric oxide, it can lead to erectile dysfunction.

A study recently set out to determine the effect arsenic exposure has specifically on erectile dysfunction. The study enrolled 177 males. The International Index of Erectile Function-5 was used to measure the level of erectile dysfunction and the results of this index were compared between men living in arsenic-endemic and non-arsenic-endemic areas. The results were that the prevalence of erectile dysfunction was 83.3% in arsenic-endemic areas and 66.7% in non-arsenic-endemic areas. The authors concluded that arsenic exposure did have a negative impact on erectile function.

Arsenic is an element that is found in bedrock and soil. Arsenic is odorless, tasteless, and you can’t see it in water. For public water supplies, there are regulations the government puts out regarding how much arsenic can be in the water. However, those with private-water supplies from wells can be at risk for having higher arsenic levels in the water, particularly in wells made out of bedrock. There are lab tests that can be done to determine how much arsenic is in your water.

-Laura Somers

Reference:

Hsieh F, Hwang T, Chen C, et al. Risk of erectile dysfunction induced by arsenic exposure through well water consumption in Taiwan. Environmental Health Perspectives [serial online]. April 2008;116(4):532-536. Available from: MEDLINE, Ipswich, MA. Accessed July 19, 2012.

                Many people have seen the “Buy Viagra Online” advertisement while surfing the internet, or are familiar with the email “Cheap Generic Viagra” that sometimes slips by the spam folder. Many people will just ignore these advertisements, however, some people answer these advertisements, and unfortunately this can sometimes have grave consequences.

People who buy drugs on the internet are at a much higher risk for experiencing life-threatening adverse events. Buying medications from the internet bypasses the safeguards that healthcare professionals provide. When you get a medication without a prior examination from a doctor, there is no way to know that that medication is appropriate and safe for you. Medications like Viagra can have life-threatening interactions with other drugs, and without a healthcare professional screening for those interactions, the use of Viagra could be fatal. There are also underlying health conditions that need to be screened for before a medication is prescribed. The FDA reported that a man died after buying VIagra online because the man had a family history of heart disease.

Not only can be taking a medication purchased on the internet be unsafe, there is also no guarantee that the medication you think you’re getting is actually the medication you’re receiving. Without the safeguards and quality controls that come with prescription medications purchased through legitimate pharmacies, medications purchased from online websites can be counterfeit, contaminated, or the potency can be incorrect. Taking a medication and not knowing what is in it is not a risk worth taking.

The FDA offers some tips for people who want to buy drugs over the internet. One is to look at the National Association Boards of Pharmacy to see if the pharmacy is legitimate and in good standing. Stay away from websites that don’t have a registered pharmacist available to speak with. Avoid websites that don’t list a U.S. address or phone number where they can be reached if there is a problem. It is also illegal to purchase medications from outside of the country, so do not deal with websites of pharmacies outside the country.

It is important to discuss medications with your doctor before you take them. There is major risk involved with purchasing medications without a prescription. The role of your pharmacist is to provide safe, and effective medication, so it is important to get your prescriptions from a legitimate pharmacy.

-Laura Somers

Reference:

Buying Medicines and Medical Products Online. Pharmacist’s Letter 2003; 19(9):190950

                When you take any medications, you can always expect to potentially see some side effects. However, one negative adverse effect experienced by men with some medications is erectile dysfunction. To compound the situation even further, many of the conditions the medications are being used for can also lead to erectile dysfunction, so the solution cannot be to simply stop taking the medications. There are ways to manage the adverse effect of erectile dysfunction with many medications.

One of the most common group of medications associated with the adverse effect of erectile dysfunction is beta-blockers. Beta-blockers, such as propranolol and metoprolol, are medications commonly used to treat hypertension, and they can also be used for other conditions such as migraines or heart failure. Beta-blockers may lead to erectile dysfunction or decreased libido by decreasing serum testosterone levels and also by inhibiting smooth muscle relaxation in the penis. To decrease the chance of developing erectile dysfunction, men can go on selective beta-blockers such as atenolol because they are less associated with erectile dysfunction.

Patients on diuretics, commonly referred to as “water pills” can also struggle with erectile dysfunction. Diuretics are first-line medications to treat hypertension. The mechanism by which they can contribute to erectile dysfunction is also by impairing the relaxation of smooth muscle in the penis, but they also decrease the brain’s response to the body’s natural excitatory substances such as dopamine. For patients that need to be on diuretics, they can be put on “loop diuretics” such as furosemide, because loop diuretics are less associated with erectile dysfunction.

Antidepressants have also been seen to cause erectile dysfunction. Common antidepressants are SSRI’s , such as citalopram and fluoxetine. There are several potential mechanisms for SSRI’s leading to erectile dysfunction. SSRI’s decrease dopamine levels, which is the body’s natural excitatory substance. SSRI’s also reduce the production of nitric oxide, which is an important substance necessary for an erection to form. If men are experiencing erectile dysfunction with SSRI’s, their doctor could potentially put them on mirtazapine or buproprion which are antidepressants that are less associated with erectile dysfunction.

It is important for people to take their medications, but if they are experiencing serious adverse effects such as erectile dysfunction, men should talk to their doctors because there are ways to manage medication-related erectile dysfunction.

-Laura Somers

Reference:

Drugs that may cause erectile dysfunction. Pharmacist’s Letter 2006; 22(9):220907

                For men that are on phophodiesterase 5 inhibitors, common erectile dysfunction medications, they are usually aware of the major drug interaction of phosphodiesterase 5 inhibitors with nitrates. Nitrates are medications that are used to prevent and treat chest pain. They work by relaxing the blood vessels that bring blood to the heart. Since phosphodiesterase 5 inhibitors also work by relaxing blood vessels, taking the two types of medications together can lead to dangerous hypotensive effects which can ultimately end with death. There is often a caution on prescriptions to not take these medications together since their use together is contraindicated, but it is important for men taking phosphodiesterase 5 inhibitors to be aware that there are other important drug interactions with other medications.

Phosphodiesterase 5 inhibitors also interact with alpha-blockers, which are medications used to treat high blood pressure or benign prostatic hypertrophy. Some examples of alpha-blockers are doxazosin, prazosin, or terazosin. Taking these medications together can also lead to dangerous hypotension. There are options for men if they have to be on both types of medications. Using low-dose tadalafil has less risk to cause hypotension. Also, if a man is on an alpha-blocker for benign prostatic hypertrophy, they can use a urinary selective alpha-blocker such as tamsulosin.

Another potential interaction with phosphodiesterase 5 inhibitors is the interaction with other drugs that can increase the risk of an arrhythmia in the heart. Some antidepressants, such as citalopram, or antibiotics, such as moxifloxacin or erythromycin, can increase the risk of developing an arrhythmia when used with other drugs that also increase the risk. If a man has to be on both types of these medications, tadalafil or sildenafil could be used because those two phosphodiesterase inhibitors have less of a risk of causing arrhythmias.

It is always better to try to get all your prescriptions at one pharmacy, so your pharmacist can screen for drug interactions. It is important to tell your pharmacist all of the medications you are on to make sure you can take all of your medications together safely.

Reference:

Rumor vs. Truth: Nitrates are the only significant drug interaction to worry about with phosphodiesterase 5 inhibitors. Pharmacist Letter August 22, 2011.