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PROSTAGLANDIN El (PGEl)

Effectiveness
There are a multitude of publications on the use of PGEl. One large multicentre trial of 187 patients with erectile dysfunction reported good or very good patient satisfaction in 91% of patients. In a study by Stackl of 550 sufferers, 70% reported a full erection lasting for more than 30 minutes and all were adequate for vaginal penetration. More recently, in an open flexible-dose study of 683 men with erectile dysfunction, 11 924 of 13 762 PGEl injections given (87%) resulted in a satisfactory sexual performance. Satisfaction rates of between 77% and 86% amongst partners was also reported.

Safety and side-effects
PGEl occurs naturally in human tissues. There is no significant rise in levels of PGEl in the systemic circulation on intracavernosal injection and it is metabolised by the lungs with a half-life of about 1 min. This perhaps explains why the rate of priapism, the most serious side-effect of intracavernosal injection therapy, is reduced with PGEl. With PGEl the reported rate of priapism is 1-1.3%, compared with 2.3-15% on papaverine. The other frequently reported side-effect is pain on injection, sometimes as high as 16.8%. However, this is usually mild and rarely interferes with sexual intercourse. Also reported are haematoma (1.5%), local fibrosis, and haemosiderin deposits (0.1%). Cialis Super Active

Prescribing and injecting
To find the lowest effective dose in patients with erectile dysfunction of a psychogenic or neurogenic aetiology, it is best to increase from 2.5 ug of PGEl in 2.5-ug increments at different visits. In a recent single-blind dose escalation study of 201 men, the median effective (70% rigidity for > 10 min by RigiScan testing) dose was 3.0, 4.0, and 5.0 ug in the psychogenic, neurogenic, and vasculogenic aetiological groups, respectively. However, many patients with erectile dysfunction of a vasculogenic aetiology require a significantly higher dose of PGEl. In a recent study a maintenance dose of 20 ug was necessary in patients with erectile dysfunction of vasculogenic aetiology, compared with 5 ug in patients with a neurogenic aetiology. Therefore, in patients with erectile dysfunction of vasculogenic cause, an initial test dose of 10 ug is reasonable. Once the correct dose is determined, and after full discussion on the possible risks, including priapism, consent should be obtained before initiating home self-injection. Levitra Plus

The majority of patients cope well with the injection, although abdominal obesity or poor eyesight can be significant obstacles. In these patients an autoinjector or teaching the partner to inject may help. Once confident to self-inject they should do so not more than every 3 days and if possible alternate the side to be injected. Viagra Professional (Sildenafil)