Androgens

Drug	Available Strength	Dosage	Remarks
Mesterolone	25 mg/tab	Initial dose: 25 mg PO 8 hourly or 75-100 mg/day PO in divided doses Maintenance dose: 50-75 mg/day PO in divided doses	Administration Implant: Insert SC into area with relative little movement (eg lower abdominal wall, buttocks) Adverse Reactions Priapism, excessive sexual stimulation, oligospermia, decreased ejaculatory volume, nitrogen, sodium and water retention, edema, hypercalcemia, hypercalciuria, increased vascularity of the skin, impaired glucose tolerance, increased LDL-C, increased hematocrit, and increased fibrinolytic activity, headache, depression, GI bleed, may induce sleep apnea in susceptible patients, abnormal liver function tests, prostatic hyperplasia Special Instructions Avoid in men with breast or prostate cancer Examine prostate regularly during treatment Use with caution in patients with CV disorders, renal or hepatic impairment, epilepsy, migraine, DM or other conditions aggravated by fluid retention, sleep apnea, erythrocytosis and benign prostatic hyperplasia Contraindicated in men with breast or prostate cancer Patient should be informed to seek medical assistance immediately if erection lasts >4 hours
Methyltestosterone	10 mg/cap	10-50 mg PO 8 hourly
Testosterone	200 mg implant	800-1,200 mg implanted SC based on individual requirement lasting up to 6 months
Testosterone cypionate	100 mg/mL injection	50-400 mg IM every 2-4 weeks
Testosterone enantate (Testosterone enanthate)	250 mg/mL injection	Initial dose: 250 mg IM every 2-3 weeks Maintenance dose: 250 mg IM every 3-6 weeks
Testosterone propionate	25 mg/mL injection	50 mg IM 2-3x/week
Testosterone undecanoate	40 mg/cap	Initial dose: 120-160 mg/day PO divided 12 hourly x 2-3 weeks Maintenance dose: 40-120 mg PO 24 hourly
Testosterone undecanoate	1,000 mg/4 mL injection	1,000 mg slow IM every 10-14 weeks first injection interval may be reduced to a minimum of 6 weeks

Intracavernosal Injection Therapy

Drug	Dosage	Remarks
Alprostadil (Prostaglandin E₁)	Dose titration under medical supervision: Follow titration until erectile response is suitable for intercourse and does not exceed 1 hour If partial response is made wait 1 day before administering next titrated dose, if no response may give next dose within 1 hour Neurogenic ED: First injection: 1.25 mcg by direct intracavernosal injection Second injection: 2.5 mcg Third injection: 5 mcg Followed by additional 5 mcg increments until erection suitable for intercourse is achieved, not lasting >1 hour Max dose: 60 mcg Vasculogenic, psychogenic or mixed etiology ED: First injection: 2.5 mcg by direct intracavernosal injection Second injection: 5 mcg if partial response or 7.5 mcg if no response Third injection onwards: 5-10 mcg increments from previous dose until erection suitable for intercourse is achieved, not lasting >1 hour Max dose: 60 mcg Patient should be instructed and trained on injection technique once effective dose has been achieved Max frequency: Not >1 injection in a 24 hr period and not >3 injections/week	Adverse Reactions Penile pain, hematoma at injection site, prolonged erection, priapism, ecchymosis at injection site, penile rash, penile edema or fibrosis, hypotension Special Instructions Avoid in patients predisposed to priapism (eg sickle cell anemia, leukemia and multiple myeloma), patients with penile deformities and penile implants, and in men with inadvisable sexual activity Use with caution in patients with CV disorders and anticoagulants Once reconstituted, should be used within 48 hours at room temp (<25°C) or within 7 days under refrigeration Patient should be informed to seek medical assistance immediately if erection lasts >4 hours
Papaverinex`	Neurogenic ED: 5 mg direct intracavernosal injection initially Other causes of ED: 15 mg direct intracavernosal injection initially Usual dose: 2.5-60 mg Dose adjusted according to response	Adverse Reactions Priapism, penile fibrosis, arrhythmia, occasional increase in serum aminotransferase concentration Special Instructions Has been combined with Phentolamine to increase effectiveness Avoid in patients with complete AV block, penile fibrosis, penile deformation, penile implants, and conditions predisposing to priapism (eg sickle cell anemia, multiple myeloma, and leukemia) Use with caution in patients with glaucoma, CV disorders, and hepatic impairment Patient should be informed to seek medical assistance immediately if erection lasts >4 hours
Aviptadil/phentolamine mesilate	25 mcg/2 mg direct intracavernosal injection prior to sexual intercourse	Adverse Reactions Hematoma at injection site, penile rash, penile edema, priapism, headache, dizziness; CV effects (tachycardia, angina, chest pain) Special Instructions Avoid in patients predisposed to priapism (eg sickle cell anemia, leukemia and multiple myeloma), patients with penile deformities and penile implants, and in men with inadvisable sexual activity, patients taking anticoagulants Use with caution in patients with CV disease, lung disease, previous stroke Do not administer more than one injection a day and not more than 3 injections per week

Intraurethral Therapy

Drug

Dosage

Remarks

Alprostadil

Apply contents of unit dose cream to urethral opening 10-15 minutes prior to intercourse
Initial dose: 250 mcg
Dose may be increased (up to 1,000 mcg) or decreased (until 125 mcg) in a stepwise manner until the patient achieves an erection
Max frequency: 2 administrations per 24-hour period or 7 doses per week

Adverse Reactions

Urethral pain, urethral burning, penile fullness, redness at application site

Special Instructions

Use condom barrier for sexual intercourse with pregnant or lactating women and for oral sex
Recommended to urinate prior to application of drug
Avoid in patients predisposed to priapism (eg sickle cell anemia, patients with penile deformities), patients in whom sexual intercourse is inadvisable
Use with caution in patients with preexisting MI or orthostatic hypotension

Phosphodiesterase Inhibitors (Oral)

Drug	Dosage	Remarks
Avanafil	Initial dose: 100 mg PO 15-30 minutes prior to sexual intercourse May increase dose to 200 mg or decrease to 50 mg based on patient response Max dose: 200 mg/day	Adverse Reactions Headache, flushing, stomach upset, visual disturbances (eg transient altered color vision), dizziness, nasal congestion, priapism Potentially fatal: Serious CV events (eg MI, arrhythmia, tachycardia, unstable angina) Special Instructions Sexual stimulation is required for drugs to be effective Coadministration with nitrates is contraindicated Administer with caution in patients on α-adrenergic blocker Diabetics may require the max doses of PDE5 inhibitors Use with caution in patients with pre-existing CV risk factors, in patients predisposed to priapism (eg sickle cell anemia, patients with penile deformities) Contraindicated in patients with severe CV disorders, severe hepatic or renal impairment, severe hypotension, recent stroke or MI, degenerative retinal disorders Dose adjustment is necessary in patient’s taking potent CYP450 3A4 inhibitors (eg Ketoconazole, Itraconazole, Ritonavir, Indinavir and Erythromycin) Tadalafil: 10 mg dose appears safe in patients with mild-moderate hepatic failure and renal failure Patient should be informed to seek medical assistance immediately if erection lasts >4 hours
Sildenafil	Initial dose: 50 mg PO 1 hour prior to sexual intercourse Initial dose for elderly (>65 years old), hepatic or renal impairment: 25 mg PO 1 hour prior to sexual intercourse May increase dose to 100 mg or decrease to 25 mg based on patient response Max dose: 100 mg/day
Tadalafil	Initial dose: 10-20 mg PO 30 minutes-36 hours prior to sexual intercourse Patient may adjust timing based on their own response Patients who anticipate frequent use: 2.5-5 mg PO 24 hourly at same time daily, dose adjusted depending on response and tolerability Max dose: 20 mg/day
Udenafil	Initial dose: 100 mg PO 30 minutes -12 hours prior to sexual activity May increase dose to 200 mg based on patient response and tolerance to adverse reactions Max dose: 200 mg/day
Vardenafil	Initial dose: 10 mg PO 25-60 minutes prior to sexual activity May increase dose to 20 mg or decrease to 5 mg based on patient response Max dose: 20 mg/day

Disclaimer

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated.
Not all products are available or approved for above use in all countries.
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.

Erectile Dysfunction Drug Summary

Androgens

Intracavernosal Injection Therapy

Intraurethral Therapy

Phosphodiesterase Inhibitors (Oral)

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