Aviptadil plus phentolamine shows potential for refractory ED management

Intracavernosal injection (ICI) of aviptadil with phentolamine mesylate (AvP) demonstrates efficacy in more than half of the men with refractory erectile dysfunction (ED) who participated in a recent study.

This retrospective single-centre analysis involved 308 men referred for AvP due to the development of intolerable pain following alprostadil ICI (group PA) or failed maximal dose (40 μg) of alprostadil (group FA). Self-administration was taught in a nurse-led clinic, followed by a telephone follow-up at 6 weeks.

The researchers then evaluated efficacy at 3 months. Efficacy was defined as resumption of penetrative sexual activity.

All men had a trial of alprostadil ICI, of whom 96 percent had failed phosphodiesterase 5 inhibitor (PDE5-i), 66 percent had trailed a vacuum erection device, and 36 had failed intraurethral alprostadil.

Of the patients, 182 (59 percent) found AvP ICI effective. Indications were 177 and 131 in the PA and FA groups, respectively. The efficacy rate of AvP was 76 percent in the PA group and 36 percent in the FA group (p<0.0001).

Facial flushing was the most common adverse event, occurring in 69 men (22.5 percent). Only one patient (0.3 percent) reported ischaemic priapism.

“AvP represents an effective and well-accepted second-line option for men who have experienced failure with most nonsurgical treatments for ED,” the researchers said.

The study was limited by its retrospective design and lack of validated instruments to assess erectile function objectively.