Phentolamine is our preferred agent to add to a regime if there is incomplete rigidity with intracavernosal alprostadil. There is currently limited availability globally. Papavarine is available and can be used. Do researchers and clinicians use other ICI agents?
the aim of the intracevernosal injection is to induce a sufficient erection for examination ( doppler study) or for sexual activity (ICI). PGE,papaverine and phentolamine can be used single or Mix( Bi, Tri, Quadri....latest with atropine ) to avoid side effects caused by one agent or other of the mix preparations. So I think instead of trying to find a new medicine to inject , increasing the dose or using a mix is very helpful. A patient who is not responding to all of them should think of penile prosthesis assuming that his androgenic state is within normal.
In 2000, an important article by our group (Int J Impotence Res) demonstrated that phentolamine improves by 30% the clinical as well as vascular responses to ICI-test with alrpostadil alone
Here un Argentina we use the combination of three durgs. PGE1,phentolamine and Papaverine.
I start with PGE1 20 / Phentolamine 2,5 / Papaverine 70. And this doses could climb upon the patient response.
Tri-mix is used effectively and the risk of pain is deminished with the combination of the 3 meds. If pain does occur, then you can take out PGE1 and still use Phentolamine and Papaverine (Bi-mix). Using this for penile rehabilitation after a Robotic Prostatectomy is something to consider as well.
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