Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

542 Erectile Dysfunction

Contraindicated in men taking nitrates

Consultation with a cardiologist in men with severe cardiovas-

cular disease

Side effects include dyspepsia, nasal congestion, headache,

and visual changes

➣Yohimbine – alpha-2-adrenergic receptor antagonist acts at the

adrenergic receptors in brain

Marginal effects on ED

Side effects include palpitation, fine tremor, elevation of blood

pressure, and anxiety

➣Apomorphine – sublingual medication

Acts at the central dopaminergic (D1/D2) receptors

Released in Europe, not approved in United States

Major side effects are nausea and vomiting.

■Second-line therapy

➣Need appropriate training and education by medical personnel

before beginning

➣Vacuum constriction device (VCD)

Advantages: no drug interactions, very reliable and effective

when used properly

Disadvantages: Cumbersome and gives an unnatural erection

Side effects include petechiae, numbness and a trapped ejac-

ulate.

➣Transurethral therapy

Advantages: locally acting medication, low risk of priapism,

avoids needles

Major disadvantages: penile pain, urethral bleeding and burn-

ing, and moderate response rate

➣Intracavernous injection therapy (ICI)

Advantages: very effective

Most common medications used: alprostadil, phentolamine,

papaverine, or combinations (only alprostadil is FDA-

approved)

Disadvantages: requires injection, high dropout rate, and can

cause priapism/fibrosis

Surgical

■Patients who fail or are dissatisfied with medical management

■Curative surgery

➣Patients with congenital or traumatically acquired erectile dys-

function