Zebra,
Below is an abstract on paper on alprostadil, prazosin combination. There is another paper which shows that the two drugs don't effect sperm motility/quality and an editorial and response in J. of Urology which I have not seen and reflects some little controversy probably.
The abstract is rather unsatisfactory. It appears that for a given alprostadil dose adding some prazosin increases response, but there is no synergism and in any case it appears that the difference between 51.8 and 58.9 is not significant - otherwise they would have said so in the abstract. Then at the end of the abstract to get a significant result it appears that they have to pool the 125/500 and 250/500 combinations when comparing with 250 alprostadil alone, so we do not know if 125/500 is significantly better than 250 alprostadil alone which would have been good.
Anyway it seems that with prazosin you can probably get away with less alprostadil which presumably? reduces the pain.
Hope the full paper and their presentation at the forthcoming conference is more promising than the abstract.
Erectile response to transurethral alprostadil, prazosin and
alprostadil-prazosin combinations
Peterson_CA, Bennett_AH, Hellstrom_WJG, Kaiser_FE, Morley_JE,
Nemo_KJ, PadmaNathan_H, Place_VA, Prendergast_JJ, Tam_PY,
Tanagho_EA, Todd_LK, Varady_JC, Gesundheit_N
VIVUS INC,DEPT CLIN RES,MENLO PK,CA
UNIV SO CALIF,DEPT UROL,LOS ANGELES,CA,90033
MALE CLIN,SANTA MONICA,CA
PACIFIC MED RES SERV,ATHERTON,CA
UNIV CALIF SAN FRANCISCO,DEPT UROL,SAN FRANCISCO,CA,94143
ALBANY MED COLL,DIV UROL,ALBANY,NY,12208
TULANE UNIV,DEPT UROL,NEW ORLEANS,LA,70118
ST LOUIS UNIV,SCH MED,DIV GERIATR MED,ST LOUIS,MO,63104
VET AFFAIRS MED CTR,CTR GERIATR RES EDUC & CLIN,ST LOUIS,MO
JOURNAL OF UROLOGY, 1998, Vol.159, No.5, pp.1523-1527
AB: Purpose: Transurethral alprostadil has been shown to be
efficacious in many men with erectile dysfunction. We compared transurethral alprostadil and prazosin alone, and in
combination to treat this disorder.
Materials and Methods: In this double-blind, placebo controlled
study the erectile responses to transurethral alprostadil,
prazosin and alprostadil-prazosin combinations were assessed in
234 men 26.8 to 81.5 years old with complete organic erectile
dysfunction. Patients self-administered a random sequence of 7
doses in the clinic in 4 weeks. The erectile response was
assessed using categorical and visual analog scales.
Results: Full penile enlargement or rigidity was achieved by
165 of the 234 men (70.5%) after at least 1 active dose of
medication. The most effective alprostadil dose (500 mu g.)
resulted in full penile enlargement or rigidity in 51.8% of
administrations, whereas the most effective prazosin dose
(2,000 mu g.) and placebo resulted in a similar response in
12.7 and 2.7%, respectively (p < 0.001). The 500/2,000 mu g.
alprostadil/prazosin combination, which resulted in full
enlargement or rigidity in 58.9% of doses, was only slightly
better than the most effective dose of alprostadil alone (500
mu g) However, combinations of 125/500 and 250/500 mu g
alprostadil/prazosin were more effective (p < 0.01) than 125
and 250 mu g. alprostadil given alone, respectively. The most
common side effect of therapy was penile pain, which rarely led
to study discontinuation. Hypotension most commonly developed
at the higher alprostadil-prazosin combination.
Conclusions: Transurethral alprostadil and alprostadil-prazosin
combinations produced erections in men with complete organic
erectile dysfunction. This combination therapy may be an option
in patients who do not respond to transurethral alprostadil
alone.
DaiS
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