Sildenafil Citrate
Sildenafil citrate is a PDE5 inhibitor that may be used to support erectile function and may help manage pulmonary arterial hypertension.
Erectile dysfunction (ED) is defined as difficulty achieving or maintaining an erection sufficient for sexual intercourse. The condition becomes more prevalent with age and is thought to affect more than 50% of men in the US, aged 40 -70. ED can be exacerbated by low libido, a condition where there is little to no desire for sex. This can be problematic because sexuality is important for overall health and wellbeing.
There are three types of possible ejaculation problems: premature ejaculation, delayed or inhibited ejaculation, and retrograde ejaculation. Premature ejaculation is defined as reaching orgasm too early, before, or soon after penetration. Delayed or inhibited ejaculation is when orgasm is reached too slowly or not at all. In retrograde ejaculation, patients ejaculate into the bladder rather than through the penis.
Typical sexual responses are complex interactions of the mind, nervous, circulatory, and hormonal systems. Male sexual problems like erectile dysfunction can be caused by physical or psychological reasons or a combination of those issues.
Our Erectile Dysfunction (ED) Medications
Tadalafil
Tadalafil is a PDE5 inhibitor that may help increase smooth muscle relaxation and blood flow.
Phenylephrine HCL
Phenylephrine is used as a rescue medication for priapism. It works by tightening blood vessels in the penis so the trapped blood can drain, helping the erection go down.
Alprostadil / Papaverine HCL / Phentolamine Mesylate (TriMix)
Tri Mix penile injection combines alprostadil, papaverine, and phentolamine which may offer a fast‑acting option that supports stronger and more reliable erections when oral medications are not achieving desired results.
Papaverine HCL / Phentolamine Mesylate (BiMix)
Papaverine and phentolamine (Bi Mix injection) relaxes cavernosal smooth muscle to enhance penile blood flow and promote tumescence.
Testosterone Cypionate / DHEA Grapeseed Oil
A testosterone cypionate/DHEA grapeseed oil injection combines long‑acting testosterone with DHEA, a hormone that the body can naturally convert into other hormones.
Testosterone
Testosterone is a sex hormone that plays a number of important roles in reproductive health and general wellness in both women and men.
About Erectile Dysfunction (ED)
Causes
Reasons for Erectile Dysfunction:
Hormonal and Nonhormonal Causes
Erectile dysfunction can be the result of one or more of the following: hormonal imbalances, conditions affecting blood flow and circulatory mechanisms (neurogenic), diseases impacting nerve signaling (neurogenic), or due to outside medications or substances (iatrogenic). There may be psychological factors as well.
Hormonal Causes
As male patients age, testosterone levels typically decline and may negatively impact libido. Libido is a measure of a person’s interest in sexual intimacy. Studies show that fluctuations in desire for sex can be linked to testosterone levels. During andropause, hormonal support with testosterone therapy may help restore energy and improve sex drive.
Psychological Causes
Interpersonal relationship conflict with partners can affect intimacy. Situational stressors may increase performance anxiety or limit interest in sexual connection. Psychological reasons such as depression or trauma should never be overlooked. These underlying issues are known to have a great impact on sexual function.
Additional Physical Causes of Sexual Dysfunction:
- Low testosterone levels or other hormonal imbalances
- Heart or blood vessel disease, such as clogged arteries, and high blood pressure
- Nerve disorders
- Diabetic nerve damage
- Obesity
- Chronic kidney or liver diseases
- Smoking
- Heavy drinking or long-term drug use
- Parkinson’s disease
- Multiple sclerosis
- Treatments for prostate cancer or enlarged prostate
- Injury to the penis
Additional Psychological Causes of Sexual Dysfunction:
- Relationship problems
- Depression, anxiety
- Past sexual trauma or feelings of guilt over sex
- Work-related stress
- Low self-confidence
- Nervousness over sexual performance
Oral Therapies
ED is the inability to create or maintain an erection for sexual penetration. It’s not uncommon for men to experience this situation once or twice and nothing comes of it. However, if it continues to occur regularly, there may be an issue worth looking into.
There are ED medications available to help achieve an erection when needed. Drugs like compounded forms of oral phosphodiesterase 5 inhibitors (PDE5i) can help prompt an erection. Tadalafil and sildenafil citrate are erectile dysfunction pills that when taken orally, sublingually, or buccally induce smooth muscle relaxation and increase blood flow to the penis. This increased blood flow helps achieve and maintain an erection sufficient for sexual intercourse.
Many conditions can be connected to ED, such as diabetes, high blood pressure, depression, high cholesterol, and cardiovascular disease. These health issues affect blood flow, nitric oxide production, and nerve signaling necessary to stimulate an erection. It is important to address the underlying cause with a medical professional before initiating medication. In addition, lifestyle changes, such as improvements in diet and exercise as well as avoiding smoking, can make a big difference for sexual wellbeing.
Injections
While oral PDE-5 inhibitors (sildenafil citrate, vardenafil, and tadalafil) are considered first line erectile dysfunction pills, not all patients see success with these agents. Absorption variation, onset delays, and side effects can contribute to challenges individuals face when seeking appropriate erectile dysfunction therapy.
Compounded intracavernosal injections are an erectile dysfunction medication alternative for patients who have not succeeded or are ineligible for oral therapy. Sterile injectable medications for erectile dysfunction are given by intracavernosal route, meaning the active pharmaceutical ingredients are directly injected into the penis. Doing so allows the drugs to rapidly enter the site of interest and can encourage more immediate activity.
When the moment strikes, waiting for medication to help isn’t always a reasonable request. Intracavernosal injections are thought to offer a more immediate onset of action for those unplanned intimate opportunities.
Alprostadil
Alprostadil is a prostaglandin and vasodilator. It can relax the smooth muscle of the penis, dilating local arteries to increase blood flow and promote an erection.
Alprostadil may be a promising alternative for patients that do not succeed with oral phosphodiesterase type 5 inhibitors (PDE5i), like sildenafil citrate, tadalafil, or vardenafil.
BiMix (Papaverine HCL /Phentolamine Mesylate)
Papaverine HCl is a non-selective phosphodiesterase (PDE) inhibitor that can prompt smooth muscle relaxation and vasodilation in the penis.
Phentolamine Mesylate is a non-selective alpha-adrenergic antagonist that can help promote an erection by blocking vasoconstriction.
These medications are used in combination only and can serve as an alternative to alprostadil monotherapy. Together, they can provide synergistic vasodilation of the penis.
TriMix (Alprostadil/Papaverine HCL/Phentolamine Mesylate)
This drug trio is thought to provide a promising and well-tolerated erectile dysfunction intervention. Combining three therapeutic options allows multiple mechanisms of action to work simultaneously, with increased potential for sexual satisfaction.
This multimodal formulation may improve sexual outcomes with lower individual medication strengths, limiting the potential for side effects.
BHRT
If low testosterone is present, perhaps having declined with age, hormone replacement therapy can offer sexual health benefits. Testosterone replacement may provide relief from many symptoms related to sexual health. Oxytocin may help increase the desire for sex and other forms of intimate connection. Other hormones can be added — like pregnenolone, testosterone cypionate/DHEA, or testosterone cypionate/anastrozole — to address hormonal imbalances or specific symptoms.
Commonly Asked Questions About Erectile Dysfunction
A medical provider will likely begin by asking questions about current symptoms, as well as a medical and sexual history. Given the topic, the questions will get personal, but don’t sink into embarrassment. Answering truthfully is important.
A physical exam can follow that could include an examination of the penis and testicles, a rectal exam to check the prostate, a blood pressure check, as well as blood tests for hormone levels, blood sugar, and cholesterol. Depending on the results, the prescriber may recommend medication(s) or coordinate a consultation from a specialist such as a urologist, endocrinologist, sex therapist, or other counselor to address any underlying physical or psychological problems.
Testosterone levels drop roughly 1% each year after age 30, for many men. This can lead to lower libido and a decrease in nitric oxide (N.O.) production, which is needed for an erection.
But low testosterone may only play a small role in ED. Testosterone is connected to a man’s desire for sexual activity (libido), which in turn triggers dopamine and oxytocin release from the brain to increase N.O. for an erection. In most cases there are other underlying causes for ED. As patients get older, disease states are often the primary culprit for ED, with decreased testosterone being just one contributing factor.
Many conditions can be connected to ED, such as diabetes, high blood pressure, depression, high cholesterol, and cardiovascular disease. These health issues affect blood flow, nitric oxide production, and nerve signaling necessary to stimulate an erection. Improving the underlying causes that relate to erectile dysfunction, may also help restore sexual function. If the patient is generally considered healthy and ED is the only complaint, it’s a sign to the provider to look deeper for cardiovascular issues. ED can be a precursor to cardiovascular events down the road.
Patients with an increased risk of priapism – erections lasting 4 hours or more – should seek medical advice before starting injectable medications for erectile dysfunction. Conditions like sickle cell disease, leukemia, and multiple myeloma can be predisposed to priapism and are encouraged to discuss appropriateness of therapy with a provider. Use is contraindicated for those with Peyronie’s disease, bleeding disorders, or recurrent priapism.
Patients with higher likelihood for priapism should also discuss risk management, such as rescue medications, for emergent situations. Injectable phenylephrine can serve as a therapeutic option for these cases.
There are other conditions that may affect candidacy for compounded erectile dysfunction injectable medications. Reach out to a medical provider to discuss appropriate therapies.
Prescription drugs such as antidepressants, high blood pressure medicines, or antihistamines, may cause or worsen sexual dysfunction symptoms. If there are concerns that current medications may be negatively affecting sexual wellbeing, contacting a medical professional is recommended.
