Drug reference
Phentolamine is a short-acting alpha- adrenoceptor antagonist that acts directly on vascular smooth muscle, resulting in vasodilatation; aviptadil is a vasoactive intestinal polypeptide that acts as a smooth muscle relaxant.
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Erectile dysfunction ▶BY INTRACAVERNOSAL INJECTION ▶Adult: 25/2000 micrograms, frequency of injection should not exceed once daily or three times weekly, duration of erection should not exceed 1 hour DOSE EQUIVALENCE AND CONVERSION ▶Dose expressed as x/y micrograms of aviptadil/phentolamine.
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Anatomical deformation of the penis (e.g. angulation, cavernosal fibrosis, Peyronie’s disease). not for use with other agents for erectile dysfunction. patients for whom sexual activity is inadvisable. penile implants. predisposition to priapism (e.g. in sickle cell anaemia or trait, multiple myeloma, or leukaemia)
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Concomitant treatment with anticoagulants (potential increased risk of bleeding). history of psychiatric disorder or addiction (potential for abuse). severe cardiovascular disease. severe cerebrovascular disease
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Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (December 2017) that aviptadil with phentolamine (Invicorp ®) is accepted for restricted use within NHS Scotland for the symptomatic treatment of erectile dysfunction due to neurogenic, vasculogenic, psychogenic, or mixed aetiology in adult males who have failed on oral therapies (oral phosphodiesterase type-5 inhibitors) and other non- injectable formulations of erectile dysfunction medications. All Wales Medicines Strategy Group (AWMSG) decisions The All Wales Medicines Strategy Group has advised (July 2017) that aviptadil with phentolamine (Invicorp ®) is recommended as an option for the symptomatic treatment of erectile dysfunction in adult males due to neurogenic, vasculogenic, psychogenic, or mixed aetiology that has not responded to oral phosphodiesterase type-5 inhibitor therapy.
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▶Common or very common Bruising. flushing ▶Uncommon Dizziness. haematoma. headache. palpitations. tachycardia ▶Rare or very rare Angina pectoris. myocardial infarction. penile fibrosis (following multiple injections). penile nodules. sexual dysfunction
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Manufacturer advises monitor regularly (e.g. every 3 months), particularly in the initial stages of self-injection therapy; careful examination of the penis is recommended to detect signs of penile fibrosis or Peyronie’s disease—discontinue treatment in patients who develop penile angulation, cavernosal fibrosis, or Peyronie’s disease.
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Manufacturer advises that the initial injections of Invicorp ® must be administered by medically trained personnel; self- administration may only be undertaken after proper training. l HANDLING AND STORAGE Manufacturer advises store in a Genito-urinary system refrigerator (2–8°C).
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Invicorp (Evolan Pharma AB) Aviptadil 71.43 microgram per 1 ml, Phentolamine mesilate 5.71 mg per 1 ml Invicorp 25micrograms/2mg/0.35ml solution for injection ampoules | 5 ampoule P £47.50 DT = £47.50 4.2 Premature ejaculation Premature ejaculation Description of condition Premature ejaculation is a common male sexual disorder characterised by brief ejaculatory latency, loss of control, and psychological distress. Treatment g Non-drug treatment (including psychosexual counselling, education, and behavioural treatments) are recommended in patients for whom premature ejaculation causes few (if any) problems or in patients who prefer not to take drug treatment. These techniques can also be used in addition to a drug treatment. For patients with life-long premature ejaculation, drug treatment is the recommended approach. h Dapoxetine below, a short-acting selective serotonin re-uptake inhibitor, is licensed to be used when required for this condition (not continuous daily use). g Other selective serotonin re-uptake inhibitors (citalopram p. 382, fluoxetine p. 383, fluvoxamine maleate p. 384, escitalopram p. 382, paroxetine p. 384, sertraline p. 385 [unlicensed indications]) and the tricyclic antidepressant clomipramine [unlicensed indication] have been widely used as regular, daily treatment. Caution is suggested in prescribing selective serotonin re-uptake inhibitors for young adolescents with premature ejaculation, and to men who also have a depressive disorder, particularly when associated with suicidal ideation. Ejaculation delay may start a few days after the start of treatment, but it is more evident after 1 to 2 weeks, since receptor desensitisation requires time to occur. If premature ejaculation is secondary to Erectile dysfunction p. 857, the erectile dysfunction should be treated first. h Topical anaesthetic preparations for the management of premature ejaculation are available without prescription. Other drugs used for Premature ejaculation Lidocaine with prilocaine, p. 1425 SELECTIVE SEROTONIN RE-UPTAKE INHIBITORS
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Manufacturer advises that patients should be instructed to report any erection lasting 4 hours or longer.
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25/2000 micrograms, frequency of injection
First-line fragment. Read the complete Indications and Dose section above.
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