Drug reference
Spermicidal contraceptive in conjunction with barrier methods of contraception such as diaphragms or caps Genito-urinary system ▶BY VAGINA ▶Females of childbearing potential: (consult product literature)
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Genital erosion. increased risk of HIV infection. pain. paraesthesia. skin reactions. vaginal redness SIDE-EFFECTS, FURTHER INFORMATION High frequency use of the spermicide nonoxinol-9 has been associated with genital lesions, which may increase the risk of acquiring sexually transmitted infections.
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No evidence of harm to diaphragms.
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Toxicity in animal studies.
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Present in milk in animal studies.
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There can be variation in the licensing of different medicines containing the same drug. Gel EXCIPIENTS: May contain Hydroxybenzoates (parabens), propylene glycol, sorbic acid ▶Gygel (Marlborough Pharmaceuticals Ltd) Nonoxinol-9 20 mg per 1 ml Gygel 2% contraceptive jelly | 81 gram G £11.00 DT = £11.00 Erectile and ejaculatory conditions 4.1 Erectile dysfunction Erectile dysfunction Description of condition Erectile dysfunction (impotence) is the persistent inability to attain and maintain an erection that is sufficient to permit satisfactory sexual performance. It can have physical or psychological causes. Erectile dysfunction can also be a side- effect of drugs such as antihypertensives, antidepressants, antipsychotics, cytotoxic drugs and recreational drugs (including alcohol). Risk factors for erectile dysfunction include sedentary lifestyle, obesity, smoking, hypercholesterolaemia and metabolic syndrome. Erectile dysfunction increases the risk of cardiovascular disease. All men with unexplained erectile dysfunction should be evaluated for the presence of cardiovascular risk factors and any identified risk should be addressed. Drug treatment g The recommended approach for the management of erectile dysfunction is a combination of drug treatment and lifestyle changes (including regular exercise, reduction in body mass index, Smoking cessation p. 520, and reduced alcohol consumption). An oral phosphodiesterase type-5 inhibitor is the first-line drug treatment for erectile dysfunction, regardless of the cause. h These drugs act by increasing the blood flow to the penis. They do not initiate an erection—sexual stimulation is required. The choice of oral phosphodiesterase type-5 inhibitor depends on the frequency of intercourse and response to treatment. g Avanafil below, sildenafil p. 859 and vardenafil p. 861 are short-acting drugs and are suitable for occasional use as required. Tadalafil p. 860 is a longer-acting drug. It can be used as required, but can also be used as a regular lower daily dose to allow for spontaneous (rather than scheduled) sexual activity or in those who have frequent sexual activity. A patient with erectile dysfunction Genito-urinary system should receive six doses of an individual phosphodiesterase type-5 inhibitor at the maximum dose (with sexual stimulation) before being classified as a non-responder. Patients who fail to respond to the maximum dose of at least two different phosphodiesterase type-5 inhibitors should be referred to a specialist. Intracavernosal, intraurethral or topical application of alprostadil (prostaglandin E1) p. 862 is recommended as second-line therapy under careful medical supervision. Intracavernosal or intraurethral preparations can also be used to aid diagnosis. h Priapism associated with alprostadil Manufacturers advise that patients should seek medical help if a prolonged erection lasting four hours or more occurs; application of an ice pack to the upper-inner thigh (alternating between the left and right thighs every two minutes for up to ten minutes) may result in reflex opening of the venous valves. If priapism has lasted more than six hours, treatment should not be delayed; manufacturer advises management as follows: . Initial therapy by penile aspiration: using aseptic technique, 20–50mL of blood should be aspirated using a 19–21 gauge butterfly needle inserted into the corpus cavernosum; if necessary the procedure may be repeated on the opposite side; . Lavage: if initial aspiration is unsuccessful, a second 19–21 gauge butterfly needle can be inserted into the opposite corpus cavernosum; sterile physiological saline can be injected through the first needle and drained through the second; . If aspiration and lavage of are unsuccessful, intracavernosal injection of a sympathomimetic with action on alpha-adrenergic receptors can be given, with continuous monitoring of blood pressure and pulse— see phenylephrine hydrochloride p. 865 [unlicensed indication], adrenaline/epinephrine p. 864 [unlicensed indication], and metaraminol p. 865 [unlicensed indication]. Extreme caution is required in patients with coronary heart disease, hypertension, cerebral ischaemia and in patients taking a monoamine-oxidase inhibitor (facilities for managing hypertensive crisis should be available when administered to patients taking MAOIs); . If necessary the sympathomimetic injections can be followed by further aspiration of blood through the same butterfly needle; . If administration of a sympathomimetic drug is unsuccessful, urgent referral for surgical management is required. Prescribing on the NHS Some drug treatments for erectile dysfunction may only be prescribed on the NHS under certain circumstances; for details see the criteria listed in part XVIIIB of the Drug Tariff (Part XIb of the Northern Ireland Drug Tariff, Part 12 of the Scottish Drug Tariff). The Drug Tariffs can be accessed online at: National Health Service Drug Tariff for England and Wales: www.nhsbsa.nhs.uk/pharmacies-gp-practices-and- appliance-contractors/drug-tariff. Health and Personal Social Services for Northern Ireland Drug Tariff: www.hscbusiness.hscni.net/services/2034.htm. Scottish Drug Tariff: www.isdscotland.org/Health-Topics/ Prescribing-and-Medicines/Scottish-Drug-Tariff/. Related drugs Other drugs used for Erectile dysfunction: aviptadil with phentolamine mesilate p. 865. PHOSPHODIESTERASE TYPE-5 INHIBITORS
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