Injected medications for erection problems

Examples

Generic Name Brand Name
alprostadil Caverject
papaverine hydrochloride Pavabid
papaverine hydrochloride and phentolamine mesylate Bimix
papaverine hydrochloride and phentolamine mesylate and alprostadil Trimix

The medicines in Bimix and Trimix must be mixed together by the pharmacist.

You inject this medicine into the side of the penis with a tiny needle. The shots usually are not very painful, but you may find the thought of injecting yourself uncomfortable. Less commonly, these medicines also may be available in an auto-injector in which the needle is hidden, making them easier to use. You can adjust the dose of medicine to create an erection that lasts the desired length of time.

See a picture of an injection.

Your doctor may give you a trial use of this medicine while you are in the office. This allows the doctor to see how well the medicine works for you, see whether you can use it properly, and check for adverse reactions, such as a painfully long-lasting erection (priapism) or an allergic reaction.

How It Works

The medicines are injected into the penis before sex to relax the muscles that surround the blood vessels in the penis, increasing the blood flow into the penis and producing an erection that lasts 30 minutes to an hour or longer. How long the erection lasts depends on how much medicine you inject.

Why It Is Used

These medicines may be prescribed for erection problems (erectile dysfunction) caused by psychological or physical factors.

How Well It Works

Papaverine by itself works in about half of the men who try it for erection problems. Alprostadil alone works in about 8 out of 10 men who try it for erection problems. The combination of papaverine and phentolamine (Bimix) works for about 7 out of 10 men who use it. Trimix (the combination of papaverine, phentolamine, and alprostadil) seems to work the best. It works in almost 9 out of 10 men who try it.1

Side Effects

Injections occasionally can result in a painful, prolonged erection (priapism). Call your doctor if an erection lasts longer than 3 hours. If the erection isn't relieved, it may damage tissues inside the penis.

Other side effects of injections may include:

  • Bruising.
  • Pain in the penis (usually mild to moderate). Pain in the penis was reported by about 4 out of 10 men in one study.2 Injecting the medicine slowly may help prevent pain. Only a few men stop using the medicine because of pain.
  • Formation of scar tissue in the penis (fibrosis).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

When investigating injections for erection problems, it is important to include your partner in your decision.

These medicines are less likely to be effective for men in whom blood flow into or out of the penis is severely impaired.

They may cause problems for men with severe mental illness or for those who would have difficulty giving the injection. If you have vision problems, your partner can learn to give you the injections. Make sure your partner is comfortable with helping you and with using injections.

These medicines can be used by men who are taking medicine to prevent blood clots. Medicines to prevent blood clots include anticoagulants, such as warfarin (Coumadin), and antiplatelet medicines, such as clopidogrel (Plavix) or ticlopidine (Ticlid).

Medicines that are injected into the penis can be given no more than every other day. Excessive use may cause scarring.

Some men may find the idea of self-injections unpleasant, or they may find self-injections difficult to do. The use of an auto-injector, in which the needle is hidden, may make the shots easier for some men to use.

Couples trying to have children may prefer injections over a vacuum device, because the vacuum device blocks ejaculation.

Up to 60% of men stop using the medicines. Reasons include:3

  • Not wanting to use injections because of fear, discomfort, and the loss of spontaneity about giving an injection into the penis, or some other reason.
  • Partner relationship issues (being able to have erections doesn't solve relationship problems) or loss of partner.
  • Cost of the medicines.
  • Not being happy with the quality of erections from injections.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Lue TF, Broderick GA (2007). Evaluation and nonsurgical management of erectile dysfunction and premature ejaculation. In AJ Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 1, pp. 750–787. Philadelphia: Saunders Elsevier.
  2. Tharyan P, Gopalakrishanan G (2006). Erectile dysfunction, search date August 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  3. Bella AJ, Lue TF (2008). Male sexual dysfunction. In EA Tanagho, JW McAninch, eds., Smith's General Urology, 17th ed., pp. 589–610. New York: McGraw-Hill.

Last Updated: May 21, 2008

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