87 receptor blockers, often used for treatment of BPH, need to be taken at least 4 hours apart. Among second-line therapies, external vacuum devices (VCDs) are a good, non-surgical option for patients with ED. VCDs are clear plastic chambers placed over the penis, tightened against the lower abdomen with a mechanism to create a vacuum inside the chamber. This directs blood into the penis. If an adequate erection occurs inside the chamber, the patient slips a small constriction band off the end of the VCD and onto the base of the penis. An erection beyond 30 minutes is not recommended. While cumbersome, these devices are considered safe.
atropine, which work alone or in combination to elicit an erection. Response is dose related, usually occurs within 10– 15 minutes, and does not require stimulation. A concern with ICI use is priapism, and if this occurs the patient will need to seek urgent medical attention. Bruising can also occur, due to it being an injected medication. The intraurethral suppository consists of a tiny pellet of prostaglandin E1 inserted into the urethral meatus. Response is dose related, and onset usually occurs within 10–15 minutes. Patients need to be trained on the technique of the IUS before use, and should be advised that pain or burning may occur with this medication.
Outlook
“Other second-line therapy includes the use of either intracavernosal injection (ICI) or intraurethral suppositories (IUS). A small needle is used to inject the ICI medication into the lateral aspect of the penis through a small-gauge needle. These vasoactive agents include prostaglandin E1, papaverine and phentolamine and sometimes
“In men who fail to respond to first or second-line therapy, or who are not interested in conservative therapies, penile prosthesis implantation is available. Penile implants include malleable and inflatable devices, although most implants used are of the inflatable variety. Adverse effects including malfunction and infection are rare, and patient satisfaction is high.”
“Stem cell studies may also provide advancements in the treatment of ED in the future. The mechanism of action of stem cells is to generate angiogenesis with subsequent increase in cavernosal smooth muscle cells within the corporal bodies.
Theresa told us that future Therapies for ED Clinical studies in gene therapy are looking towards replacing proteins that may not be functioning properly in the penile tissue of men with erectile dysfunction. She says, “Replacement of these proteins may result in improvement in ED. Experimental animal models have demonstrated improvement in erectile function with gene therapy. Human studies may demonstrate success with this therapy in the future, however, gene therapy in humans is controversial, and can take a long time for regulatory approval and public acceptance.
“The clinical studies published to date provide encouraging
results, with improvement of sexual function reported with no side effects. Although pioneering, stem cell studies to date are small scale, with a short follow up period, various aetiologies of ED and without a control group. Melanocortin activators are drugs that act through the central nervous system, and have been shown in animal studies to produce an erection. Initial studies in humans suggest that the drug (PT-141) can be effective if given intranasally in men with psychological rather than physical causes, and mild to moderate ED. “Larger studies are necessary, however, to demonstrate the safety and overall effectiveness of these drugs. Another potential new treatment for ED, is penile low intensity shock wave lithotripsy. This consists of 1500 shocks twice a week for 3–6 weeks. The purpose is to stimulate neovascularisation to the corporal bodies with improvement in penile blood flow and endothelial function. The use of low-intensity shock wave lithotripsy may convert PDE5 inhibitor non-responders to responders.”
Pharmacy Role in ED Care Background of ED Erectile dysfunction is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Erectile dysfunction is one of the most common health conditions affecting men. EAU guidelines from 2020 indicate a prevalence of 52% of men aged 40-70 years with erectile dysfunction (ED).4 ED is very common in Ireland, one in 5 Irish men experience this regularly. Causes of ED There are many causes of ED which can result from both physical and psychological conditions Physical Causes • Conditions such as heart disease, atherosclerosis, high blood pressure diabetes, metabolic syndrome, parkinson’s disease and multiple sclerosis • Obesity • Certain Prescription medication (10-25% of ED causes are drug induced)* • Treatment for prostate cancer • Tobacco Use
• Excessive substance abuse such as alcoholism • Sleep Disorders
Written by Lisa Byrne, Superintendent Pharmacist, McCabes Pharmacy Group
• Low Testosterone Psychological Causes • Depression, anxiety or other mental health conditions • Stress • Relationship problems * Common medicines that cause ED are antidepressants, antihistamines, high blood pressure medicines and diuretics of which thiazides are the most common cause of ED following by beta blockers. Other classes of medications include Parkinsons disease medicines, chemotherapy and hormonal medicines, opiate analgesics and recreational drugs. We would always advise men who are unsure of the reason behind their ED to speak confidentially to their pharmacist, we always recommend a visit to a GP to ascertain underlying conditions that might cause this. Lifestyle changes Modifiable risk factors that can help improve symptoms of ED include losing weight, exercise daily, stop smoking, eat a healthy diet and reduce stress and anxiety.
Treatment of ED Sildenafil has been licensed for the treatment of ED since 1998 and is available in three different strengths on prescription. Sildenafil 50mg (Viagra Connect) is available without a prescription to those over 18 from the pharmacy, following consultation with a pharmacist which can be done in the privacy of a consultation room. Studies have reported that patients sought out online platforms for accessing ED treatments citing convenience, shame and discretion as treatment barriers.2 Pharmacists have a key role to allow customers access to medication in an environment that encourages them to seek treatment, be afforded counselling, and thus building a trusting relationships.3 At McCabes Pharmacy there is the option to Click & Collect. The customer completes an online
consultation form on the website and collects their medication in store from the pharmacist, after answering a few questions to ascertain if it is indeed the most appropriate medication for their needs. This has proved to be a very popular service, by nature of its discretion. Referenc es vailable on request
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