Priapism is a very uncommon adverse event; however, due to its serious consequences of corporal scarring and possible irreversible damage, the patient is instructed to seek immediate medical attention for a painful erection lasting longer than 4 hours. Pharmacologic reversal of a prolonged erection less than 24 hours duration may be accomplished with phenylephrine solution, a vasoconstricting agent. An intermittent injection of 200 mcg/mL phenylephrine is administered to the side of the shaft of the penis every 10 minutes or until the erection has subsided (maximum of 10 injections).
Pharmacologic treatment using vasoactive agents is now coming to the forefront as one of the most effective means of treating impotence. These agents, directly administered into the corpora cavernosum, mimic the vascular phenomenon of erection, eliciting a response within 5-10 minutes that lasts 30 minutes to one hour.
Pharmacists can have a significant impact on the quality of life of men who suffer from erectile dysfunction. To impact the care of these patients one must first recognize that there is a potential problem and then develop sensitive communication skills to stimulate discussion with the patient and/or his significant other. This approach can help the patient understand the various treatment options that can be utilized to overcome impotence.
Vascular: The most common cause of erectile dysfunction is vascular — an impaired blood flow into (arterial insufficiency) or excess blood flow out of (veno-occlusive disease) the penis. Hypertension, hyperlipidemias, diabetes and excessive cigarette smoking are factors known to contribute to vascular impotency (Table 1).