Video: Latest Treatment for Hep C.

Phentolamine Mesylate

Class: Non-selective alpha-Adrenergic Blocking Agents
VA Class: AU200
CAS Number: 65-28-1
Brands: Regitine, Vasomax, Z-Max

Introduction

α-adrenergic blocking agent, an imidazoline.177 a

Uses for Phentolamine Mesylate

Diagnosis of Pheochromocytoma

Used as an aid in the diagnosis of pheochromocytoma.a 177

Determination of blood catecholamine concentrations, urinary assay of catecholamines, or other biochemical assays are the safest and most reliable diagnostic methods and they have largely replaced phentolamine and other pharmaceutical tests.177 a No test, however, is completely reliable.177 a

May be used when additional confirmatory evidence of pheochromocytoma is required and potential benefits outweigh the possible risks.177 a

Test is more reliable with sustained than with paroxysmal hypertension; no diagnostic value in absence of hypertension at the time of the test.177 a

Sudden and marked reduction in BP following parenteral administration of phentolamine suggests pheochromocytoma;a however, false-negative and false-positive responses are frequent.177 a

Hypertension in Pheochromocytoma

May be administered immediately prior to or during pheochromocytomectomy to prevent or control paroxysmal hypertension resulting from anesthesia, stress, or operative manipulation of the tumor.a

Has been used to manage pheochromocytoma until surgery is performed and for prolonged treatment of hypertension when the tumor is not operable; however, phenoxybenzamine is considered the drug of choice because it has a longer duration of action.a

Hypertensive Crises

Has been used to treat hypertensive crises caused by sympathomimetic amines (e.g., methoxamine, phenylephrine) or catecholamine excess by certain foods or drugs in patients taking MAO inhibitors (e.g., isocarboxazid [no longer commercially available in the US], tranylcypromine), or by clonidine withdrawal syndrome.a 180

Slideshow: Worried About Ebola? You’re More Likely to Get These 10 Serious Infections

If used, the initial goal is to reduce mean arterial BP by no more than 25% within minutes to 1 hour, followed by further reduction if stable toward 160/100 to 110 mm Hg within the next 2–6 hours, avoiding excessive declines in pressure that could precipitate renal, cerebral, or coronary ischemia.164

If this BP is well tolerated and the patient is clinically stable, may implement further gradual reductions toward normal in the next 24–48 hours.a In patients with aortic dissection, reduce systolic BP to <100 mm Hg if tolerated.a

Extravasation of Catecholamines

Used to prevent dermal necrosis and sloughing following IV administration or extravasation of norepinephrine.177 180 a

Has been used to prevent necrosis after extravasation of dopamine.a

MI

Has been used to decrease impedance to left ventricular ejection and the infarct size in patients with MI associated with left ventricular failure.a

However, contraindicated in patients with MI,177 a and investigators do not recommend for routine use, since left ventricular function and the ECG must be monitored continuously.a

Erectile Dysfunction

Self-injection of small doses combined with papaverine hydrochloride into the corpus cavernosum has been effective for the treatment of erectile dysfunction (ED, impotence).103 105 106 107 108 110 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127

Combination has been effective in patients with neurogenic103 105 106 108 110 112 113 115 116 118 119 120 122 123 124 127 and/or limited vasculogenic impotence103 105 106 108 110 112 113 115 116 120 122 123 124 127 or with psychogenic impotence,105 106 108 123 124 127 but efficacy in those with a vasculogenic component of their impotence may be variable depending on the extent and type of vascular dysfunction.103 108 110 115 120 123 124

Erection, which can be potentiated by sexual arousal, usually occurs within 10 minutes after injection of the drugs and may persist for 1 to several hours;105 106 108 113 114 116 118 119 124 tolerance to the drugs may occur during long-term use;105 114 124 priapism may occur.103 105 106 107 108 110 113 115 116 124 125 126 127

Cocaine-induced Acute Coronary Syndrome

Used as an adjunct in the management of cocaine overdose to reverse coronary vasoconstriction175 180 following use of oxygen, benzodiazepines (e.g., diazepam, lorazepam), and nitroglycerin.175

Phentolamine Mesylate Dosage and Administration

General

Diagnosis of Pheochromocytoma

  • Withhold sedatives, analgesics (e.g., opiates), and all other medications except essential drugs (e.g., digitalis, insulin) for at least 24 hours (preferably 48-72 hours) prior to the test.177

  • Withhold antihypertensive drugs until BP returns to untreated hypertensive levels.177

  • Before injection, the patient should rest in a supine position (preferably in a quiet, darkened room) until the BP is stabilized; read BP every 10 minutes for at least 30 minutes to establish basal BP.177 a

  • After insertion of needle, delay IV injection until venipuncture effect on blood pressure has passed; then inject rapidly.177 a

  • After IV injection, record BP immediately (at 30-second intervals for the first 3 minutes, then 1-minute intervals for the next 7 minutes).177 a

  • After IM administration, determine BP at 5-minute intervals for 30-45 minutes.a

  • Typical BP response in patients with pheochromocytoma is a decrease of 60 mm Hg systolic and 25 mm Hg diastolic within 2 minutes after IV administration or 20 minutes after IM administration.177 a BP usually returns to pretest levels within 15–30 minutes or 3–4 hours, following IV177 or IM administration, respectively.a

  • Positive response/test is a BP decrease ≥35 mm Hg systolic and 25 mm Hg diastolic;a negative response is when BP is unchanged, elevated, or lowered <35 mm Hg systolic and 25 mm Hg diastolic.177 a

  • Confirm positive response by other diagnostic procedures, preferably by measurement of urinary catecholamines or their metabolites.177

Administration

Administer usually by IV or IM injection; also may be administered by IV infusion.177 a Has been administered by intracavernous injection for the treatment of impotence.103 105 106 107 108 110 112 113 114 115

IV administration

Reconstitution

Reconstitute vial containing 5 mg of lyophilized drug with 1 mL of sterile water to provide solution containing 5 mg of phentolamine mesylate per mL.177 a

Dilution

IV infusion: for prevention of tissue necrosis and sloughing following extravasation or IV administration of norepinephrine, may add reconstituted phentolamine mesylate to each L of solution containing norepinephrine.177 a

Rate of Administration

IV injection for pheochromocytoma test: inject rapidly.177 a

IM Administration

Reconstitution

Reconstitute vial containing 5 mg of lyophilized drug with 1 mL of sterile water to provide solution containing 5 mg of phentolamine mesylate per mL.177 a

Local Infiltration

Reconstitution

Reconstitute vial containing 5 mg of lyophilized drug with 1 mL of sterile water to provide solution containing 5 mg of phentolamine mesylate per mL.177 a

Dilution

For treatment or prevention of tissue necrosis and sloughing following extravasation of catecholamines, dilute the appropriate amount of reconstituted phentolamine mesylate in 10–15 mL of 0.9% sodium chloride injection.177 a

Dosage

Available as phentolamine mesylate; dosage expressed in terms of phentolamine mesylate.177 a

Pediatric Patients

Diagnosis of Pheochromocytoma
IV (Preferred Route)

1 mg,177 a 0.1 mg/kg, or 3 mg/m2.a

IM

3 mg.177 a

Hypertension in Pheochromocytoma
Pheochromocytomectomy
IV

Preoperative: 1 mg,177 a 0.1 mg/kg, or 3 mg/m2, 1–2 hours before surgery; may repeat if necessary.a

During surgery: 1mg,177 a 0.1 mg/kg, or 3 mg/m2.a

Postoperative: may administer norepinephrine to control hypotension (usually following complete pheochromocytoma removal);177 however, hypotension is prevented more frequently by administration of blood, plasma, or 5% albumin in 0.9% sodium chloride injection to correct the reduced blood volume.a

IM

Preoperative: 1mg,177 a 0.1 mg/kg, or 3 mg/m2, 1–2 hours before surgery; may repeat if necessary.a

Extravasation of Catecholamines
Dopamine Extravasation
Local Infiltration

Prevention of tissue necrosis and sloughing: 0.1–0.2 mg/kg (maximum 10 mg per dose).a

Immediate and conspicuous local hyperemic changes occur if the area is infiltrated within 12 hours.a

Adults

Diagnosis of Pheochromocytoma
IV (Preferred Route) or IM

5 mg.177 a

Hypertension in Pheochromocytoma
Hypertensive Crises Secondary to Catecholamine Excess
IV

Usually 5–15 mg.a

Pheochromocytomectomy
IV

Preoperative: 5 mg, 1-2 hours before surgery; repeat if necessary.177 a

During surgery, to prevent or control paroxysms of hypertension, tachycardia, respiratory depression, convulsions, or other effects of excessive epinephrine secretion due to manipulation of the tumor: 5 mg as needed.177 a

IM

Preoperative: 5 mg, 1-2 hours before surgery; repeat if necessary.177 a

Hypertensive Crises
IV

5–15 mg has been used.a

Extravasation of Catecholamines
IV Administration or Extravasation of Norepinephrine
Local Infiltration

Treatment of tissue necrosis and sloughing: 5–10 mg (in 10–15 mL of 0.9% sodium chloride) into affected area.177 180 a

Immediate and conspicuous local hyperemic changes occur if the area is infiltrated within 12 hours; ineffective if used >12 hours after extravasation.177 a

IV Infusion

Prevention of tissue necrosis and sloughing: 10 mg added to each liter of IV fluid containing norepinephrine; pressor effect of norepinephrine is unaffected.177 a

Extravasation of Dopamine Injection
Local Infiltration

Prevention of tissue necrosis and sloughing: 5–10 mg (in 10–15 mL of 0.9% sodium chloride) infiltrated (using a syringe with a fine hypodermic needle) liberally throughout the affected area.a

Immediate and conspicuous local hyperemic changes occur if the area is infiltrated within 12 hours.a

MI
IV Infusion

For treatment of left ventricular failure secondary to acute MI, dosages of 0.17–0.4 mg/minute have been used.a

Erectile Dysfunction
Intracavernosal Self-injection

Usually 0.5–1 mg (range: 0.08–1.25 mg) combined with papaverine hydrochloride 2.5–37.5 mg has been effective. a

Tolerance with long-term use may require dosage increase.105 114 124

Prescribing Limits

Pediatric Patients

Extravasation of Catecholamines
Dopamine Extravasation
Local Infiltration

Maximum 10 mg per dose.a

Cautions for Phentolamine Mesylate

Contraindications

  • MI or history of MI.177 a However, results of some studies indicate that the drug may have a beneficial effect in patients with MI.a

  • Coronary insufficiency, angina, or other evidence suggestive of CAD.177 a

  • Known hypersensitivity to phentolamine, related compounds, or any ingredient in the formulation.177 a

Warnings/Precautions

Warnings

Cardiovascular Effects

Risk of MI, cerebrovascular spasm or occlusion, usually in association with marked hypotension.177 a

Risk of tachycardia, cardiac arrhythmias; defer cardiac glycoside administration until cardiac rhythm returns to normal.177

Risk of severe hypotension or other signs and symptoms of shock; treat with prompt supportive measures and norepinephrine (if necessary).a Do not administer epinephrine for hypotension since it may cause a paradoxical fall in BP.a

Diagnostic Tests for Pheochromocytoma

Phentolamine and other pharmaceutical tests no longer procedures of choice for diagnosis of pheochromocytoma; may be used when additional confirmatory evidence of pheochromocytoma is required and the potential benefits of the tests outweigh the possible risks.177 a Urinary assay of catecholamines or other biochemical assays are the safest and most reliable methods.177 a Consider that no test is completely reliable.177 a

Possible false-negative responses to phentolamine test (e.g., in patients with paroxysmal hypertension or with a pheochromocytoma not secreting enough epinephrine or norepinephrine to elevate BP or sustain an elevation).a

False-positive reactions (occurring more commonly than false-negative) reported in patients with essential hypertension, uremia, or in those who received sedatives, opiates, or antihypertensive drugs.a (See Specific Drugs under Interactions.)

Do not perform test on normotensive patients.a

Major Toxicities

Intracavernosal Therapy

Intracavernosal therapy for impotence could result in persistent priapism (a medical emergency) which requires immediate medical and/or surgical intervention.103 105 106 107 108 110 113 115 116 120 124 125 126 127 128 If not treated immediately, penile tissue damage and permanent loss of potency may occur.142 152 161 162 163

Intracavernosal therapy (administered by self-injection) may be problematic in patients receiving anticoagulants, those who cannot tolerate transient hypotension, and those with poor manual dexterity, poor vision, or severe psychiatric disease.125

General Precautions

GI Conditions

Use with caution in patients with gastritis or peptic ulcer.a

MI

Monitor left ventricular function and ECG continuously during IV infusion of the drug.a

Specific Populations

Pregnancy

Category C.177

Lactation

Not known whether phentolamine is distributed into milk.177 Discontinue nursing or the drug.177

Common Adverse Effects

Abdominal pain, nausea, vomiting, diarrhea, exacerbation of peptic ulcer, weakness, dizziness, flushing, orthostatic hypotension, and nasal congestion.177 a

Interactions for Phentolamine Mesylate

Specific Drugs

Drug

Interaction

Comments

Antihypertensive Agents

Possible false-positive test for pheochromocytomaa

Withdraw antihypertensive agents and do not perform phentolamine test until blood pressure returns to pretreatment hypertensive levelsa

Epinephrine

Possible paradoxical fall in blood pressurea

Do not administer for phentolamine-associated hypotensiona

Opiate analgesics

Possible false-positive test for pheochromocytomaa

Withdraw opiates ≥24 hours (preferably 48–72 hours) prior to phentolamine testa

Rauwolfia alkaloids

Possible false-positive test for pheochromocytomaa

Withdraw rauwolfia drugs at least 4 weeks prior to phentolamine testa

Sedatives

Possible false-positive test for pheochromocytomaa

Withdraw sedatives ≥24 hours (preferably 48–72 hours) prior to phentolamine test.a

Phentolamine Mesylate Pharmacokinetics

Absorption

Onset

IV injection: maximum effect (in positive pheochromocytoma test) within 2 minutes.177 a

IM injection: maximum effect usually within 20 minutes.177 a

Intracavernous injection: (penile erection) within 10 minutes.105 106 108 113 114 116 118 119 124

Duration

IV injection: return to pretest BP usually within 15–30 minutes or less.a

IM injection: return to pretest BP within 3–4 hours.a

Intracavernous injection: penile erection may persist for 1 to several hours.105 106 108 113 114 116 118 119 124

Distribution

Extent

Not known whether phentolamine is distributed into milk.177 a

Elimination

Elimination Route

Excreted in urine (10–13%) as unchanged drug; the fate of the remainder is not known.177 a

Half-life

19 minutes following IV administration.177

Stability

Storage

Parenteral

Powder for Injection

15–30°C.177 a

Use reconstituted solution at time of preparation; do not store.177 a

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Drug Compatibility

Admixture CompatibilityHID

Compatible

Dobutamine HCl

Verapamil HCl

Y-Site CompatibilityHID

Compatible

Amiodarone HCl

Actions

  • Competitively blocks α-adrenergic receptors (primarily excitatory responses of smooth muscle and exocrine glands), but action is transient and incomplete.a

  • More effective in antagonizing responses to circulating epinephrine and/or norepinephrine than in antagonizing responses to mediator released at the adrenergic nerve ending.a

  • Causes peripheral vasodilation and decreases peripheral resistance, primarily by direct relaxation of vascular smooth muscle, but α-adrenergic blockade also contributes to vasodilation.a

  • Stimulates β-adrenergic receptors and produces a positive inotropic and chronotropic effect on the cardiac muscle (increasing cardiac output)a and vascular effects on vascular smooth muscle.177

  • Usual doses lower BP maintained by circulating epinephrine or norepinephrine, but have little effect on the BP of healthy individuals or patients with essential hypertension.a

  • In patients with AMI associated with hypertension and/or left ventricular failure, administration of IV phentolamine results in improvement in left ventricular performance; cardiac output, stroke index, heart rate, and cardiac index are increased and left ventricular filling pressure is decreased.a

Advice to Patients

  • Advise patients (using intracavernosal therapy for impotence) to contact their clinician if they develop a persistent (e.g., longer than 4 hours) erection during such therapy.132 133

  • Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.

  • Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.177 a

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Phentolamine Mesylate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection

5 mg*

Phentolamine Mesylate for Injection

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions April 1, 2010. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

100. Tu YH, Allen LV Jr, Wang DP. Stability of papaverine hydrochloride and phentolamine mesylate in injectable mixtures. Am J Hosp Pharm. 1987; 44:2524-7. [PubMed 2446497]

101. Romankiewicz JA, McManus J, Gotz VP et al. Medications not to be refrigerated. Am J Hosp Pharm. 1979; 36:1541-5. [PubMed 517543]

102. Stillwell S (Eli Lilly and Company, Indianapolis, IN): Personal communication; 1986 Sept 10.

103. Sidi AA, Cameron JS, Duffy LM et al. Intracavernous drug-induced erections in the management of male erectile dysfunction: experience with 100 patients. J Urol. 1986; 135:704-6. [IDIS 214073] [PubMed 2421014]

104. Lindoro J, Castro JC, Cruz F et al. Treatment of priapism. Lancet. 1984; 2:1348. [PubMed 6150362]

105. Anon. Intracavernous injections for impotence. Med Lett Drugs Ther. 1987; 29:95-6. [PubMed 3670212]

106. Robinette MA, Moffat MJ. Intracorporal injection of papaverine and phentolamine in the management of impotence. Br J Urol. 1986; 58:692-5. [PubMed 3801830]

107. Ellis LR, Nellans RE, Kramer-Levien DJ et al. Evaluation of the first 300 patients treated at an outpatient center for male sexual dysfunction. West J Med. 1987; 147:296-300. [IDIS 233499] [PubMed 3673062]

108. Nellans RE, Ellis LR, Kramer-Levien D. Pharmacological erection: diagnosis and treatment applications in 69 patients. J Urol. 1987; 138:52-4. [IDIS 232011] [PubMed 2439712]

109. Fernandez JA, Basha MA, Wilson GC. Emergency treatment of papaverine priapism. J Emerg Med. 1987; 5:289-91. [PubMed 3624835]

110. Lue TF, Tanagho EA. Physiology of erection and pharmacological management of impotence. J Urol. 1987; 137:829-36. [IDIS 229174] [PubMed 3553617]

111. Mizutani M, Nakano H, Sagami K et al. Treatment of post-traumatic priapism by intracavernous injection of α-stimulant. Urol Int. 1986; 41:312-4. [PubMed 3787856]

112. Sidi AA, Cameron JS, Dykstra DD et al. Vasoactive intracavernous pharmacotherapy for the treatment of erectile impotence in men with spinal cord injury. J Urol. 1987; 248:539-42.

113. Gasser TC, Roach RM, Larsen EH et al. Intracavernous self-injection with phentolamine and papaverine for the treatment of impotence. J Urol. 1987; 137:678-80. [IDIS 227800] [PubMed 3550149]

114. Larsen EH, Gasser TC, Bruskewitz RC. Fibrosis of corpus cavernosum after intracavernous injection of phentolamine/papaverine. J Urol. 1987; 137:292-3. [IDIS 225679] [PubMed 3806824]

115. Trapp JD. Pharmacologic erection program for the treatment of male impotence. South Med J. 1987; 60:426-7.

116. Zorgniotti AW, Lefleur RS. Auto-injection of the corpus cavernosum with a vasoactive drug combination for vasculogenic impotence. J Urol. 1985; 133:39-41. [PubMed 2578067]

117. Juenemann KP, Lue TF, Fournier GR Jr et al. Hemodynamics of papaverine- and phentolamine-induced penile erection. J Urol. 1986; 136:158-61. [PubMed 3712604]

118. Wyndaele JJ, de Meyer JM, de Sy WA et al. Intracavernous injection of vasoactive drugs, an alternative for treating impotence in spinal cord injury patients. Paraplegia. 1986; 24:271-5. [PubMed 3774363]

119. Al-Juburi AZ, O’Donnell PD. Penile self-injection for impotence in patients after radical cystectomy-ileal loop. Urology. 1987; 30:29-30. [PubMed 3603906]

120. Kiely EA, Williams G, Goldie L. Assessment of the immediate and long-term effects of pharmacologically induced penile erections in the treatment of psychogenic and organic impotence. Br J Urol. 1987; 59:164-9. [PubMed 3828713]

121. Puyau FA, Lewis RW, Balkin P et al. Dynamic corpus cavernosography: effect of papaverine injection. Radiology. 1987; 164:179-82. [IDIS 232219] [PubMed 3588901]

122. Zorgniotti AW. Corpus cavernosum blockade for impotence: practical aspects and results in 250 cases. J Urol. 1986; 135:306A.

123. Williams G. Impotence: treatment by autoinjection of vasoactive drugs. BMJ. 1987; 295:1279. [IDIS 235999] [PubMed 3120975]

124. Anon. Intracavernous injections for impotence. Med Lett Drugs Ther. 1990; 32:116-7. [PubMed 2255296]

125. NIH Consensus Development Panel on Impotence. Impotence. JAMA. 1993; 270:83-90. [IDIS 316686] [PubMed 8510302]

126. Anon. Vasodilators provide new therapy for erectile dysfunction. F-D-C Rep. 1992; 54:16-7.

127. Krane RJ, Goldstein I, Saenz de Tejada I. Impotence. N Engl J Med. 1989; 321:1648-59. [PubMed 2685600]

128. Kirby RS. Impotence: diagnosis and management of male erectile dysfunction. BMJ. 1994; 308:957-61. [IDIS 328981] [PubMed 8173405]

129. Bennett AH, Carpenter AJ, Barada JH. An improved vasoactive drug combination for a pharmacological erection program. J Urol. 1991; 146:1564-5. [IDIS 296354] [PubMed 1719248]

130. Montorsi F, Guazzoni G, Bergamaschi F et al. Four-drug intracavernous therapy for impotence due to corporeal veno-occlusive dysfunction. J Urol. 1993; 149:1291-5. [IDIS 313863] [PubMed 7683061]

131. Montorsi F, Guazzoni G, Bergamaschi F et al. Effectiveness and safety of multidrug intracavernous therapy for vasculogenic impotence. Urology. 1993; 42:554-8. [PubMed 7694416]

132. von Heyden B, Donatucci CF, Kaula N et al. Intracavernous pharmacotherapy for impotence: selection of appropriate agent and dose. J Urol. 1993; 149:1288-90. [IDIS 313862] [PubMed 8479018]

133. Reviewers’ comments on papaverine (personal observations).

134. Biering-Sorensen F, Sonksen J. Penile erection in men with spinal cord or cauda equina lesions. Semin Neurol. 1992; 12:98-105. [PubMed 1502437]

135. Govier FE, McClure RD, Weissman RM et al. Experience with triple-drug therapy in a pharmacological erection program. J Urol. 1993; 150:1822-4. [IDIS 321901] [PubMed 8230514]

136. Montorsi F, Guazzoni G, Bergamaschi F et al. Clinical reliability of multi-drug intracavernous vasoactive pharmacotherapy for diabetic impotence. Acta Diabetol. 1994; 31:1-5. [PubMed 8043890]

137. McGuffey E, Kramer L. Drugs for impotence. Am Pharm. 1992; NS32:23. [PubMed 1285547]

138. von Heyden B, Donatucci CF, Marshall GA et al. A prostaglandin El dose-response study in man. J Urol. 1993; 150:1825-8. [IDIS 321902] [PubMed 8230515]

139. Mahmoud KZ, El Dakhli MR, Fahmi IM et al. Comparative value of prostaglandin El and papaverine in treatment of erectile failure: double-blind crossover study among Egyptian patients. J Urol. 1992; 147:623-6. [IDIS 292378] [PubMed 1538443]

140. Allen RP, Engel RM, Smolev JK et al. Objective double-blind evaluation of erectile function with intracorporeal papaverine in combination with phentolamine and/or prostaglandin El. J Urol. 1992; 148:1181-3. [IDIS 303448] [PubMed 1404632]

141. Lomas GM, Jarow JP. Risk factors for papaverine-induced priapism. J Urol. 1992; 147:1280-1. [IDIS 296028] [PubMed 1569668]

142. The Upjohn Company. Caverject (alprostadil) injection for intracavernosal use prescribing information. Kalamazoo, MI; 1995 Jul.

143. Martinez-Pineiro L, Lopez-Tello J, Dorrego JMA et al. Preliminary results of a comparative study with intracavernous sodium nitroprusside and prostaglandin E1 in patients with erectile dysfunction. J Urol. 1995; 153:1487-90. [IDIS 345270] [PubMed 7714974]

144. Whitehead ED. Impotence: should primary care physicians give penile injections? Geriatrics. 1995; 50:14. Letter. (IDIS 341817)

145. von Heyden B, Donatucci CF, Marshall GA et al. A prostaglandin E1 dose-response study in man. J Urol. 1993; 150:1825-8. [IDIS 321902] [PubMed 8230515]

146. Montorsi F, Guazzoni G, Bergamaschi F et al. Four-drug intracavernous therapy for impotence due to corporeal veno-occlusive dysfunction. J Urol. 1993; 149:1291-5. [IDIS 313863] [PubMed 7683061]

147. von Heyden B, Donatucci CF, Kaula N et al. Intracavernous pharmacotherapy for impotence: selection of appropriate agent and dose. J Urol. 1993; 149:1288-90. [IDIS 313862] [PubMed 8479018]

148. Gerber GS, Levine LA. Pharmacological erection program using prostaglandin E1. J Urol. 1991; 146:786-9. [IDIS 287641] [PubMed 1875494]

149. Artoux MJ, McQueen KD. Alprostadil in impotence. DICP. 1991; 25:363-6. [IDIS 280091] [PubMed 1926907]

150. Whitehead ED, Klyde BJ, Zussman S et al. Treatment alternatives for impotence. Postgrad Med. 1990; 88:139-52. [IDIS 269901] [PubMed 2199954]

151. Godschalk MF, Chen J, Katz PG et al. Prostaglandin E1 as treatment for erectile failure in elderly men. J Am Geriatr Soc. 1994; 42:1263-5. [IDIS 339613] [PubMed 7983289]

152. Linet OI, Neff LL. Intracavernous prostaglandin E1 in erectile dysfunction. Clin Investig. 1994; 72:139-49. [PubMed 8186662]

153. Linet OI, Ogrinc FG. Dose-escalating study with maintenance phase using alprostadil (prostaglandin E1, PGE1) sterile powder in patients with erectile dysfunction. Technical Report No. 9124-93-006. The Upjohn Company: Kalamazoo, MI; 1993 Dec 3.

154. Linet OI, Ogrinc FG. Long-term safety study with alprostadil sterile powder (alprostadil S.Po.; prostaglandin E1, PGE1) in patients with erectile dysfunction. Technical Report No. 9124-93-007. The Upjohn Company: Kalamazoo, MI; 1993 Dec 10.

155. Linet OI, Ogrinc FG. Dose-escalating study with maintenance phase using alprostadil (prostaglandin E1, PGE1) sterile powder (S.Po.) in elderly patients with erectile dysfunction. Technical Report No. 9124-95-002. The Upjohn Company: Kalamazoo, MI; 1995 Jan 17.

156. Linet OI. Clinical pharmacology of alprostadil. In: Goldstein I, Lue TF, eds. The role of alprostadil in the diagnosis and treatment of erectile dysfunction. Princeton: Excerpta Medica; 1993:28-39.

157. Waldhauser M, Schramek P. Efficiency and side effects of prostaglandin E1 in the treatment of erectile dysfunction. J Urol. 1988; 140:525-7. [IDIS 247072] [PubMed 3045341]

158. The Upjohn Company, Kalamazoo, MI: Personal communication.

159. Ravnik-Oblak M, Oblak C, Vodusek DB et al. Intracavernous injection of prostaglandin E1 in impotent diabetic men. Int J Impotence Res. 1990; 2:143-49.

160. Lue TF, Tanagho EA. Physiology of erection and pharmacological management of impotence. J Urol. 1987; 137:829-36. [IDIS 229174] [PubMed 3553617]

161. Krane RJ, Goldstein I, Saenz de Tejada I. Impotence. N Engl J Med. 1989; 321:1648-59. [PubMed 2685600]

162. Kirby RS. Impotence: diagnosis and management of male erectile dysfunction. BMJ. 1994; 308:957-61. [IDIS 328981] [PubMed 8173405]

163. Bénard F, Lue TF. Self-administration in the pharmacological treatment of impotence. Drugs. 1990; 39:394-8. [PubMed 2184008]

164. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Bethesda, MD: National Institutes of Health; 1997 Nov. (NIH publication No. 98-4080.)

165. Koestenblatt CP. Dear Pharmacist letter. Summit, NJ: CibaGeneva Pharmaceuticals; 1996 July 8.

166. Novartis, East Hanover, NJ: Personal communication.

167. The Process of Care Consensus Panel. Position paper: the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11:59-70.

168. Sarramon JP. Editorial comments on the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11:73.

169. Padma-Nathan H. A new era in the treatment of erectile dysfunction. Am J Cardiol. 1999; 84:18-23N. [PubMed 10404845]

170. Goldstein I, Lue TF, Padma-Nathan H et al. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med. 1998; 338:1397-404. [IDIS 405966] [PubMed 9580646]

171. Goldstein I, Rosen RC, Steers WD. Sildenafil in the treatment of erectile dysfunction. N Engl J Med. 1998; 339:701-2.

172. Standing Medical Advisory Committee, United Kingdom Department of Health. The use of sildenafil in the treatment of erectile dysfunction. London; November 9, 1998. From the United Kingdom Department of Health Web Site.

173. Lipshultz LI, Kim ED. Treatment of erectile dysfunction in men with diabetes. JAMA. 1999; 281:465-6. [IDIS 418627] [PubMed 9952210]

174. Pfizer Inc, New York, NY: Personal communication on sildenafil.

175. The American Heart Association in Collaboration with the International Liaison Committee on Resuscitation. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2000; 102(Suppl I) I-321,I-323.

176. Catalano DJ. Dear health care professional letter regarding discontinuation of Regitine. East Hanover, NJ: Novartis; 2000 May 31.

177. Bedford Laboratories. Phentolamine mesylate for injection, USP prescribing information. Bedford, OH; 1999 May.

178. Erectile Dysfunction Guideline Update Panel, American Urological Association Education and Research. Management of erectile dysfunction: An update. 2005. Available from website. Accessed 2005 Oct. 20.

179. Priapism Guideline on the Management of Priapism Panel, American Urological Association Education and Research. An update. 2003. Available from website. Accessed 2005 Oct. 20.

180. The American Heart Association. Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005; 112(Suppl I): IV1-211.

a. AHFS drug information 2005 McEvoy GK, ed. Phentolamine. Bethesda, MD: American Society of Health-System Pharmacists; 2005:1330-2

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1336-7.

Hide
(web3)