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Drug Interactions between alprostadil and papaverine

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

papaverine alprostadil

Applies to: papaverine and alprostadil

MONITOR: Concomitant use of multiple vasodilator drugs for the treatment of erectile dysfunction (ED) may increase the risk of additive adverse effects, including hypotension, dizziness, syncope, prolonged erection, or priapism. However, available data are conflicting. For example, approximately 4.9% and 7.1% of people in selected studies using single ingredient intracavernosal injections (ICIs) of papaverine reported experiencing painful/prolonged erections and priapism, respectively. Conversely, selected studies of people using ICIs containing papaverine and phentolamine reported an increase in the average rate of prolonged/painful erections to approximately 8.9%, but a reduction in the average rate of priapism to approximately 5.5%. Additionally, 1 case series reported an increase in dizziness and syncope when patients used both oral agents and ICIs to treat ED. Clinical data are not available for all possible combinations. The route of administration and amount of medication absorbed systemically may affect the clinical significance and severity of this interaction.

MANAGEMENT: Most clinical guidelines advise caution and closer clinical monitoring for patients on erectile dysfunction (ED) regimens that include multiple vasodilative agents due to the potential for additive adverse effects. Some drug manufacturers recommend avoiding combinations due to the potential risks and a lack of established data on safety. However, some of these medications are available as combinations (either commercially or via compounding) and some ED guidelines indicate that combination therapy may be appropriate in certain situations. Healthcare providers should refer to the product labeling and appropriate treatment guidelines for the most up to date information and recommendations; as well as, counsel patients on potential adverse effects and what to do should they occur.

References

  1. (2021) "Product Information. Papaverine Hydrochloride (papaverine)." Oryza Pharmaceuticals Inc
  2. (2023) "Product Information. Invicorp (aviptadil-fentolamin)." Evolan Pharma AB
  3. (2023) "Product Information. Caverject (alprostadil)." Pfizer U.S. Pharmaceuticals Group
  4. (2021) "Product Information. Caverject (alprostadil)." Pfizer Ltd
  5. (2019) "Product Information. Caverject Impulse (alprostadil)." Pfizer Australia Pty Ltd, pfpcaviv10519
  6. (2018) "Product Information. Muse (alprostadil)." Meda Pharmaceuticals
  7. (2018) "Product Information. Muse (alprostadil)." Viatris UK Healthcare Ltd
  8. Dhir RR, Lin HC, Canfield SE, Wang R (2011) "Combination therapy for erectile dysfunction: an update review." Asian J Androl, 13, p. 382-90
  9. Al-Adl AM, Abdel-Wahab O, El-Karamany T, Aal AA (2011) "Combined intracavernous vasoactive drugs and sildenafil citrate in treatment of severe erectile dysfunction not responding to on-demand monotherapy." Arab J Urol, 9, p. 153-8
  10. Karakus S, Burnett AL (2024) The medical and surgical treatment of erectile dysfunction: a review and update. https://www.canjurol.com/abstract.php?ArticleID=&version=1.0&PMID=32876000
  11. Burnett AL, Nehra A, Breau RH, et al. (2018) "Erectile Dysfunction: AUA Guideline." J Urol, 200, p. 633-41
  12. Hackett G, Kirby M, Wylie K, et al. (2018) "British society for sexual medicine guidelines on the management of erectile dysfunction in men - 2017." J Sex Med, 15, p. 430-57
  13. Lowy M, Ramanathan V (2024) Erectile dysfunction: causes, assessment and management options. https://australianprescriber.tg.org.au/articles/erectile-dysfunction-causes-assessment-and-management-options.html
  14. Domes T, Najafabadi BT, Roberts M, et al. (2021) "Canadian urological association guideline: erectile dysfunction." Can Urol Assoc J, 10, p. 310-22
View all 14 references

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Drug and food interactions

Moderate

papaverine food

Applies to: papaverine

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Non-nitrate vasodilators

Therapeutic duplication

The recommended maximum number of medicines in the 'non-nitrate vasodilators' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'non-nitrate vasodilators' category:

  • alprostadil
  • papaverine

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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