We are pleased to report that Pfizer's Caverject Dual Chamber is back in stock and available for immediate dispensing.

This erectile dysfunction product has been out of stock because of production difficulties for some time. We have been able to prescribe alternatives but many patients find the dual chamber product much easier to use than some of the competitor products available.

If you are already registered with The Online Clinic then you can login to your account at the top of the page and request this product. If you have not used The Online Clinic before then please register using the button below.

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The new treatment for erectile dysfunction has finally arrived. Spedra (also known as Avanafil) is a second generation PDE5 inhibitor. Spedra works in the same way as Viagra and Cialis but it gets to work much quicker than its more established competitors. Some patients in clinical trials have reported that the medication has been effective within 10 – 12 minutes of oral administration. The official recommendation is that it needs to be taken 30 minutes before sexual activity as this is the maximum time that it was noticed to take effect.

Although Spedra is an effective medication, it should be pointed out that the success rate is lower than those of all of Viagra, Cialis and Levitra. Having said that, the success rate was still reasonably high at just under 60%. It was noted that Spedra has fewer side effects than its competitors as it is a highly selective PDE5 inhibitor. The pricing of this product is a bit more competitive as well – as you would expect for a late entrant to a pretty mature market. We are happy to prescribe this for patients who wish to try this treatment but we recommend a small prescription to start off with to make sure that it is going to be effective on an individual basis. The recommended starting dose is 100 mg.

If you are already registered with The Online Clinic for erectile dysfunction then please login to your account and update your medical record; you will be considered for Spedra automatically. If you are new to The Online Clinic, you can complete a quick online consultation by clicking on the button below.

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You may be aware that there has been an ongoing manufacturing issue with Caverject, a treatment for erectile dysfunction. This has been very bad news for a number of men, as Caverject was the only medication that worked for them.  Caverject is an injection directly into the penis so it is really only suitable for men who do not respond to other medications to treat erectile dysfunction.

There is an alternative to Caverject called Invicorp that is not yet licensed in the UK. The product is licensed in Denmark and we have managed to secure a reliable supply. This product is now available through The Online Clinic for next day delivery.

Invicorp has a success rate comparable to Caverject and most men who have used the treatment say that there is no pain on injection. There are very few contraindications. You can read more about Invicorp here.

The relationship between erectile dysfunction and cardiovascular disease has been the cause of numerous debates and resulted in various research publications. However, there have not been many reviews recently that have compared the studies and their implications for clinical management of erectile dysfunction. Here we consider the findings from a recently published review that looked at the relationships between erectile dysfunction and cardiovascular disease.

The study, which was published in The Journal of Urology , was a literature review that evaluated all studies and clinical guidelines that had been published with regards to erectile dysfunction and cardiovascular diseases. The researchers were keen to see whether a combination of lifestyle change and use of pharmacotherapies could lead to improved vascular health and sexual functioning in men with erectile dysfunction.

Based on their methodological and statistical evaluation of the literature, the researchers concluded that there was persuasive evidence to suggest that erectile dysfunction can have predictive value for cardiovascular diseases in various populations. However, they also pointed out that finding an appropriate tool to assess these risks varied between populations. In addition to that, the researchers pointed to somewhat inconsistent findings between statins, diuretics, beta –blockers and rennin-anglotensin system modifiers and erectile dysfunction, with some studies indicating negative effects on erectile dysfunction and other studies suggesting a positive effect on erectile dysfunction. Lastly, the researchers stressed that the intervention based studies consistently demonstrated the relationship between improved vascular health and improved sexual functioning.

We were intrigued by the current study, as it addressed a large area of research in this field. Although the relationship between cardiovascular disease and erectile dysfunction should not come as a surprise to most people, there is a clear need for further divisions between at risk populations..

The study also raised some interesting clinical concerns worth addressing. Perhaps the most important one being the possibility that erectile dysfunction may help predict whether an individual is at higher risk for cardiovascular disease. As such, it is important that the clinician establishes whether there is a need for treatment plans that can help prevent or decrease the effect of cardiovascular diseases.

It is our hope that the current findings are acknowledged and lead to clinical guidelines that have an impact on the way clinicians look at erectile dysfunction and its treatment.

Spedra, the new erectile dysfunction medication, has just been approved by the European Commission and can therefore be marketed in Europe. The medication is for men suffering from erectile dysfunction.

The approval of the marketing authorisation application (MAA) has come after a positive review by the European Medicine Agency (EMA). In specific, the positive feedback was given by the Committee for Medicinal Products for Human Use (CHMP) just a few months ago (April 2013).

Just a week ago Vivus, the pharmaceutical company that filed the application, had released the results of clinical studies that proved not only the effectiveness of Spedra, but also the ability of the medication to work within 15 minutes and sometimes in as little as 10 minutes. Significant improvement in erectile function was found after administering any of the tested doses (50 mg, 100 mg and 200 mg) of Avanafil, the active ingredient in Spedra, as the MAA specified. Vivus is now looking for partners to be able to commercialise the medication in Europe.

Back in April we announced that Spedra was expected to be available soon in Europe. The medication for patients with erectile dysfunction is owned by the pharmaceutical company Vivus and in the US is called Stendra.

Vivus has claimed that this medication is effective within as little as 15 minutes. This month the company has published the results of the study and it has confirmed that the drug has does indeed have this rapid onset. Patients on this treatment actually achieved erections in as little as 10 minutes.

The active ingredient in this medication is called Avanafil and it acts as any other PDE5 inhibitor. Specifically, this type of medication relaxes and opens the blood vessels in the penis, causing the blood to enter the organ and distend it. Since it takes much less time for Avanafil to be effective (compared with Viagra and any other PDE5 inhibitor), many men might prefer it once it is actually on the market. We will keep you updated on the progress of getting this medication onto the European market, which is expected to be later this year.

More information can be read here.

Vitaros®, the topical cream produced by Apricus Biosciences, can now be marketed in Europe. It has recently been approved through the European Decentralised Procedure. The cream is designated to treat patients with Erectile Dysfunction.

The cream’s active ingredient is alprostadil, which is a vasodilator. The product also contains a permeation enhancer (NexACT®). This medication is unique because alprostadil has only been able to be administered to patients via injection or pellet. Therefore Vitaros® cream becomes a much more desirable option and targets those men with erectile dysfunction that were wary of the earlier applications of the active ingredient.

The Netherlands applied, as a reference member state, on behalf of Belgium, France, Germany, Italy, Ireland, Luxembourg, Spain, Sweden, and the UK. Apricus Biosciences will partner up with other European businesses, such as Takeda, Sandoz and Bracco, in order to market the product throughout Europe.

Apricus Biosciences is also looking to treat Female Sexual Arousal Disorder (FSAD) with Femprox®. This cream also has alprostadil as the main active ingredient, along with the DDAIP.HCL proprietary permeation enhancer. Experimental studies have been completed in the US and in China. We await further information on this product.

Another alternative to Viagra is expected to be available soon in the European Market.  The pill will be called Spedra and Avanafil is the active ingredient. The medication, which is awaiting marketing authorisation from the European Commission, has been given a green light from the Committee for Medicinal Products for Human Use (CHMP).

A few people are wondering whether this alternative medication for Erectile Dysfunction will be a valuable option in the European market, since there are already two alternatives to Viagra –namely, Levitra and Cialis. As with any medication, Avanafil can cause side effects which include: headaches, indigestion and back pain. However, Avanafil has got a distinctive characteristic that is appealing to some erectile dysfunction patients: it is able to help achieve an erection in as little as 15 minutes.

The Food and Drug Administration (FDA) has just approved the medication under the name of Stendra but it is not yet being manufactured.

We expect that the manufacturer will want to launch this product as soon as possible so we may be in a position to prescribe this medication within the next few months.

Researchers at University of Texas have postulated a potential link between recreational use of erectile medication drugs (EMD) and decreased erectile function (EF).

The study, which was an online survey, looked at levels of sexual function, levels of confidence in the ability to gain and maintain erection and the frequency of using EMD. In total, 1207 male students with a mean age of 21.9 years from various US Universities took part. Within that sample 2 per cent (24) had been prescribed EDM by a doctor and an additional six per cent (72) had been using EDMs recreationally. The key findings suggested that non-users and recreational users of EMD did not have problems with EF. Not surprisingly, the key finding was that there appeared to be an inverse relationship between recreational use of EMD and confidence.

This implies that there is a possibility that recreational use of EMD led to decreased confidence, which in turn led to continuing to use EMD, which then may have further decreased confidence. Without knowing the initial level of confidence, this is impossible to measure.

Although this study had a substantial sample, the total amount of men who were relevant to the key findings is rather low, thus making it hard to compare the groups. As such, a replication would be beneficial, such replication would have to incorporate the other suggestions that we have made to give any validity to the findings if corroborated by a better structured study. You can read the full report here.

Intriguingly, the Journal of Sexual Medicine has recently published a study which suggests that the venom released by the Brazilian wandering spider might cure the problem of erectile dysfunction (ED) in men. And it’s all down to a peptide found in the spider’s venom which has been shown to improve sexual function in rats by increasing blood flow to the penis. A toxin found in the venom increased the amount of nitric oxide available in the body. Nitric oxide is a chemical that is responsible for blood vessel dilation and essential for the formation of an erection. As we age, the availability of this chemical decreases, inhibiting the expansion of blood vessels in response to sexual arousal. This deficiency of nitric oxide is quite often the cause of age related erectile dysfunction.

As strange as all this sounds, it seems quite plausible that spider venom could in fact cure erectile dysfunction. So far it works on rats and it is quite possible the toxin will have the same effect on men. The injection of the peptide got working between 15 and 20 minutes: very quickly when compared with other ED treatments on the market such as Viagra, Levitra and Cialis. There are plenty of drugs on the market for the treatment of this condition however not all men respond to common treatments so research like this is exciting.

We believe that the properties of the peptide within the venom, was discovered after men who were bitten by the spider suffered priapism (a prolonged erection that can cause damage to the blood vessels in the penis). A lot of new drugs are discovered completely by accident so this could be the beginning of some very interesting research and development but don’t hold your breath.

The Food and Drug Administration in the States has approved Avanafil for market and it will be branded as Stendra .The drug is expected to join the 4 billion dollar global erectile dysfunction treatment market by 2013 after the drug manufacturers have made decisions regarding the packaging and distribution of the drug.

As we have explained before, Stendra will have an advantage over its competitors in that it begins to work within 30 minutes and has been reported to work after only 15 minutes in some patients. Other PDE5 inhibitors are known to take around 1 hour to get working in certain cases.

The pharmaceutical company also applied to the European Medicines Agency (EMA) on March 26^th of this year and a Marketing Authorization Application was accepted by the European regulators. We will update our pages with the latest news on the approval of Avanafil in Europe as soon as we have it but we expect Avanafil to be approved in the EU before the end of 2012.

We will find out if Avanafil has been approved by the FDA as a treatment for erectile dysfunction after 29^th April. An application has already been submitted in the European Medicine Agency but it is the Food and Drug Administration (FDA) in the US that will be first to make a decision.

Avanafil has a much faster onset than any of the current PDE5 medications on the market and is said to kick in within 15 minutes of administration. There is no doubt that it will have a place on the market but it is going to be difficult to overtake Viagra and Cialis. With Sildenafil (the active ingredient in Viagra) coming off patent next year, Avanafil may also struggle on price – we shall see. We have no doubt that Avanafil will be approved; it is just a question of how large a market share it will be able to develop.

Men who experience erectile dysfunction as a result of clogged arteries leading to the penis may soon have another option for treatment beyond the oral and urethral medications available which do not work for every man. Medtronic Inc, the pharmaceutical company responsible for this new treatment usually use it to treat patients with heart disease however they have carried out a study that explored the use of their drug coated stent in erectile dysfunction patients.

30 men participated in the study and each of them had a stent implanted. The men were an average age of 60 years and had erectile dysfunction due to narrow arteries in the pelvis. 3 months after the stent had been implanted men noticed a 68% improvement. For men who do not benefit from the conventional therapies out there, the stent could be a realistic option. The stent basically props open arteries to allow blood flow so this is an invasive treatment that requires more safety and efficacy evaluations before it is taken to the market.

The pharmaceutical company will be carrying out a second study, Impasse, and this will involve 350 men. Given the invasive nature of the treatment, it will be very much a last resort.

A study published in the American Journal of Sociology has reported that men who experience erectile dysfunction actually blame their wives for the condition and suggest that suffering the condition is directly related to their wives becoming friends with their own friends. The sociologists at Cornell University who publish the report call this situation ‘partner betweenness’. This term is given to the experience of a man whose partner has greater contact to some of his closest friends than he does.

The researchers say that erectile dysfunction occurs when the male’s female partner comes between him and his friends. When their female partner is close to the same males as he is, this intimidates the male and according to the research, men who experience ‘partner betweenness’ are 92% more likely to have trouble achieving an erection or reaching orgasm.

Supposedly, central to traditional notions surrounding masculinity are feelings of independence and privacy and when these feelings are disturbed, sexual problems with their partners ensue.

The study’s participants were all aged between 57 and 85 years and although the risk of this condition increases with age, and is related to cardiovascular conditions and diabetes, ‘partner betweenness’ affected even the healthy men among the participants. They were at an increased risk of experiencing problems if their partners were closer to their shared friends than he was.

The statistics show that at least 25% of men experience this problem within at least one of their close relationships but the effects of this situation tend to lessen as the male gets older.

Apricus Biosciences is finally ready to market their erectile dysfunction treatment, Vitaros this November in Canada. They hope that the drug will be available in Europe by the end of 2012 if it is approved by the regulators here.

This drug will be the first topical treatment for erectile dysfunction that is sold on prescription and requires less time to get to work than current treatments available. A drop is placed at the tip of the penis and produces results within 6 minutes. The active ingredient in Vitaros is Alprostadil, an ingredient that is usually injected into the penis or administered as a suppository into the urethra. As one can imagine, this topical version of the ingredient will be a more attractive alternative.

Additionally, since the topical treatment is non-systemic and gets to work on the isolated area of the penis, there are little or no side effects experienced such as those that are associated with the taking of PDE5 inhibitors like Viagra, Cialis and Levitra.

The pharmaceutical company ran into trouble with this drug in 2009 having run out of cash but over the last year and a half they have been working hard to get themselves back on track and Vitaros is not their only market hopeful.

Phase III trials for Femprox, a treatment for female sexual dysfunction, revealed a 44% higher arousal rate in women compared to those who had been given a placebo. With such interest in the area of female sexual dysfunction (especially hypoactive sexual desire disorder), the company looks set to enjoy a wealth of success over the coming years if it can get its products through the regulators.

According to the results of a recent study carried out in Luzhou Medical College, China, researchers have established a connection between periodontitis (inflammation/ infection of the gums) and erectile dysfunction (ED). However, many doctors and dentists believe that the evidence is a little exaggerated. The study is published in the Journal of Sexual Medicine.

The study revealed a correlation between the gum condition and sexual function in male rats. An older study revealed that the gum condition is more common in men who have erectile dysfunction.

Those at the medical school believe that treating periodontitis could improve a patient’s sexual health but others suggest that the gum infection indicated problems with one’s general health and that it is the poor overall health that might increase one’s chances of suffering from erectile dysfunction.

The gum condition has before been linked with heart disease and as we know heart disease is associated with ED but many think it unreasonable to suggest a direct link between gum health and the penis.

The bodies of the rats with periodontitis experienced inflammation and at high levels this can be dangerous for one’s general health. Rats also had less of an enzyme called eNOS which plays a role in biological signalling that will cause an erection to form. The research suggests that the inflammation might have decreased the amount of this enzyme and therefore inhibited the formation of an erection.

Our guess is that people with periodontics are less healthy, therefore more prone to systemic health issues, of which erectile dysfunction can be a marker.

According to a recent study carried out in the States, more young men than ever are taking treatment for erectile dysfunction (ED) and there is a strong relationship between drinking and smoking and suffering from the condition.

The research was carried out at the Children’s Memorial Hospital, Chicago and revealed that almost 13% of college-aged young men experienced ED on occasion. Among those who drank regularly, the percentage increased.

95% of the men were heterosexual and two thirds of them were white. 13% of the men reported problems with getting or maintaining an erection at some point in their lives and 25% of them reported losing their erections while putting on a condom.

More young men are turning to treatments like Viagra, Cialis and Levitra- 6% of the participants had taken one of these three PDE5 inhibitors at some stage to treat ED. When surveyed the young men admitted that they thought their problems might be associated with alcohol and recreational drug abuse.

The researchers suggest that young men who suffer the condition should seek counselling as the stress of this condition can lead to psychological problems down the line even if there is a medical cause for the condition. Dealing with ED is a much more traumatic experience for young men considering that approximately 50% of men who are over the age of 40 years suffer with ED; the condition is more commonplace among the older generations.

The results of this study accord with our own clinical experience. We are seeing more and more young men present with erectile dysfunction than ever before. Given that drugs such as Viagra and Cialis are relatively new, it may be the incidence of erectile dysfunction in young men is the same as it has always been but more people are coming forward in the knowledge that treatments are available.

13 million Mexican men suffer from erectile dysfunction (ED). One in every two men over 40 years of age experiences some level of ED. A spokesperson for the Boston Medical Group shares some insights as why they think this is the case and reminds us that ED is a serious condition that possibly suggests underlying health conditions associated with the health of the heart.

The usual reasons such as the stresses of everyday life and an unhealthy diet all contribute to the the condition and this is why more young men are becoming increasingly affected by Erectile Dysfunction. A large portion of men, one in every three, between the ages of 20 and 50 also suffer from premature ejaculation (PE).The spokesperson for the Boston medical Group suggests that the reasons for this are often grounded in culture and are often psychological at the root. It is thought that the experience of Premature Ejaculation here is often due to a lack of good sex education and their religious background that often characterises sex as sinful.

Another reason that Mexicans suffer with ED is that there are 10 million diabetics in the country and also among the male population, there are many who are overweight or obese - all contributing factors to the chronic condition of Erectile Dysfunction.

According to a recent study published in Clinical Cardiology, CRT (cardiac resynchronisation therapy), improves libido and improves sexual performance in men who have experienced heart failure. After chronic heart failure, many men find that they lose their libido and experience ED. This therapy, which comes in the form of a pacemaker is said to improve these symptoms and rejuvenate the sex life of sufferers as well as increase survival rates among heart failure patients.

The study showed that out of 31 men, 25 experienced an improvement and 23 men were able to report that they had no experience of ED after the therapy.

Research published in The Journal of Sexual Medicine has shown that asthma could be a cause of ED (erectile dysfunction) and the risk has been shown to increase the more severe the asthma is.

Information on 3,466 men who had just been diagnosed with asthma and who were between the ages of 18 and 55 was gathered between 2000 and 2007. The incidences of erectile dysfunction were recorded approximately four and a half years later and the data were compared to the information collected on 13,836 men without asthma: the control group.

114 men experienced ED and among this group were 34 patients (0.98%) who suffered from asthma and 80 (0.58%) from the control group. This indicates a 1.9 times higher incidence in ED cases with men who had asthma and the risk of experiencing this condition increased with the number of asthma related visits the patient made to their clinic.

There is not enough research to be certain that asthma treatment has anything to do with the progression of the condition of erectile dysfunction but the study is on-going. Erectile dysfunction has many causes but treatments will work for most. It is recommended that oral treatments like the three main PDE5 inhibitors, Viagra, Cialis and Levitra should be tried before more invasive solutions are employed.

The latest in erectile dysfunction products comes in the form of a condom that helps men to maintain an erection. The condoms contain a gel composed of lubricant and a vasodilator which is absorbed into the skin and helps to maintain an erection by enhancing blood flow.

The challenge with creating such a product was making a gel that did not ruin the quality of the condom but approval looks imminent. The condom is not marketed as an erectile dysfunction treatment but rather it is a device for men who have a problem maintaining an erection while wearing a condom.

Chances for European approval look high since it will also encourage men to use barrier contraception. The product might also serve to once again promote the products of Durex, a company that has experienced a waning in their sales of late.

An American medical group is under scrutiny at the moment as they are accused of manipulating eager erectile dysfunction (ED) sufferers into parting with large sums of money while they are in a state of arousal. Furthermore, the company has been sued over not discussing the risk of potentially serious side effects with their patients.

Their advertisements suggest they can provide a permanent solution to the problem of impotence in just one visit. It is only at this visit that the men are told they will have their penis injected, which then gives them an instant erection. It is at this point that the salesmen offer their pitch and sell the aroused patients a 6 months’ supply of treatment said to cure their impotence permanently for a sum of $1,500.

Men have reported cases of priapism subsequent to such injections, which is known to cause permanent impotence. In one case, a man was advised to continue with his injections over the phone despite reporting priapism. The man waited 36 hours before seeking help and has had to undergo corrective surgery on his penis.

The company is also accused of overcharging for its service and not discussing the possibility of side effects with patients and instead discuss the dangers of erectile dysfunction pills and other options for the treatment of ED in order to deter patients from trying another treatment.

This type of injected treatment is supposed to be a last resort for those who have not found success with PDE5 inhibitors however some patients have reported that they had never tried another method of treatment prior to their visit to the clinic. Finally, specialists who have treated patients of the clinic after their injections said that there were many cases where men were given injections that they did not need. The group has already been involved in a number of lawsuits and despite a recent pay-out that had threatened to make the company bankrupt, they are still enticing customers.

Viagra, Cialis and Levitra are approved ED treatments and come in the form of tablets. These are the best options for many men who suffer from ED and should be explored as options for treatment before invasive procedures such as injections and implants are suggested. For men who have not responded to the usual oral medications, we normally recommend a medicated urethral suppository called MUSE but this is never the first line of treatment.

Researchers from the University of Guelph, Ontario have published a review in Food Research International and reveal that saffron and ginseng come out on top when it comes to aphrodisiacs, with chocolate at the bottom of the pile. They warn against the traditional aphrodisiac Spanish Fly which is made from blister beetles and used in traditional Chinese and African culture.

At the review’s outset, the research team did not believe in the supposed power of the aphrodisiac however, it was revealed that certain substances do work although all of the tests were done on animals so there is no direct evidence that the substances tested would have any beneficial impact on the libido of humans.

The review also strays onto the rise in Viagra and Cialis prescriptions for the treatment of erectile dysfunction (ED), without any indication that the author has any qualifications to opine on matters medical. The review suggests that the side effects of such ED drugs are too dangerous and outweigh the benefits. It is also stated that the drugs are potentially harmful if taken in conjunction with other prescription medications. The review’s author hopes that present ED treatments will be replaced by these natural remedies – what a load of misleading and dangerous nonsense!

Erectile dysfunction does not occur due to a lack of desire or a low libido. ED is a medical condition, which is sometimes the symptom of a more serious cardiovascular illness. There are physiological reasons for the lack of blood flow to the penis which no saffron or ginseng can remedy.

As for comments made about the danger of taking ED treatment with other medication, there is no basis for this concern. PDE5 inhibitors such as Viagra, Cialis and Levitra, can only be purchased with a prescription and after a medical consultation. If patients are taking conflicting medications, they will not be prescribed these ED treatments and other options will be explored. The author should stick to his area of expertise – food and nutrition.

Vivus announced that it has completed its phase III human studies for its erectile dysfunction treatment, Avanafil. An application for a marketing authorization in the US and the EU will be made shortly.

Avanafil is faster acting than Viagra or Cialis and thereby allows for greater spontaneity. However, with Pfizer’s patent for Viagra set to run out next year, competition in this area of the market is set to get fierce so Avanafil may struggle. When Vivus launched MUSE, at the time a breakthrough drug inserted into the urethra to combat erectile dysfunction, Viagra was born one year later and MUSE paled into insignificance.

With Qnexa, Vivus’s diet pill, still failing to impress the FDA (Food and Drug Administration), Avanafil’s success must be key to the future of Vivus.

Regular use of painkillers has been reported to be potentially linked to erectile dysfunction (ED). Middle-aged men often take more painkillers and NSAIDS, such as Ibuprofen, in order to seek relief from the inevitable aches and pains that come with getting older but unfortunately thus contributing to another age related condition, ED. The study published in The Journal of Urology showed that aspirin, ibuprofen, and naproxen were commonly used by older men and the majority of ED sufferers are found to being among the older generations too. Often older men take aspirin every day to decrease the risk they have of heart attacks and strokes and the study’s authors are definitely not advocating that they stop.

The study showed that 1 in 3 men in their forties stated that they used NSAIDS regularly and of that group, 13% of them reported ED. More than half of those participating in the over fifties group reported the regular use of these tablets and 42 per cent of them reported problems with ED. Other contributing factors were taken into consideration like diabetes, smoking and the effects of age but there were still unexplained cases where an underlying cause could not be ascertained. The evidence is not strong enough to suggest that the use of such medication has a definite impact on ED but further research will be carried out. Our view is that the evidence presented is extremely weak and if there is a link then it does not appear to be a strong one.

California based pharmaceutical development company, Vivus, will have a busy month this January as they hope make progress with the FDA on their two leading drug candidates. Avanafil, a PDE5 inhibitor used in men suffering erectile dysfunction wows with 80% of men taking it achieving erections and two thirds able to have intercourse. In addition, it only takes 15 minutes for the drug to take effect unlike the other PDE5 inhibitors which can take up to an hour.

The approval of their promising weight loss drug, Qnexa, will also be discussed with US regulators this month. Recent trials have proved successful despite the FDA requiring more information. Vivus has submitted more detail on the associations between Qnexa and side effects such as birth defects and cardiovascular risk. Vivus is not a done deal yet but the company appears confident that they will get the green light in August without a pre-authorization cardiovascular risk study.

Long term trials for Avanafil have revealed great potential for the medication. The results released last week reveal that the treatment will work on a majority of its users and due to the speed with which it is metabolized it can be used twice a day without risk.

It was announced yesterday that late stage studies went well for Vivus’ hopeful erectile dysfunction treatment, Avanafil. The new drug application will be ready for completion by early 2011.

The results were promising. Out of those who attempted sexual intercourse 15 minutes after they took the drug, there was an 80% penetration success rate. 67% taking Avanafil had successful intercourse to completion without losing their erection.

No serious side effects were reported, only minor complaints such as headache, flushing and nasal congestion as with other Erectile Dysfunction treatments, such as Viagra and Cialis. There was only a 2.8% rate of discontinuation by patients.

The application will be filed to the FDA in the first half of 2011 and yet another oral PDE5 inhibitor might be added to the list of successful treatments available for Erectile Dysfunction. Avanafil’s advantage is in that works so fast, within 15 minutes or less. It is thought that Avanafil is more selective than other treatments thus decreasing the risk of side effects.

Canadian sufferers of erectile dysfunction will soon have another option for treating their condition in the form of a gel called Vitaros. This topical gel has produced some impressive results and Health Canada has approved it for general use on prescription.

Vitaros’ manufacturer, Apricus Biosciences, will endeavour to bring the topical treatment to over 100 other countries. The gel will be officially available in Canada next year. For those who do not like to take oral medication, the gel is a successful replacement. What is more impressive is that unlike the oral medications such as Viagra, Cialis and Levitra, which take on average a half an hour to get to work, Vitaros gets to work within minutes.

Often men are contraindicated for Viagra, Cialis or Levitra as a result of underlying cardiovascular problems or medications that they are taking. It might be some time before Vitaro wins approval in the US or Europe but as it contains alprostadil (which is already licensed in injectable and urethral suppository form) it should not encounter too many problems so long as it is effective as a gel.

Vivus, the biopharmaceutical company behind investigational drugs Qnexa and Avanafil, has just reported its financial results for the first nine months of 2010. Within those results there is a clear indication that the company has not in any way been floored by the recent decision by the FDA not to approve Qnexa, its investigational weight loss drug that contains low dose phentermine and topiramate, both of which are licensed separately in the US. Vivus says that it will answer the FDA’s questions within 6 weeks. It has already released the extended clinical data requested by the FDA that demonstrates the safety and efficacy of Qnexa over 108 weeks, with patients achieving and maintaining a weight loss of at least 10% of body weight over the period – far in excess of the 2.5% achieved by trial subjects on the placebo.

The FDA’s concerns relating to Qnexa surround the increased heart rate identified in some cases during the trial period. The main concern that needs to be addressed is that the increase in heart rate does not affect overall cardiovascular risk. The FDA is also concerned about potential birth defects caused by the Topiramate element, which has an established risk in this area, albeit at a much higher dose than in Qnexa. 13 women gave birth during the Qnexa clinical trials and none of the babies suffered birth defects. We would expect pregnancy to be included as a contraindication with this drug, just to be on the safe side. There is a possibility that Qnexa will be approved as a controlled drug and will therefore not be available online through legitimate channels.

Vivus has now indicated that it will be applying for a license for Qnexa in the EU before the end of 2010 – this is real news for most of our readers as it is the first time that it has been mentioned explicitly by the company.

Vivus has also stated that it is pushing to complete phase III trials of Avanafil, its investigational medication for the treatment of erectile dysfunction. Avanfil is very similar to established drugs in this area such as Viagra and Cialis but it has a much faster onset time. Patients taking Avanafil were able to achieve erections sufficient for penetration within 15 minutes of oral administration. Given that the medication is very similar to other licensed medications and no major new side effects have been reported, we would expect Avanafil to get a license.

Studies presented at the Pfizer Urology and Diabetes Symposium in Abu Dhabi highlighted the link between diabetes and erectile dysfunction. It was stated that 50% of diabetic men are likely to suffer from ED within 10 years of diagnosis. ED is a symptom of other health conditions such as cardiovascular disease.

Erectile Dysfunction can be the first indication of type 2 diabetes. Men who have diabetes are 3 times more likely to have ED than men without it. Erectile Dysfunction can serve as a five year warning of heart attack. Many men are not aware that their erectile dysfunction can be symptomatic of cardiovascular disease. As we reported last week, the penile artery measures 1-2 mm in thickness, whereas the coronary artery measures 4mm. If the penile artery is blocked, preventing an erection from forming, it can signify problems with the coronary artery that will only become evident later on.

Other discoveries were affirmed at the symposium including the articulation of a direct correlation between self-esteem and the firmness of an erection. Another highlight of the symposium was the release of a regional study which described a standardized scale for measuring the hardness of an erection. It has been shown that men who experience the hardest erections have improved self-esteem and confidence. They are generally happier with their sex lives and their relationships. Physicians can play a huge part in changing the sex lives of their patients and they can do this while ruling out any future health risks indicated by erectile dysfunction.

A hospital in Wales has pioneered a potentially transformative piece of surgery to resolve erectile dysfunction. The surgery involves inserting a stent into the penile artery, much the same way as surgeons now do to resolve coronary artery blockages.

This type of surgery will always be the last resort for most erectile dysfunction patients as there are medications that normally resolve the issue but around 25 -30% of patients do not respond to drugs like Viagra so an alternative is necessary for the rehabilitation of their sex lives.

One little known but important fact about erectile dysfunction is that it can be a marker for cardiovascular disease. The penile artery is only 1 -2 mm thick as opposed to the coronary artery, which is around 4 mm thick. Vascular disease affects the whole body so it is likely that the penile artery will block before the coronary artery so erectile dysfunction will normally be an early warning signal and it needs to be checked out. We always make this point when prescribing medications for erectile dysfunction and it is essential that a patient’s GP is kept informed so that tests can be carried out and medications prescribed to prevent cardiovascular events.

The pioneering new procedure may become in demand on the NHS but was cannot see many hospitals giving it priority when there are some many other demands on the resources of our publicly funded health service.

The latest in erectile dysfunction news presents a wafer that melts on the tongue and said to get to work faster than Viagra. Unlike the other PDE-5 inhibitors that can take anything from 30 minutes to a couple of hours to fully take effect, the wafer gets to work quickly with a majority of men in trials responding within 30 minutes of consumption. Intelgex, a Canadian firm are set to carry out trials on a larger scale and hope to have the wafer ready for the market in 3 years.

This treatment may allow for an element of spontaneity that had otherwise disappeared in the sex lives of erectile dysfunction sufferers. It contains the same active ingredients as the other impotence treatments but the molecules are smaller. The wafer releases similar amounts of the ingredient into the bloodstream and is accessed via the many blood vessels of the mouth.

Trials have shown that the wafer works even better than Viagra, 30% faster as it happens. Furthermore, the same type of technology may be appropriate for the treatment of pain relief, high blood pressure or depression in the future.

One of the most frequent questions that we get asked is, which erectile dysfunction medication is the best? Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardenafil ) are the three oral treatments for erectile dysfunction. Sometimes men are confused by which one to choose.  Each one has a similar rate of effectiveness but some work better than others on an individual basis.

Each of these PDE-5 inhibitors relaxes the arteries of the penis allowing the blood flow to create an erection. The function of these drugs is to keep high levels of cGMP in the penis. This is a substance that is produced naturally in the tissue and aids vascular muscular relaxation. PDE-5 inhibitors block PDE-5 which neutralizes the cGMP so that an erection cannot occur. These treatments block or inhibit the PDE-5 in order that the cGMP stays in the penis, allowing for a maintained erection. All three of the approved drugs carry out the same function but have different effects.

Viagra can be purchased in 25mg, 50mg or 100mg dosages. The usual starting dose is 50mg. It should be taken 1 hour before sexual activity and can take anything from 30 minutes to 1 hour to kick in. The effects usually last for approximately 4 hours. Viagra was the first drug approved for erectile dysfunction and it is one of the best known brands in the world so it is a popular choice for many men.

Cialis is available in 10mg and 20mg dosages and the recommended starting dose is 10mg. Cialis is also available in a one a day format but this is quite an expensive way of taking the medication for most people. The half-life of Cialis is much longer than the other two medications. The effects can last from 17 to 36 hours. This does not mean that an erection will last this long but the drug will still be effective upon being stimulated sexually. If one is to experience side effects, then these side effects may last for a long period as well however so this needs to be borne in mind.

Side effects from all three PDE5 inhibitors are similar and can include headaches, facial flushing, back pain and indigestion. Some people have noticed a bluish tinge to their vision while Viagra is in their system but these side effects are not experienced by all men.

Levitra is prescribed in 5mg, 10mg and 20mg doses. Men usually start off on the 10mg dose. Levitra is usually taken between 25 minutes and 1 hour before sexual intercourse takes place and the effects last for roughly 5 hours. A new version of Levitra will be available in November, which melts in the mouth and has an even faster absorption rate.

The drug that will suit an individual best cannot be predicted so trial and error is often the only way to find out which one is going to work best for you. If you have any specific questions about these medications then one of our medical staff will be happy to answer any question that you may have.

Men who take Viagra are being warned that the treatment will not work if the reason for their erectile dysfunction lies with low testosterone levels according to Dr Geoffrey Hackett, a sexual health specialist at the Good Hope Hospital, Birmingham.

Although around 40% of men over 40 experience erectile dysfunction, more than 1 in 5 men experience erectile dysfunction resulting from a low level of testosterone. It is normal for the levels of this hormone to deplete over time however abnormally low levels of testosterone can be an indicator for future issues such as cardiovascular events, diabetes and osteoporosis.

Quite often we have men for whom Viagra and other medications such as Cialis and Levitra do not work and we always recommend a check up with a doctor face to face. Even if Viagra is working for a patient it is always advisable to rule out underlying health problems as the root cause.

Bremelanotide is a research compound that we have written about many times in the past. Research has been carried out for some time on its use in the treatment of sexual dysfunction and the latest studies were discontinued in 2008 due to vastly increased blood pressure levels amongst those taking the drug. However, Palatin Technologies (the pharmaceutical company behind bremelanotide) has just boasted positive Phase 1 results. They say that they have eliminated the problem of the increase in the level of blood pressure by having the bremelanotide administered subcutaneously. This method of application presents consistent blood plasma levels without changing the blood pressure levels. Not only may these results get bremelanotide further down the regulatory route to a license, but Erectile Dysfunction is not the only condition that is treatable in this way. As of yet there is no FDA approved treatment for Female Sexual Dysfunction(with Intrinsa only licensed in the EU), but Palatin thinks it may have a chance with bremelanotide.

Palatin will meet with the Food and Drug Administration (FDA) towards the end of 2010 to discuss the next phase of bremelanotide’s trials. In this phase, Palatin hope to test bremelanotide as a treatment on its own and also as a drug which will work alongside a PDE-5 inhibitor (such as Viagra, Cialis or Levitra). The PDE-5 inhibitor family of medications is not successful for all men who suffer from erectile dysfunction, so combining both or even a new mono-therapy may make for some promising results.

Over 25% of men with ED do not respond to oral treatments currently available, such as Viagra. The CEO of Palatin explains that this is another reason why the future of bremelanotide is important for the likes of these men who don’t have another option. As it stands, what will not come with this treatment is the convenience of administering it orally. Subcutaneous application might inhibit the popularity of the treatment but if it means that men who otherwise have no other option may finally be able to treat their condition, perhaps convenience will not be the primary concern.

Medsafe, New Zealand’s government medicines regulator, has recalled four supposed ‘treatments’ for male and female sexual dysfunction with a warning issued under Section 98 of the Medicines Act 1981. All four products were tested by the Institute of Environmental Science and Research and were shown to have traces of prescription drugs used in Viagra, Cialis and Letriva. The drugs, including, So Hard For Men, Pulse 8 for Women, The Rock and Tonic 66 have been recalled. The Acting Director-General of Medsafe has stated that since July 2009, they have recalled 29 sexual performance enhancers which have been mixed with prescription medications.

The consequences of taking supplements like these could be very damaging to certain patients, for example, those already treating a heart condition, and the results could even be fatal. Erectile dysfunction and female sexual dysfunction treatments may only be prescribed to those who have had a consultation with a doctor, where medical history is seriously considered not to increase the risk of present or future medical conditions. Tadalafil and sildenafil, used in prescription medications Cialis and Viagra respectively were among the chemicals discovered. Hydroxyhomosildenafil was also traced, however this chemicals’ safety has not even been evaluated.

The products were being sold over the counter in sex shops and online, making the ‘treatments’ accessible and probably less expensive. Having a consultation with your GP or online with a GMC regulated doctor is the safest options for treating erectile dysfunction.

Of all the insane products that make spurious promises to turn men suffering from premature ejaculation into Warren Beatty crossed with Russell Brand, this one has to take the biscuit. It’s an I-Pad app for P.E.

For £2.99, the app claims that it will help men ‘take control of (their) mind and body and become a great lover.’ Designed by a British hypnotist Darren Marks,  the app, called Premature Ejaculation HD,  is intended to help users relax and feel confident and in control when in bed. 

It provides access to hypnotherapy sessions via audio which are meant to get you into a meditative state – prior, obviously, to having sex, rather than during. - getting an IPad involved between the sheets could be somewhat awkward. You also get to look at calming images of waterfalls and other such screen-saver type images to really help you get in the mood.

Clearly, men suffering from Premature Ejaculation can benefit from doing relaxation exercises before they try to have intercourse and hypnotherapy sessions on an I-Pad are not going to do any harm, as for example buying unlicensed medications might do.

Still, it’s still a bit depressing that people are still trying to make money out of desperate individuals, making promises to turn someone into a ‘great lover’ when they are totally unable, and are worst of all unqualified to do so!   

Results have been released by Vivus Pharmaceuticals showing that their new drug, avanafil, could help diabetics suffering from erectile dysfunction.

The drug is being trialled amongst men with no other health problems, but the company also launched a trial specific to men with diabetes. Diabetes is a strong risk factor for erectile dysfunction, as it is thought to affect blood flow and can cause nerve damage. Vivus says that nearly half of all men with diabetes suffer from erectile dysfunction.

The Revive-diabetes study saw 390 men with diabetes receive either a placebo or a dose of avanafil. More than 60% of the subjects on the higher dose were able to achieve erections sufficient for penetration, which those treated with the 100mg said that their ability to have intercourse increased 3-fold.

The drug is in late-stage trials and has already been shown to have faster reaction times that other competitors on the market. Viagra takes up to half an hour to have an effect, whereas Avanafil takes up to 15 minutes.

The lead scientist on the study, Laurence Belkoff of the Philedelphoa College of Oestepathic Medicine, has described the results as positive for men with diabetes and erectile dysfunction. He said that the hard-to-treat section of the population would be ‘encouraged’ that there the drug had proved to be well-tolerated, effective and fast acting.