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SEX PHARMACOTHERAPY A. PDE 5 inhibiters (PDE 5 inhibiter prevents the breakdown of cGMP causing enhanced relaxation of cavernosal smooth muscles, increased arterial flow into corpora cavernosa, compression of subtunical veins and finally penile erection. It helps in maintaining the erection and not the initiation. Erotic literature, fantasy or foreplay helps in initiation of erection. Contraindications: Nitrates, cardiac diseases, Hypotension, Optic neuropathy, Erythromycin, Rifampicin) 1. Sildenafil (Viagra, Penegra) : 25, 50, 100mg tab. 30 min after dinner. 2. Vardenafil (Levitra) : 5, 10, 20 mg tab 30 min after dinner. Onset of action after 30 min 2. Tadalafil (Forzest, Megalis) 10, 20 mg tab after dinner Onset of action after 30 min. 3. Intracevernosal ing. Papaverine: 3 to 80 mg B. Alpha Blockers Alpha adrenergic receptor blocker dilates the arteries and reduces the venous return. (Beta adrenergic Blocking agents are contraindicated since they may cause sexual dysfunction). Contraindication: Hypotension 1. Prazosin (prazopress): 0.25, 0.5mg. tab H.S. 2. Terazosin (Hytrin): 1, 2, 5, mg tab. H.S. 3. Indoramine (Doralese) : 20 mg tab H. S. 4. Tolazoline (priscoline) 25 mg tab . 5. Yohimbine: 2mg: 1 to 2 tab T.D.S. 6. Dihydroergotamine: 1 mg tab T.D.S 7. I.C. Ing. Chlorpromazine: 0.06 to 0.6 mg 8. I.C. Ing . Phentolamine mesylate : 0.05to 1mg C. Dopamine Agonists (These drugs stimulate the Dopamine receptors. Dopamine is aneurotransmitter . It causes vasodilatation and has effects on motor, behavioral and endocrine system) 1. Bromergocriptine 2. fenfluramine 3. Inj. Apomorphine D. Antidepressants (These are selective serotonin reuptake inhibitors . It takes 3 to 6 weeks of continuous treatment for suppression of symptoms. They delay the orgasm. This effects is made use of in the treatment of Premature Ejaculation for which the drug is given 2 to 4 hours before the coitus) 1. Fluoxetine : 10 , 20, 30 mg in the morning 2. Paraxetine : 10, 30, 40, mg tab in the morning 3. Trazodone : 25, 50 mg tab after meal 4. Dapoxetine : 30, 60 mg tab o.d. 3 hours before coitus E. Peripheral Vasodilators ( Vasodilators dilate the blood vessels and cause erection. They are also used in Hypertension) 1. Hydrallazine sulphate ( Nepresol): 25 mg tab B.D. 2.Nifedipine ( Nifelat) : 5, 10, 20 mg tab T.D.S. 3. Amlodipine (Amlodac) 2, 5, 5, 10 mg tab O.D. 4. Pentoxifylline( Trental) 400 mg tab T.D.S.after meals 5. Cyclandelate ( Cyclasyn) : 200 , 400 mg. tab T.D.S. 6. Xanthinol nicotinate(Complamina)150, 500 mg tab TDS with meals 7. L- Arginine (Arginitric) 500 mg cap F. Local Vasodilators ( For local application. Drug should be washed off before coitus) 1. Nitroglycerin Ointment 2. Minoxidil (Mintop): 2%, 5% Solution. Apply <2ml G. Nitrates (Nitrates are converted to Nitric oxide that relaxes smooth muscles and causes vasodilatation. Nitrates are used for Angina. Sildenafil/ Tadalafil should NOT be given to the person who are on Nitrates) 1. Pentaerythritol Tetranitrate (Peritrate) : 10 mg tab 2. Isorbide Dinitrate(Sorbitrate): 5, 10mg tab H. Prostaglandin (Prostaglandin E1 causes smooth muscle relaxation and vasodilatation. Not effective orally in Sexual dysfunctions.) 1. I.C. INJ. PGE1(Prostin VR): 2.5 to 40 mcg 2.PGE1 Pallet (alprostadil): 125 to 500 mcg by muse (medicated Urethral system for erection) I. Hormones (testosterone increases the life span and fertilizing power of spermatozoa. It helps in final maturation of spermatozoa during spermatogenesis. In hypogonadism it stimulates libido and improves E.D. serum P.S.A. should be estimated and digital PR should be done prior to giving testosterone . in normal individuals, it does not improve libido or erection.) 1. testosterone ( nuvir) : 40 mg cap, T.D.S. with fatty meals for 3 weeks 2. Inj. Testosterone enanthate (testoviron depot) : 100, 250 mg, deep intramuscular, 1ml every 2 weeks 3. Inj. Human chorionic gonadotropin ( profasi): 5000, 10000, 20000 I.U. Powder with diluent. Uses for ovulation, spermatogenesis & for undescended testis. 4. Levonorgestrel (Ecee2, Norlevo, I pill) : 750 mcg tab . two tabs taken together, preferably within 12 hours (no longer than 72 hours) after unprotected sex. 5. Tibolone ( livial , tibomax ): 2.5 mg tab O.D. for 3 months for menopause. 6. clomiphene citrate (clomid, fertyl): 25, 50mg tab. Female: for ovulation. 50mg O.D. For 5 days (from 5th to 9th day of menstrual cycle. For 3 menstrual cycles only. 7. Male: for Oligospermia : 25mgO.D. For 3 months only estrogen (evalon , Dienoestrol) cream for intravaginal use in senile atrophic vaginitis, once daily, for not more than 2 weeks. J. Antioxidents (antioxydents are substances that protect the cells against the effects of free radicals. These include vit . A, C, E, Coenzyme Q 10, Zinc , selenium, lycopene and L- Carnitine . they improve the sperm count and / motility and hence proved be effective in oligo – asthenospermia that leads to male infertility . antioxidants are also available in vegetables, fruits , tomato, papaya, water melon, fish & egg) 1. lycopene, zinc, selenium (Lycored) Cap . 2B.D.for months (lycotin) cap.1B.D. for 3 months . 2. L-Carnitine (Carnivit , L-tine ) Tab. 2 T.D.S. for 3 months 3. Coenzyme Q 10 (CoQ10, Zyme Q10 ) Cap .1 T.D.S. For 3 months 4. Vit. A, C, E, Zinc , Selenium (Cytovit, Oxyvit) Cap . 1 T.D.S. For 3 months K. Antimicrobials For mixed Vaginal infection Fluconazole + Ornidazole+ Azithromycin ( Medikit, Zocon –AS) 4 tabs. Given orally for vaginal candidiasis, Trichomoniasis & Bacterial vaginitis For male genital tract infection / Chlamidial infection Doxycycline (Doxt, Doxy1) : 100mg O.D. For 15 days. Both are treated. L. Ayurvedic Adjuvants(Empirical) 1. Chyavan prash: Tonic 2. Vigomax Forte: 1B.D. With milk. for ED 3. Confido : 1T.D.S. For Oligo- asthenospermia 4. Vivadona : 1B.D. For female libido Drugs causing Sexual Dysfunction 1.Anticholinergic -Atropine, Propantheline 2.Antihypertensive-Beta blockers, Methyldopa, 3.Antimicrobials -Ethionamide, Vidarabine 4. Antipsychotics -Tranquilizers 5.C.N.S. Depressants -Barbiturates, Opiates 6.Diuretics-Thiazides, Spironolactone 7.H2 receptor antagonists-Cimetidine 8.Hormones -Estrogen 9.Recreational drugs -Alcohol, Tobacco