I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

Anyone used Combination Therapy?

User
Posted 08 Sep 2023 at 17:32

I've started to use alprostadil via the viridal duo injection method. However, the two times I've used it, I've only managed to keep an erection for 7/10 minutes. 

Before this, I was using the pump with cialis, but recently this was not working as well as in previous years.

So, I was referred to UCLH who have got me started on the injections.

I know the literature says don't use cialis within 72 hours of injecting with alprostadil, but I noticed a few reports on the internet of studies done where either viagra or alprostadil didn't work. These men were then given a combination of the two with good results and few side effects. https://pubmed.ncbi.nlm.nih.gov/12180059/

I was just wondering if anyone does this.

Mike

User
Posted 09 Sep 2023 at 20:46

I think you need to go back to UCLH and explain the injections don't work for long.

It sounds like something changed, and they probably need to investigate what that is, and devise a treatment to counteract it if possible. This is worth doing even if you weren't interested in erections, because some of these conditions are early indications of other problems which need tackling before they cause a major health event.

There is a condition called Venous Leak where too much blood leaks out of the Corpus Cavernosum (expandable part of the penis) for it to remain erect. If the erection was generated by Alprostadil being injected into the Corpus Cavernosum, then it's going to get washed out by this and cause loss of erection. This can also cause light-headedness because the Alprostadil is washed into your main blood stream much more quickly than normal, pulling down your blood pressure. What you could try is a cock ring which applies pressure around the outside of the base of the penis, not a pump constriction ring (which applies enough pressure to close arteries and veins), but something more gentle (such as a Durex Pleasure ring) which just applies pressure to the veins around the edge (although too deep to be seen) which drain the blood from the Corpus Cavernosum. That might help to keep the blood in the Corpus Cavernosum, counteracting Venous Leak to some degree. Cock rings mustn't be kept on for more than 30 mins, and never allow yourself to fall asleep with one on.

Another option would be to use the pump to generate an erection (without any extra medications) and a pump constriction ring to maintain it. Again, 30 mins max.

As for combination therapy... Did you get any sense that Cialis had any effect by itself, even if insufficient for what you wanted? That would indicate if you have any working nerves. With no working nerves, there's no point using Cialis for erections. I think only a clinician can advise you in using drug combinations which are excluded in their respective patient information sheets.

User
Posted 10 Sep 2023 at 14:29

If Cialis works a bit, then it's probably worth trying Cialis with a cock ring. One advantage of Cialis over injections is it's systemic (applied to whole body), so if there is Venous Leak, you won't lose the Cialis as it's in all your blood, versus the injections which are lost from the penis through Venous Leak.

The max event dose of Cialis/Tadalafil is 20mg. If you were given it originally for nerve healing, then you might be on a lower dose, in which case ask if you can try the 20mg dose.

If you do get a good erection with a cock ring, you might find you can take it off and the erection remains (but don't risk damaging your penis by dragging the ring off while erect - get your fingers in it and pull it much larger so it comes off easily). Your penis includes a structure called the tunica albuginea which does the function of the cock ring once the Corpus Cavernosum is erect, in blocking off the veins which drain the Corpus Cavernosum.

Edited by member 10 Sep 2023 at 14:47  | Reason: Not specified

User
Posted 21 Oct 2023 at 09:30

You could try asking for Invicorp. It's a combination of Aviptadil and Phentolamine Mesylate and works in a different way. The Phenolamine stops the blood leaking out I think

There seems to be no shortage at the moment

Cheers

Bill

 

 

. 

Edited by member 21 Oct 2023 at 09:33  | Reason: Not specified

Show Most Thanked Posts
User
Posted 09 Sep 2023 at 12:24

Did you have nerve sparing surgery.  I had non nerve sparing surgery so viagara was useless.  

User
Posted 09 Sep 2023 at 14:56

It was in 2011, and although they tried to spare the nerves, it didn't succeed that well. I've had ED ever since. 

I know it's early days, and maybe I should be a bit more patient, but I think I'm doing the injections OK.

If I turn out to be in the minority for whom this is not effective, the only alternative is the route you took - implant. However, although I'm healthy with no underlaying problems, I am 79 so it may not be available.

I've read your experience, by the way, and I think your ongoing descriptions were not only refreshingly honest, but very helpful for the rest of us.

Mike

User
Posted 09 Sep 2023 at 20:46

I think you need to go back to UCLH and explain the injections don't work for long.

It sounds like something changed, and they probably need to investigate what that is, and devise a treatment to counteract it if possible. This is worth doing even if you weren't interested in erections, because some of these conditions are early indications of other problems which need tackling before they cause a major health event.

There is a condition called Venous Leak where too much blood leaks out of the Corpus Cavernosum (expandable part of the penis) for it to remain erect. If the erection was generated by Alprostadil being injected into the Corpus Cavernosum, then it's going to get washed out by this and cause loss of erection. This can also cause light-headedness because the Alprostadil is washed into your main blood stream much more quickly than normal, pulling down your blood pressure. What you could try is a cock ring which applies pressure around the outside of the base of the penis, not a pump constriction ring (which applies enough pressure to close arteries and veins), but something more gentle (such as a Durex Pleasure ring) which just applies pressure to the veins around the edge (although too deep to be seen) which drain the blood from the Corpus Cavernosum. That might help to keep the blood in the Corpus Cavernosum, counteracting Venous Leak to some degree. Cock rings mustn't be kept on for more than 30 mins, and never allow yourself to fall asleep with one on.

Another option would be to use the pump to generate an erection (without any extra medications) and a pump constriction ring to maintain it. Again, 30 mins max.

As for combination therapy... Did you get any sense that Cialis had any effect by itself, even if insufficient for what you wanted? That would indicate if you have any working nerves. With no working nerves, there's no point using Cialis for erections. I think only a clinician can advise you in using drug combinations which are excluded in their respective patient information sheets.

User
Posted 10 Sep 2023 at 12:12

Thanks for that Andy. I'm not due to contact UCLH until January, but I'll look into the cock ring idea. Its mildly interesting that when I've used the pump recently, that also looses the erection quicker than it used to, so maybe something like the Venous Leak might be happening.

When I was originally prescribed Cialis by the hospital, they made it clear that the reason was to encourage blood flow, not necessarily erections. On its own, it now produces what is I suppose, a half erection, so some nerves were spared, and that has got gradually better over the years.

User
Posted 10 Sep 2023 at 14:29

If Cialis works a bit, then it's probably worth trying Cialis with a cock ring. One advantage of Cialis over injections is it's systemic (applied to whole body), so if there is Venous Leak, you won't lose the Cialis as it's in all your blood, versus the injections which are lost from the penis through Venous Leak.

The max event dose of Cialis/Tadalafil is 20mg. If you were given it originally for nerve healing, then you might be on a lower dose, in which case ask if you can try the 20mg dose.

If you do get a good erection with a cock ring, you might find you can take it off and the erection remains (but don't risk damaging your penis by dragging the ring off while erect - get your fingers in it and pull it much larger so it comes off easily). Your penis includes a structure called the tunica albuginea which does the function of the cock ring once the Corpus Cavernosum is erect, in blocking off the veins which drain the Corpus Cavernosum.

Edited by member 10 Sep 2023 at 14:47  | Reason: Not specified

User
Posted 11 Sep 2023 at 22:45

Thanks again Andy - I'll bear that in mind.

I've had a reply from UCLH regarding combining Cialis with the injection, and they've said it's OK to try it, but I should start with a lower dose than the 20mg that I get on prescription, so I'll cut one and see how I get on.

User
Posted 20 Oct 2023 at 22:34

Well, I cut my 20mg Cialis tablet so I could try 5mg with the injection, and it worked very well. I was able to sustain an erection for about one and a quarter hours. This was mid September

However, since then I've been unable to get any more Alprostadil. Turns out, there's a shortage which won't be  resolved until January 2024.

When I can get the supplies, I'll try a few more times to confirm the combination works OK.

User
Posted 21 Oct 2023 at 09:30

You could try asking for Invicorp. It's a combination of Aviptadil and Phentolamine Mesylate and works in a different way. The Phenolamine stops the blood leaking out I think

There seems to be no shortage at the moment

Cheers

Bill

 

 

. 

Edited by member 21 Oct 2023 at 09:33  | Reason: Not specified

User
Posted 31 Oct 2023 at 23:14

Thanks Bill, I'll look into it.

 
Forum Jump  
©2024 Prostate Cancer UK