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Home > Archive > Impotence Support > February 2007 > Alprostadil Question
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Alprostadil Question
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| sepigoth@comcast.net 2007-01-27, 9:56 pm |
| I have a question regarding Alprostadil. I have high blood pressure
and am currently taking Cialis for the ED that the medicine causes. I
recently faced the fact that I suffer from PE. So I did some research
about treatments and found that SSRI's are the typical treatment.
Along the way I read about Alprostadil injections and it seemed like
the perfect solution - stop taking Cialis, start using the injections.
My rational to my doctor was that while the Alprostadil would not treat
the PE in any way, it wouldn't matter because the erection would last
for an hour or more irregardless.
He said he typically prescribed Zoloft for PE, but said he would email
a urologist for a consult rather than make me try to get an
appointment. Two weeks go by and I get my answer. He said the
urologist was completely against the idea of alprostadil at first. My
doctor explained that I knew it wouldn't treat the PE but that the
erection would last after ejaculation.
The urologist said that in his experience he did not find alprostadil
produced erections to last much beyond ejaculation. The doctor said he
could get a second opinion. I told him we could go ahead and start the
Zoloft and if I didn't see any significant improvements we could go for
a second opinion then.
So my question to you users of alprostadil is this - is this urologist
off his rocker? How is the erection after ejaculation? Could it be
that the urologist had been using too low of dosages? I'm just very
confused by his response. Thanks for any input you can give.
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| sepigoth@comcast.net wrote:
> I have a question regarding Alprostadil. I have high blood pressure
> and am currently taking Cialis for the ED that the medicine causes. I
> recently faced the fact that I suffer from PE. So I did some research
> about treatments and found that SSRI's are the typical treatment.
>
> Along the way I read about Alprostadil injections and it seemed like
> the perfect solution - stop taking Cialis, start using the injections.
> My rational to my doctor was that while the Alprostadil would not treat
> the PE in any way, it wouldn't matter because the erection would last
> for an hour or more irregardless.
>
> He said he typically prescribed Zoloft for PE, but said he would email
> a urologist for a consult rather than make me try to get an
> appointment. Two weeks go by and I get my answer. He said the
> urologist was completely against the idea of alprostadil at first. My
> doctor explained that I knew it wouldn't treat the PE but that the
> erection would last after ejaculation.
>
> The urologist said that in his experience he did not find alprostadil
> produced erections to last much beyond ejaculation. The doctor said he
> could get a second opinion. I told him we could go ahead and start the
> Zoloft and if I didn't see any significant improvements we could go for
> a second opinion then.
>
> So my question to you users of alprostadil is this - is this urologist
> off his rocker? How is the erection after ejaculation? Could it be
> that the urologist had been using too low of dosages? I'm just very
> confused by his response. Thanks for any input you can give.
>
I'm a Trimix user rather than a straight Alph or Caverject user.
I'd say the Uro is not, "off his rocker" but, may have a limited range
of experience with a wide variety of P.E. victims.
You may be correct about the 'low dosage.' I think priapism fears tend
to discourage guys and their Urologists from exploiting their whole
range of dosing with Trimix or Quadmix. Patients and docs may just
'zero-in' on a fixed dose size that supports a fixed length of session,
then stay with that dose. In contrast my Uro had me titrate to doses
that covered a very broad range of time. My spouse and I have a range
of choices.
Never run out of Sudafed! <g>
My wife and I claim a brown belt in P.E. There's no CNS cause that
might dictate using Xanax or an SSRI and much of my problem was related
to anxiety about erectile quality and durability -- and anxiety about
the P.E. itself -- real nut case.
Oral meds helped but, Trimix wiped it out. On Trimix, I'm able to better
sense my plateau. The slightly better rigidity gives me a better
ability to control the amount and angles of stimulation --something that
I wasn't able to do when I wasn't as rigid. (Does that explanation make
sense?) My own feeling: I'd first rule out erectile quality issues
using either meds or injectibles.
If you do nail this as a CNS problem, the anti-depressant might help but
remember that many anti-depressants take a hit on libido. If you've got
to go the SSRI route, go with one that has a minimal effect on libido --
something like Wellbutrin, certainly avoid SSRIs like Prozac.
Here are some questions to think about :
1. Is erectile quality a concern--do you consistently have a 'better
than penetrable' condition whenever you need it?
2. Are you able to go through your refractory period(s) for 'seconds'
-- or 'thirds.'
3. When you look at a typical P.E. incident what were you thinking
about in the moments that led up to it. Where was your focus?
4. Have you tried Kegel exercises to gain better routine control your
pelvic floor muscles during foreplay and thrusting/copulation.
Suggestion: Trimix or Quadmix will probably offer a broader range of
dosing options than straight Alprostadil. This is drug experimentation
that's best supervised by a board Urologist who can alter the
formulation if/when needed. Most PCMs/Internal Med. types don't want to
get involved in a compounded substance that's not brand-named. It
requires reading outside their area of specialty--a waste of time unless
they can use the information on a daily basis.
You might also identify the BP med to this group and get input from others.
--
....Lmac
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| Ignatz's Bricks 2007-01-27, 9:56 pm |
| sepigoth@comcast.net asks:
> I have a question regarding Alprostadil.
> The urologist said that in his experience he did not find alprostadil
> produced erections to last much beyond ejaculation.
For me, using either trimix or caverject, I deflate after ejaculation.
However, I recover and am back up again within 5 minutes the first time
and usually can recover within 15 minutes after the second time.
Others never go down. We are all different.
IB
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sepig...@comcast.net wrote:
....
> Along the way I read about Alprostadil injections and it seemed like
> the perfect solution - stop taking Cialis, start using the injections.
> My rational to my doctor was that while the Alprostadil would not treat
> the PE in any way, it wouldn't matter because the erection would last
> for an hour or more irregardless.
>
> The urologist said that in his experience he did not find alprostadil
> produced erections to last much beyond ejaculation....
> So my question to you users of alprostadil is this - is this urologist
> off his rocker? How is the erection after ejaculation? Could it be
> that the urologist had been using too low of dosages? I'm just very
> confused by his response. Thanks for any input you can give.
_________
I don't think the consulted urologist is off his rocker at all. He is
simply reporting the experiences of his patients on a single-drug
injectible: alprostadil by itself.
lmac raises some good points. Urologists tend toward the conservative
on injectibles and promote lower rather than higher dosages, if the
lower dosage provides an acceptable sexual experience. Get an
erection, have intercourse, ejaculate, and be done with that session
with the possibility of priapism avoided.
My urologist took a different stance during my intake at the office for
trimix, explaining (even drawing graphs on a wall board) the durations
one might expect with different titrations upward. He quit at three
hours, which I thought was pretty generous, that being his marker for a
long effect and short of what he considers an erection that goes on too
long. He did lecture me about the consequences of pripisms - many of
which he has repaired surgically- that part was graphic and gross
enough to make me cautious about my at-home use of this combo of drugs.
That having been said, I do go for longer duration with the tri-mix and
have learned through some careful experimentation that I can cause 2.5
-3.0 hr erections and still stay well within the safety zone from
pripism. I don't have PE, however my experience on trimix has been
this: If I ejaculate within (and this is a guess - who looks at a
stopwatch?) the first half of the effective period - about an hour and
a half, I don't lose the erection. Later, as the drug begins to wear
off, I will lose the erection after I ejaculate, but very slowly and I
can get it back with more stimulation.
For your purposes, I am thinking that trimix will give you what you're
looking for. Although trimix doesn't seem to change ejaculation
timing, what would you care if you could stay hard after you cum and
avoid going the SSRI route? Once you learn how to titrate, you could
safely get something like 2 hours, assuring yourself of at least one
hour - that's a lot of sex - of worry-free intercourse.
Jim
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Jim wrote:[vbcol=seagreen]
> sepig...@comcast.net wrote:
> ...
______--
That's pri-a-pism. I mispelled it twice, looks like.
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| As one of the resident P.E. guys, I'd like to tag onto Jim & Ignatz'
responses -- noted below.
Jim wrote:
> sepig...@comcast.net wrote:
> ...
>
>
> _________
>
> I don't think the consulted urologist is off his rocker at all. He is
> simply reporting the experiences of his patients on a single-drug
> injectible: alprostadil by itself.
>
> lmac raises some good points. Urologists tend toward the conservative
> on injectibles and promote lower rather than higher dosages, if the
> lower dosage provides an acceptable sexual experience. Get an
> erection, have intercourse, ejaculate, and be done with that session
> with the possibility of priapism avoided.
Even more so for a Pri-care physician. About the only injectible a PCM
will deal with is Caverject, staight alprostadil. And, as Jim notes,
he/she will prescribe for a fixed dose that just does the minimal job.
Supervised titration of an injectible isn't very compatible with the
practice of Internal Medicine.
>
> My urologist took a different stance during my intake at the office for
> trimix, explaining (even drawing graphs on a wall board) the durations
> one might expect with different titrations upward. He quit at three
> hours, which I thought was pretty generous, that being his marker for a
> long effect and short of what he considers an erection that goes on too
> long. He did lecture me about the consequences of pripisms - many of
> which he has repaired surgically- that part was graphic and gross
> enough to make me cautious about my at-home use of this combo of drugs.
>
> That having been said, I do go for longer duration with the tri-mix and
> have learned through some careful experimentation that I can cause 2.5
> -3.0 hr erections and still stay well within the safety zone from
> pripism. I don't have PE, however my experience on trimix has been
> this: If I ejaculate within (and this is a guess - who looks at a
> stopwatch?) the first half of the effective period - about an hour and
> a half, I don't lose the erection. Later, as the drug begins to wear
> off, I will lose the erection after I ejaculate, but very slowly and I
> can get it back with more stimulation.
I do not have the years of Trimix experience that Jim and Ignatz do but
am somewhere between them with regard to staying erect during and
following the first climax of a session. Out of a half-dozen > 3+30
doses I've only stayed rigid during/after the first climax on two
occasions. On those two occasions I was pretty hypersensitive and not
ready to just, "carryon."(glans wise). Otherwise, same pattern as Jim
-- earlier works better.
>
> For your purposes, I am thinking that trimix will give you what you're
> looking for. Although trimix doesn't seem to change ejaculation
> timing, what would you care if you could stay hard after you cum and
> avoid going the SSRI route?...
From a P.E. perspective. If you are looking for better signals as to
'where you are' (i.e. how far you are from climax), you might get them
with more consistent rigidity. Long-duration doses of Caverject, Trimix
or Quadmix should give you just that.
The long-duration dose also permits the more classic approach to P.E. --
guys are usually much slower during 'seconds' and tend toward anorgasmia.
That should help cover either the sensory or anxiety (psychological)
sides of the P.E. problem. If that's the case then an SSRI might be the
answer. Remember that SSRI's are slow to take effect and slow to clear
when you stop them.
> ...Once you learn how to titrate, you could
> safely get something like 2 hours, assuring yourself of at least one
> hour - that's a lot of sex - of worry-free intercourse.
>
> Jim
>
Every P.E. victim's situation is probably different; however, after my
first ejaculation, I'm glans-hypersensitive and not ready for
heavy-hauling for perhaps 4 or 5 minutes. We usually have an
alternative toy or game plan ready until I settle down, get stimulated
and erect again.
End, sales pitch. HTH.
--
....Lmac
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| sepigoth@comcast.net 2007-01-27, 9:56 pm |
| I really appreciate everyone's replies. Getting feedback from actual
people is really beneficial. For the time being I decided to go ahead
with the SSRI route to see how it goes. I'm taking 100mg of Zoloft a
day and I already can tell a difference when I masturbate. Will be
testing out how it is vaginally tonight. Have only been on it for a few
days now but wanted to see how it is. Doctor said to give it two
weeks.
Since this was the initial route that my doctor recommended I thought I
would at least try it if for anything but to rule it out. If it works,
great. If not I'll have to formally find a urologist and go talk to
him.
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| Neuromancer 2007-01-30, 4:28 pm |
|
Hey guys, just an update -- I decided to play the game and try the
Zoloft fully expecting it not to work. Here is the crazy thing, its
working great, and aside from the increased duration during sex, I'm
suffering no other side effects. My wife and I had sex the other
night at at the end she yelled out a thank you to my doctor. LOL.
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| Neuromancer wrote:
> Hey guys, just an update -- I decided to play the game and try the
> Zoloft fully expecting it not to work. Here is the crazy thing, its
> working great, and aside from the increased duration during sex, I'm
> suffering no other side effects. My wife and I had sex the other
> night at at the end she yelled out a thank you to my doctor. LOL.
>
Congrats!!
Good to know -- thanks for the update.
--
....Lmac
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| Ignatz's Bricks 2007-02-01, 8:26 am |
| Neuromancer wrote:
> Hey guys, just an update -- I decided to play the game and try the
> Zoloft fully expecting it not to work. Here is the crazy thing, its
> working great, and aside from the increased duration during sex, I'm
> suffering no other side effects. My wife and I had sex the other
> night at at the end she yelled out a thank you to my doctor. LOL.
>
Congratulations!
I'd have bet money that it wouldn't have worked, because everything has
to be just right dosage and there are too many variables to accurately
predict the results.
After you have a little practice with the Zoloft, due to the possibility
of long term ED trouble from the Zoloft, you might talk to your doctor
about switching to an ED friendly BP medicine like Cozaar and reduce and
maybe eliminate the Zoloft.
I presumed that your doctor warned you of Zoloft's reactions with other
drugs.
http://www.nlm.nih.gov/medlineplus/...pdi/202651.html
Ignatz.
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| Neuromancer 2007-02-01, 8:26 am |
| On Jan 30, 5:44 pm, Ignatz's Bricks <IgnatzBri...@aol.com.no.net>
wrote:
> Neuromancer wrote:
> After you have a little practice with the Zoloft, due to the possibility
> of long term ED trouble from the Zoloft, you might talk to your doctor
> about switching to an ED friendly BP medicine like Cozaar and reduce and
> maybe eliminate the Zoloft.
Well I think if i were to switch to another BP med I would be
eliminating cialis which I take for the ED, the Zoloft was for
suffering from PE.
-Steve
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| Neuromancer wrote:
> On Jan 30, 5:44 pm, Ignatz's Bricks <IgnatzBri...@aol.com.no.net>
> wrote:
>
>
> Well I think if i were to switch to another BP med I would be
> eliminating cialis which I take for the ED, the Zoloft was for
> suffering from PE.
>
> -Steve
>
I've got a question and some thoughts as well.
First the question: If you were glans-hypersensitive going into
'seconds,' has the Zoloft helped?
Second, my thoughts on Zoloft: I don't want to speak for Ignatz on this
one (what Ignatz really meant ... etc.) however, I think a number of
guys here have concerns about the effects of any anti-depressant. My
wife has taken a variety of AD's for almost 12 years and the effects of
those meds and their accompanying mood stabilizers are a part of our
lives, 24/7. I've attended the NAMI family courses and am a regular
participant in DBSA meetings, seminars and community workshops.
I've learned that any AD takes from 3-6 weeks for it's true impact to be
felt and a similar length of time for the effect to fade out when it's
ceased. More importantly, when ceased and then restarted, the AD's
desirable effects may not again return -- causing the M.D. to search for
a substitute med, sometimes without success.
The caution I hope your GP conveyed was to take as prescribed, not to
self titrate as you might with an E.D. med and above all, to not
suddenly cease taking the med.
As a fellow PE victim I'm always interested in anything that works.
Please post some progress reports on this.
--
....Lmac
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| Ignatz's Bricks 2007-02-01, 8:26 am |
| I wrote:
>
> Well I think if i were to switch to another BP med I would be
> eliminating cialis which I take for the ED, the Zoloft was for
> suffering from PE.
I always feel it is best to avoid taking one medicine to counter the
side effects of another, if possible.
I am 67 and up until my mid-twenties, I too, suffered with PE, and
earned the nickname of "Quick draw McGraw" among a few of the girls.
There is a little truth in the old joke, "Marriage is the best cure for
PE."
PE often can be brought on by nervousness, which also can cause ED, so
nervousness is a two edged sword.
My long-forgotten PE returning in my mid-50s was the first sign of my
developing impotence. Most men find that when they are completely hard,
they can delay ejaculation almost at will. It is when they are not
quite hard enough, that PE happens.
I feel that there is a good possibility that if you switched your BP
medicine, you might be more hard and your tendency to have PE might just
go away.
IB
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| Ignatz's Bricks wrote:
> I wrote:
>
>
> I always feel it is best to avoid taking one medicine to counter the
> side effects of another, if possible.
>
> I am 67 and up until my mid-twenties, I too, suffered with PE, and
> earned the nickname of "Quick draw McGraw" among a few of the girls.
>
> There is a little truth in the old joke, "Marriage is the best cure for
> PE."
>
> PE often can be brought on by nervousness, which also can cause ED, so
> nervousness is a two edged sword.
>
> My long-forgotten PE returning in my mid-50s was the first sign of my
> developing impotence. Most men find that when they are completely hard,
> they can delay ejaculation almost at will. It is when they are not
> quite hard enough, that PE happens.
>
> I feel that there is a good possibility that if you switched your BP
> medicine, you might be more hard and your tendency to have PE might just
> go away.
>
> IB
>
Ditto!
--
....Lmac
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