Apomorphine is used to treat episodes in people with advanced Parkinson's disease. However, this recent study shows that this ...

get-erections-faster-with-this-ed-drug-everything-you-need-to-know-about-apomorphine

Get Erections Faster with this ED drug?! Everything you need to know about Apomorphine

have you ever wondered if you could get an erection faster I'm Dr Reena Malik urologist and pelvic surgeon and I'm going to explain how the drug apil morphine works and how in some cases it's been shown to cause erections for men with erectile dysfunction even faster than those you get with Cetaphil tadalfil or the other medications that you often see advertised for improvement of erections so make sure you guys watch this entire video because I'm going to explain what apomorphine does how it works what the data is on apomorphine what the side effects are and especially at the end I'm going to talk about why it wasn't improved and if you decide you want to try this medication that what you need to be weary of apil morphing is actually recognized as the oldest anti-parkinsonian drug Parkinson's disease is actually a nervous system disease that's caused by a drop in dopamine so apomorphine actually acts at the dopamine receptors to increase dopamine which we know is pro erectogenic meaning it helps with erections interestingly components of apil morphine have been found in blue and white water lily plants and they've been seen to be used even in historic times there's some evidence of it being used in ancient Egyptian times particularly the blue water lily for ancient rituals and also reserved for people of what was considered high cast to be used as an aphrodesiac White Water leaves have also been seen to be used in the classic Mayan periods for issues of fertility to maybe induce like ecstasies or hallucinations so people have been using this substance in some formulation for quite some time now how exactly does it work how aporphine works it acts on the dopamine receptors of an area called the paraventricular nucleus of the hypothalamus and this then sends signals down to the spinal cord causing it to activate parasympathetic outflow now parasympathetic and sympathetic outflow we talk about this a lot but when we learn in medical school how you think about erections and ejaculation we learn the term point and shoot point meaning with the erection because of parasympathetic stimulation this causes dilation of blood vessels and relaxation of smooth muscle which is what need to happen in order to allow blood to flow into the corpor cabosa or those cylinders that fill with blood when you get an erection and because this medication works on the central part of the body meaning the brain rather than blood vessels you can see results sooner than you can with pills like selenophile or tadalfil that cause increased blood flow or help with sustaining the erections and when this is administered it's given stabil lingually when they looked at the data the average time to obtain an erection after taking this sublingually was about 18.8 minutes about a third of people had erections within the first 10 minutes another third within 20 minutes and the rest up to 30 minutes but ultimately it's significantly faster than the other medications we have on the market so this seems really exciting right why wouldn't we want something that works really quickly underneath the tongue that can then improve right CS well let's talk about the data so the majority of the efficacy of apomorphine was looked at in what we call Placebo control trials so what that means is that people were randomized over four weeks to either receive apomorphine or a placebo and see how they improved in terms of the ability to get an erection that was firm enough for intercourse we know that if I give you a pill today that has no effect whatsoever your erections have a 40% chance of improving Bas on the placebo response cuz our brains are so powerful when we think something is going to help us it actually may help us because it has a very therapeutic effect on the brain when we looked at the men who received apomorphine over that 4 weeks the ability to have an erection that was firm enough for penetration was anywhere between 45% and 47% when we look at the placebo arm it was anywhere between 32% and 34% now this is for the 2 mgram and the 3 mgram apomorphine dosage and so basically what they're saying is that when you took the 2 milligram dose you had a 1.6 fold or 1.6 times more likely to have an erection that is suitable for intercourse compared to the 3 milligram dose where you had 2.2 times more likely to get an erection that was sufficient for intercourse now interestingly they also saw that if you started taking it and you saw a response and you contined taking it for the fourth or fifth dose you saw a sign significant Improvement in the responsiveness to the drug and we see this with medications like soil and talil as well because you know there's obviously a lot of anxiety when you start a new medication and when you're too anxious you're not going to get an erection so as you get more comfortable using the medication and knowing that you're not going to have side effects the anxiety goes down and then you're more likely to get an erection so what they saw was that at the 3 migam dose 53% achieved an adequate erection on the first dose now if you increase that to the fourth or fifth dose it went up to 70% and 73% so that's pretty impressive and also with looking at validated questionnaires they saw improvements in multitude of domains that includes of course erectile function but also intercourse satisfaction orgasmic satisfaction and overall satisfaction the only area they didn't see Improvement in was desire now the other interesting thing was this when you look at all the studies that were done many patients were also on nitrates now why is this important well nitrates are often given to patients for having things like chest pain where you put a little sublingual pill underneath your tongue to prevent you from having a heart attack now these medications work by dropping your blood pressure and so do medications like seleny or talify or other pd5 Inhibitors now this combined with nitrates can cause your blood pressure to bottom out so low that it can be dangerous and so it's really so these people taking nitrates cannot take these medications for erection so they then have to go down the tree Pathway to try some more maybe invasive things uh to get erections now this is very encouraging because this medication may be safe to use with nitrates again it wasn't studied for this but that was sort of the exciting part of it when it was all studied the other thing was that they did this across a whole bunch of different comorbidities so people had a large prostate they had heart heart disease and they had high blood pressure so people still responded now when they looked at the subset of men who had the most severe erectile dysfunction they still saw an improvement so at Baseline only 6% could achieve an erection in this severe group the placebo group went up to 18% and when these men took the 4 mgram dose the treatment response of the 4 mgram dose group was 29% of men were able to achieve an erection that was suitable for intercourse which dose is the dose that was generally recommended so when you look at all data combined they found that the 4 mgram and 5 mgram doses actually had really significant adverse effects like nausea so remember this is affecting the brain it's working on the dopamine receptors and so very often medications that work on the brain can result in nausea so nausea was a big one however nausea was generally seen in less than 5% of people there was also some dizziness about 2.4% but the big red flag here was Syncopy now you may know that this is was not approved by the FDA for treatment of erectile dysfunction so if you ask your doctor to get it they may not be able to because it's not FDA approved in the United States now the people who did get Syncopy which was a really low percent like less than 1% I think the actual number was like 4% they would often have what we call a prodrome they would feel sort of nausea and sing and dizziness so once they realized this in the studies they told men to lie down if they started feeling any of those symptoms so that they wouldn't pass out but early on um people would have sometimes have Syncopy because they didn't realize that these pre prodromal symptoms would then result in people passing out that's exactly what Syncopy is that people pass out so there were sort of two very famous cases that caused people to take caution when taking this medication and that included a man who got in his car after taking a 5 mgram dose and then had Syncopy meaning he passed out and got into a car accident got a contusion and had to be hospitalized another one was where a guy took the 5 milligram dose he then had his blood pressure drop quite significantly and had to be made to the hospital for fluids and monitoring and so that could be very serious so my takeaways from reviewing all this literature is that this medication may help some people now it's not a home run I don't think everyone is going to see a huge response with this medication but it may be helpful for some the other thing is you do need to be cautious you don't want to take always take more is better because these side effects like passing out and maybe having your blood pressure drop can be very very serious and I did mention that it may be safe with nitrates but it's never been studied for this so I would still use it with caution in people who are taking nitrate medications because we still don't know exactly what happens in a larger scale if people take them together so ultimately um is this a nice option to have in your Arsenal absolutely is this something that's going to work in every single person to get really fast strong firm erections every time probably not but it might work for some so I hope you guys found this helpful if you want to learn more about Urology make sure to subscribe to this channel uh so you can learn all about sexual health Urologic health and much more and if you didn't already know I have a podcast it's on YouTube but you can also follow it on your favorite podcast platform or check out podcast. Ramic md.com uh I'd love to see you there and a zero cost way to support me would be to either subscribe to my Channel or leave a rating or review for my podcast so that more people can find my content and benefit from it just like you and as always remember going to take care of yourself because you're worth it

Dr.

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