Is high-dose yohimbine hydrochloride effective in the treatment of mixed-type impotence? A prospective, randomized, controlled double-blind crossover study

Kunelius, Pekka; Häkkinen, Jukka; Lukkarinen, O

doi:10.1016/s0090-4295(96)00505-5

Cited by 47 publications

(23 citation statements)

References 20 publications

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“…Similar results have been seen in mixed type impotence where yohimbine was no better than placebo as ®rst-line treatment. 8 With the development of new agents such as sildena®l, however, oral therapy may prove to be effective treatment for ED. 9 The VED has an overall success rate of approximately 90%, and 83.5% of patients continue to use the device for intercourse.…”

Section: Penile Prosthesis Implantation Surgery Fm Jhaveri Et Almentioning

confidence: 99%

Penile prosthesis implantation surgery: a statewide population based analysis of 2354 patients

1998

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Aims of the study: Minimally invasive therapy for erectile dysfunction (ED) has changed the frequency of penile prosthesis surgery. The purpose of this study is to describe the changes in frequency, hospital stay, hospital charges and penile prosthesis type in North Carolina. Materials and Methods: The data source was a statewide hospital discharge database which includes data on hospitalized patients for all 151 hospitals in North Carolina. Results: From 1988±1993, 2354 patients underwent implantation of penile prostheses. The total number of penile prostheses implanted has declined over this six year period. Similarly, hospital stay has declined from an average of 4.03±2.96 d with a 46.6% decrease in total hospital days. Despite this change in hospital stay, hospital charges rose signi®cantly from an average of $7252.48 to $12 842.18 driving total charges from $2 973 516.80 to $3 826 969.60 (1993) representing a 28.7% increase. Conclusions: Minimally invasive therapy and changes in reimbursement have had a major impact on the number of patients undergoing penile prosthesis implantation for ED. This downward trend may continue as more treatment options develop from the marked increase in research in this ®eld. However, this may result in an increase of patients seeking treatment overall.

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Section: Penile Prosthesis Implantation Surgery Fm Jhaveri Et Almentioning

confidence: 99%

Penile prosthesis implantation surgery: a statewide population based analysis of 2354 patients

1998

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“…[5][6][7] Placebo-controlled studies have suggested the effectiveness of yohimbine in treating ED due to psychogenic or mild organic etiology, but the outcome of its use was, however, disappointing. 8 Since the advent of sildenafil, there has been a resurgence of interest in ED and an increase in patients presenting with this disease. 9 However, several studies showed that administering sildenafil could not result in rigidity sufficient for satisfactory sexual intercourse in 11-22% of patients with psychogenic and 36-65% with organic ED.…”

Section: Introductionmentioning

confidence: 99%

Yohimbine enhances the effect of sildenafil on erectile process in rats

Senbel

Mostafa

2008

Int J Impot Res

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Combining the centrally acting drug yohimbine with the peripheral conditioner sildenafil might be an approach to erectile dysfunction cases in which sildenafil alone failed. This work aimed to investigate the effect of yohimbine on sildenafil-induced facilitation of erectile process. Erectile responses to electrical stimulation of the cavernous nerve in anesthetized male rats were recorded. Intracavernosal pressure/systemic arterial pressure (ICP/SAP) was calculated, 1 and 5 min after intravenous administration of sildenafil, yohimbine or a combination of both. Changes in sexual arousal and copulatory performance indices were compared before and after these injections using behavioral mating experiments. It was shown that systemic administration of sildenafil produced a significant increase in ICP/SAP than control at doses X10 lmol kg À1. Yohimbine alone failed to potentiate erectile responses but yohimbine (1 lmol kg À1) significantly potentiated the effect of sildenafil 1-10 lmol kg À1 and 1 mmol kg À1, 1 and 5 min after injection. Potentiation of ICP/SAP induced by their combination was greater than the sum of the effects of the corresponding doses of either drug at the same time interval. A nonsignificant additional decrease in SAP than sildenafilinduced was observed if administered with yohimbine. Addition of sildenafil to yohimbine significantly enhanced the effect of the latter on intromission frequency, intercopulatory interval and the number of ejaculations per session. It is concluded that yohimbine may enhance and prolong the effect of sildenafil on erectile process without additional hypotension. Sildenafil may enhance the central effects of yohimbine on erection; it amplifies the effect of yohimbine on male copulatory performance but not on sexual motivation. The potential beneficial effect of the combination was found to be more pronounced on the central component than on the peripheral component of the erectile process.

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“…It is evident from the data presented that there was an arithmetic (if not statistical) advantage of the drug over placebo (complete response 13.6% vs 4.5%, respectively) in a study with a small number of subjects (n 22). Kunelius et al, 20 in a similarly small study, treated 29 patients without`purely psychogenic or organic causes'. In this study no differences were detected between the active drug and the placebo.…”

Section: Resultsmentioning

confidence: 99%

Yohimbine in erectile dysfunction: the facts

Morales

2000

Int J Impot Res

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Yohimbine, a pharmacologically well-characterized a-2-adrenoceptor antagonist with activity in the central and peripheral nervous system, has been used for over a century in the treatment of erectile dysfunction. In-depth, systematic studies in animals have shown that the drug has a remarkable positive effect on sexual performance. Meta-analyses of the few controlled, randomized human studies have consistently shown an advantage of yohimbine over placebo. Despite such a long history and encouraging activity, the drug has not yet been subjected to scienti®cally rigorous human clinical trials. Although relevant basic pharmacological and animal research information has been available for over 15 y, recent studies were designed with a lack of insight and complete disregard of those fundamental studies. Currently, dose±response investigations are not available, alternative routes of administration (i.e. sublingual) have not been investigated, nor has continuous versus`on-demand' administration been explored. Synergistic activity with other drugs was last studied nearly four decades ago. Assessment of various populations was carried out in very limited cohorts and only in most general terms. In short, properly designed trials in humans have not been done. Why? Yohimbine is an old drug. As such it does not enjoy patent protection or commercial viability. Until molecularaformulation changes can be brought about (as recently happened with two other agents: phentolamine and apomorphine), serious investigations of yohimbine will remain in limbo. It could be that the nay sayers are right and yohimbine, indeed, lacks clinical activity as a treatment for men with erectile dysfunction. As long as it remains an orphan drug, we will never know.

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Is high-dose yohimbine hydrochloride effective in the treatment of mixed-type impotence? A prospective, randomized, controlled double-blind crossover study

Cited by 47 publications

References 20 publications

Penile prosthesis implantation surgery: a statewide population based analysis of 2354 patients

Penile prosthesis implantation surgery: a statewide population based analysis of 2354 patients

Yohimbine enhances the effect of sildenafil on erectile process in rats

Yohimbine in erectile dysfunction: the facts

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