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Apomorphine in erectile dysfunction (use with nitrates)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Efficacy rates with apomorphine are lower than those reported for PDE5 inhibitors, ranging from 26 to 55% and this product has now been discontinued in the UK (1)

Sublingual apomorphine is a treatment option for erectile dysfunction

  • centrally-acting dopamine agonist - acts primarily on the D1 and D2 receptors, although it has a degree of selectivity for the latter
  • effective after about 20 minutes
  • does not affect sexual desire; only produces an erection with sexual stimulation
  • it is well tolerated at doses producing a positive response in about 40-50% of patients (1)

Adverse effects include:

  • headache
  • nausea
  • dizziness
  • syncope - there is a risk of syncope of about 1 in 500 due to a vasovagal response, so patients must be advised to exercise caution when trying the drug for the first time, or when increasing the dose (2)
  • there have been no reports of death, severe cardiovascular events such as myocardial infarction, cerebrovascular accidents or priapism throughout the phase 3 trials of apomorphine (3)

Contraindications include:

  • history of unstable angina
  • recent myocardial infarction
  • hypotension
  • severe heart failure

Note that (4):

  • the maximum recommended dose in those with "severely impaired renal function" is 2mg
  • men with "significantly impaired hepatic function" should be given the drug only if the "benefits outweigh the risks",and then started on a dose of 2mg, with "care exercised" over any dose increase
  • "the limited published evidence suggests that apomorphine improves erectile dysfunction but is less effective thn sildenafil"
  • "sublingual apomorphine is the only licensed oral drug for erectile dysfunction not absolutely contraindicated with nitrates, so may have a place in men taking such therapy "

The summary of drug characteristics must be consulted before prescribing this drug.

Reference:


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