ED Drugs- A Personal Perspective

by Dan Copeland

updated with new information

I do not use ED drugs recreationally. I was diagnosed with a condition commonly associated with ED, and I take two different drugs with ED as a known side effect. Talk about a triple whammy. Needless to say, ED treatments are rather important to me.

I tried Viagra years ago when it was much more expensive and I was in much better health. It worked most of the time, but the timing could be an issue, and having a heavy meal before hand did delay the amount of time it took to take effect.

Sildenafil, as it is properly called, works by relaxing the muscles in the walls of blood vessels and increases blood flow.

Viagra is the brand name, but it is also available under other names. For example, Revatio is used to treat arterial hypertension and improve your ability to exercise. It is sildenafil, and should not be mixed with Viagra. Sildenafil is also incompatible with a lot of other medications, so you want to check online first. I say this because I know a lot of people, as I did years ago, try this without a prescription.

I have not experienced the sudden and temporary vision loss that a few men have, but I have had the slight blue tinge to my vision. That was years ago, though, and I have not experienced that with recent use. I do experience the flushing, headache and upset stomach, though, but not every time. They are not a big deal but they are annoying.

The big plus for Viagra is that it is now much cheaper, but not as cheap as it will be. In December 2017, Teva Pharmaceuticals and Mylan will introduce the first FDA approved generic Viagra. Even so, through Kaiser, I now get Viagra in the form of five tiny pills to a dose for $11.35. There were 40 pills, or $1.42 per dose. That is very reasonable. However, many insurance companies stopped paying for Viagra in 2016. Without insurance, the price skyrockets to about $100 per pill.

Another drug that works in essentially the same way is vardenafil. It can be found in the brand names Levitra and Staxyn. I have not tried it, but based on what I have read, Levitra is essentially the same with the exception that its effects last a little longer by about an hour. I have tried Staxyn, which you dissolve under your tongue. The advantage is that it does work faster, in as little as 15 minutes, and lasts even longer than Levitra- by about an hour. Other than that, I did not experience anything that was all that different than my experiences with Viagra. They do suggest that you use Levitra first before trying Staxyn to make sure there are no problems. I did not know that when I tried it.

Stendra and Spedra are ED drugs with avanafil as the active ingredient. They work in basically the same way that Viagra does. Stendra is the newest ED drug to get FDA approval. It is believed that avanafil is a more effective PDE 5 blocker than sildenafil. This means in theory fewer side effects. Men using it report that it works much faster than sildenafil, cutting the time in half. Like Staxyn, it gives about two hours more functionality than Viagra (four hours compared to six). It is still relatively new, though, so there is not as much user data available is with the other ED drugs.

I had tried Cialis years ago and remembered that it worked better for me than Viagra. So, we asked our doctor for a prescription. When we went to pick up the 20 tablets, the cost was $1,000. Talk about over the top sticker shock. That is insane. None the less, we got three tablets to try to see if it was worth exploring any further.

Cialis has a lot of advantages over Viagra. I have not had the side effects I get from Viagra, but have experienced the known side effect of muscle pain. Since I already have muscle pain, it is difficult for me to assess exactly what is happening, but it does seem that I have had more pain after taking Cialis, but not on every occasion, so I can not give a definitive answer.

The big advantage is timing. While for me it takes a lot longer, even hours, before it really gets working, the main advantage is that it continues to work for a long time. Theoretically, it is supposed to last for up to 36 hours, but I have gotten several days benefit from it. It seems to me to work even better on the second day. This can make for a great weekend.

There is also a daily dosage of 5mg that you take every day. It is almost impossible to do comparison shopping on drug prices because insurance companies vary so much in their coverage, but any way you go this option is going to be very expensive.

The good news is that Cialis goes out of patent at the end of 2017. It would be a top choice if I could get it at a lesser price, but right now, even with insurance, the cost is prohibitive.  At this time, no companies had announced plans for a generic version, with the exception of Lily partner Sanofi, which announced an over the counter version. How long that will take to get to market here is unknown. I would not expect it any time soon, as adding the over the counter option requires new FDA approval. In the meantime, Lilly can still charge the same ridiculous prices.

I have also tried the final option, one that sends shivers down the spine of many men. I am talking about injection therapy. The main advantage in my experience is that it is highly effective. It works in about 15 minutes, and even when I am experiencing a lot of pain that is distracting enough to throw off the effectiveness of other drugs. When I need a sure thing, this is what works.

The bad news is two-fold. First, you have to stick a needle into your penis. The technique is easy to learn, but I still have to try not to think “Oh my god, I’m sticking a needle in my penis” right before I use it. The pain of the injection is negligible, it is mostly the psychological reaction that can be challenging.

The second problem is that while for me it has been pretty much a sure thing, it is a short-lived sure thing. You can keep going for 30 minutes up to an hour or until you orgasm. It may not be the best solution for an all night orgy, but it can make penetrative sex a possibility when it otherwise would not be. For hard cases like myself, or rather not so hard cases, it has been very beneficial.

Through my insurance it is quite inexpensive, around thirty to forty dollars for a month’s supply. However, you need to wait 24 hours before you use it again, and you can only use it twice a week, so a maximum usage is just 8 times. It is only good for abut a month or so, but in reality I found it was still effective longer than that.

Here is the official description of what it is: “Single drug injection therapy uses alprostadil, a type of prostaglandinE1 (PGE1), and is called either Caverject® or Edex®. Combination therapies, called “bi-mix” (for 2 drugs mixtures) or “tri-mix” (for 3 drugs mixtures), are a mixture of either two, or all three, of the following most commonly used drugs: papaverine, phentolamine and/or alprostadil (the same thing as prostaglandinE1, also known as PGE). ”

I had been using a bi-mix, but suddenly it became unavailable for months through Kaiser, and buying it on the open market would have cost hundreds of dollars. They then sent me papaverine by itself, which did little to nothing for me. Now I have the trimix, and for me, it is the ultimate.

On the trimix, I got a hard erection that lasted around two and a half hours. That was with a dosage of .3ml. Lesser dosage reduce the time of erection. On the needle that reads as 30 units. The mixture I use is 1MG phentalomine, 30MG papaverine and 20MCG prostagandinE1.

I actually got very little information from my urologist, and there were a lot of things he did not explain. Keep in mind that i am not a doctor and this is not medical advice. This is a report on my experiences and what I learned from doing a little research.

One of the issues is on the storage of trimix. Advice on the Internet is all over the place. Some say never freeze, others say freeze. There is little agreement on how long the stuff is effective, and mine have been labled as discard after as little as 30 days for storage in the refrigerator and discard after 90 days when stored in a freezer. Fortunately, there have been studies that give some real answers. Jeff Booth, who does the Sex Science Saturday segment on his Jeff Booth Show, pulled this up for me. You can find it through Pubmed.

It is titled “Long-term stability of trimix: a three-drug injection used to treat erectile dysfunction.” Their conclusion: “Alprostadil was the least stable of the drug components at room temperature and under refrigeration. About 8% alprostadil loss occurred in five days at room temperature; under refrigeration losses of about 6% and 11% occurred after 1 and 2 months, respectively. Frozen at -20 deg C and -70 deg C, less than 5% loss of any of the drug components occurred in 6 months.” The bottom line is that you you can keep this stored in a freezer for six months with only minor loss of effectiveness.

They send me a bunch of tiny vials, each one has a few doses depending upon how much you use. You take it out of the freezer, and give the vial a half hour or more to thaw. You then put it back in the freezer. Thanks to the study, we know that you can thaw and freeze it four times with no loss of potency.

You lose 12.5% of the alprostadil in 7 days at room temperature, but only 2% after seven days in the refrigerator and 6% after 30 days. The stuff does lose potency over time, but certainly lasts much longer than the pharmacy has been telling me. Freezer storage is the way to go.

There are some other things I learned that my doctor did not explain to me. If there is a lot of resistance when you press the plunger, just back the needle out a little bit and try again. You do not want to pull the needle all the way out and try again if you can help it, as you want to minimize the number of times you put a needle into your tissue, so as to minimize any scarring. That sounds scary, but it is actually not all that likely, but it can happen.

That is also why they have you alternate sides of the penis for the injection. Repeated injections in the same place should be avoided. The basic recommendation as been one side of the penis per week, which is also why they tell you not to use this more than twice a week. However, if you do, your penis is not going to fall off. You just do not want to use it more than two times a week on a regular basis. If you have a hot date and it is the third time that week, I have read of nothing bad that will happen to you. Just don’t do it frequently.

Another tip that I have tried that seems to make it work better is to keep pressure on the injection area for a couple of minutes. Then rub the penis, if you do not have someone there to rub it for you. I inject in private so I do this part myself. Supposedly, the rubbing helps distribute the mixture. I do not know if this is true or not, but I did seem to get better results.

There are newer things that I have not tried personally. Muse is designed for people who are not getting good results from PDE-5 inhibitors like Viagra, Cialis and Levitra. It is the size of a grain of rice, and you insert it into the urethra. Like the injection drug therapy, you can only use it once in a 24 hour period, and only 3 times a week. One possible side effect is a burning in the urethra. Considering how much I dislike catheters, this would not be my first choice.

There are also penis pumps. They are the only option where discretion is probably not an option. Known as vacuum constriction devices, or VCDs,  you put your penis in them and then pump the air out. The vacuum draws blood into the penis.  You maintain the erection by sliding on what is essentially a cock ring.  As with everything here, your insurance might or might not cover it. They run around $300, but it is a one time expense.

So, the bottom line is that there is no perfect solution, but at least we have solutions, as imperfect as they might be. For some, Viagra might be all you need. For most, though, if cost were no object, I prefer Cialis. When I absolutely positively have to get it on overnight, nothing is as effective as injection therapy.