ARCHIVE: Verapamil - Injections & Topical Applications including Iontophoresis

[allj]

Doug - I am assuming when you say anti arrhythmics you mean beta blockers. When  I mentioned that peyronie's is a potential side effect of toprol, I had to show my cardiologist this info in the Physicians Desk Assistant. I tried to get off toprol and started taking verapramil 360 mg. Unfortunately, because of the high dose I had to take along with lipitor and more importantly 2 grms of niacin for my cholesterol by liver shut down. Much to my chagrin I am back on toprol. My urologist said he doubts it causes it peyronie's but said that the reason it is in the PDA is because it has a fibrotic effect. Alan

[Tim468]

Hi All,

Here is the latest update I got pushed to me via email on verapamil. The upshot is (again) that it seems to work, and that it works better over a long time. What I did not get out of this study abstract (I cannot access this journal online) is A) how it stacked up against the "weak" calcium channel blockers, B) what the demographics were in the groups (ie age and length of illness), and C) how they measured erectile quality.

Still - this suggests that patience is a virtue when it comes to verapamil. It also suggests that Texas continues to push this treatment - making me wonder what the connections are between PDL labs and this research group., if any.

Tim


AU Fitch WP 3rd.  Easterling WJ.  Talbert RL.  Bordovsky MJ.  Mosier   M.

IN Urology Consultants, P.A., San Antonio, TX, USA.
 [email protected]
TI Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie's disease--a placebo-controlled pilot study.
SO Journal of Sexual Medicine.  4(2):477-84, 2007 Mar.
AB INTRODUCTION: Transdermal and intralesional verapamil has been
 reported to be useful in the treatment of Peyronie's Disease. This
 study evaluates a topically applied calcium channel blocker
 (verapamil hydrochloride 15% gel), a topically applied calmodulin
 blocker (trifluoperazine), and a topically applied weak calcium
 channel blocker (magnesium sulfate), each incorporated in a
 transdermal vehicle. AIM: This pilot study was conducted to assess
 the efficacy of a 15% verapamil gel applied topically to the penile
 shaft twice daily for the treatment of Peyronie's Disease. MAIN
 OUTCOME MEASURE: To assess improvement in curvature, plaque size,
 resolution of painful erections, and improvement in erection
 quality. METHODS: Two simultaneous, three armed, double blinded,
 placebo-controlled studies were conducted. After randomization into
 one of four groups, patients were treated for 3 months. At the end
 of 3 months' treatment using blinded drug, each patient was treated
 with open label topical verapamil for 6 months. The studies were
 completed after each patient had been treated and evaluated for 9
 months after randomization. RESULTS: Fifty-seven patients were
 randomized. In total, 94.4% of patients treated for 9 months with
 topical verapamil experienced improvement in curvature with an
 average percent curvature change of 61.1% compared with 43.6%
 curvature improvement at 3 months. At 9 months the average percent
 plaque change was 84.7% compared with 55% at 3 months. Pain
 resolution at 9 months was 100% compared with 87.5% at 3 months.
 Patient perception of erection quality also increased at 9 months to
 81.8% compared with 72.7% at 3 months. CONCLUSIONS: Topical
 verapamil gel proved effective in eliminating pain on erection,
 decreasing the size of plaque, decreasing curvature, and improving
 erection quality in patients with Peyronie's Disease. Treatment
 results improved significantly after 9 months' treatment as compared
 with 3 months' treatment.

[Hawk]

Tim,

Good post!  It does raise a host of questions however.

Also, can you shed some light on the term "armed" as used in the sentence

Two simultaneous, three armed, double blinded,  placebo-controlled studies were conducted.

[jon]

oh sonofabitch. my uro is part of the office that conducted that study. I'm gonna have to give him a piece of my mind for not telling me about it.

[dahc]

After 6 weeks of waiting I finally got to see the doctor here in Atlanta that Dr. Levine suggested I see. I have agreed to go through a 10 week Verapamil injection program. He says he uses enough numbing agent that it shouldn't be painful. Dr. Ritenour says some people respond to Verapamil and some don't.

[Steve]

  Just be ready for that 'numbing' shot!  Unless they apply some kind of topical first (my Uro didn't), you sure do feel it.  As I remember, the Verapamil shots still are not 'painless'.

Hope you have better luck with your shots than I did--12 shots semi-weekly, and no change at all that I could see (other than some really ugly bruising a couple of times)!

Steve

[meanmrmustard]

are shots really much more effective than iontophoresis? i'm currently going through my second cycle of iontopheresis and quite glad I'm being given verapamil that way rather than having to take shots ...

[Old Man]

Steve and meanmrmustard:

The following is just my personal opinion and position of verapamil injections:


1. I had numbing shots with the first one or two when the schedule was started. I soon realized that the numbing shots were just another puncture into the area and in turn amounted to sometimes three or four "invasions" into the corpus chambers, etc.

2. After about 5 or 6 of the injections, some with numbing and some without, I developed a nodule for each and every injection I received. So, my uro and I decided that after 12 of them, they should be stopped and not cause more nodules. Some of the nodules "joined together" and caused more plaque to form.

3. Research on several forums for verapamil treatment therapy convinced me that they were not for me if I was going to get more nodules and/or plaque from them.

So, as I said, the above is basically the bottom line for me on taking verapamil injections. I would recommend that anyone who has a high threshold of pain not take the numbing shots. This, of course, would reduce the number of invasion of "needles" into the penile tissue. If one just has to have the numbing shots, use only the smallest amount to deaden the pain, etc.  IMHO, any invasion of the penile tissue can aggravate the Peyronies Disease symptoms.

The above is just my considered opinion after taking at least 12 verapamil injections for my Peyronies Disease. And, it took quite a bit of other therapy sessions to eliminate most of my Peyronies Disease.

Old Man

[Steve]

MMM,

Let's see...12 shots and no discernable improvement...I don't know...is Ionto more effictive?  At least it's not as painful (or so I've heard).

Of course, I'm speaking only from personal experience--I assume that VI has helped someone somewhere   just not me

Followup to Old Man:
Yeah, after about half the injections, I noticed the waisting beginning to occur.  My Uro assured me that this was a 'normal' progression of Peyronies Disease, and not a result of the injections (yeah. right).  Now, a year later, I can definately detect some deep scaring in the area of the injection sites.  So, bottom line, if someone asks me my personal opinion on VI, I'd recommend to try another treatment--VED isn't invasive, and is relatively painless (although as yet, it hasn't helped me either).

[dahc]

I saw the survey for Verapamil injections on this forum and it didn't look too good, but my doc is working with one of the top Peyronie's disease doctors around and it is part of what he recommended. I'm hoping that along with the Pentox, L-Arginine and the traction device I'm using my outcome will be different. I guess I'll find out over the next couple of months.

Chad  

[dahc]

I have seen where some people think that the injections themselves were causing more scarring and it is definitely a concern. My Peyronie's appeared about 6 months ago and my doctor along with Dr. Levine are for early intervention with Verapamil injections being PART of the plan to treat, not cure, Peyronie's. I really appreciate the warnings, but this new Urologist I'm seeing really has my respect and confidence. I'll post the outcome whether it's good or bad.

[Hawk]

Chad,

You would provide an invaluable service to keep all of us updated.  While there are many warnings and discouragement with VI patients, reportedly there is some success.  i am also not convinced all VI is equal.  Technique may account for a big difference.  Also, the combination of traction, arginine, etc may be a key.  If you make some OBJECTIVE starting assessment of: length, girth, and curve, and keep us informed it will help answer such questions for thousands.

Good Luck !!!

[voulezvous]

Pardon the pun...allow me to "inject" my thoughts on shots.

I had a series of 10 (out of 12 suggested) also on a bi-week basis @ the VA hospital here in Minneapolis. No discernable improvement...in fact, as stated by others, more plaque then ever.

One of the memorable comments I recall from one of the urologists was that it was like try to inject "into a brick" & he could not be sure that he was even going into the scar material. That did it. If they can't even be sure where the needle is going (oh yeah, "watch that you don't hit the urethra" was another comment to remember), then I am outa here!

I am meeting with a private urologist next week to discuss implant surgery.

[hopeful]

Can you please let  me know what IONYO protocol you are using? Is it www.physion.com ?- Ar eyou doing it yourself or going to a doctor.. if yourself- who prescribd for you.. what kind of success??- Please

Hopeful

i'm currently going through my second cycle of iontopheresis and quite glad I'm being given verapamil that way rather than having to take shots ...

[meanmrmustard]

12 sessions, during four weeks: 2x a week, then weekly. I am going to a doctor in Spain, where I'm currently residing.

as I told in previous posts, I most certainly don't have Peyronies Disease, but something that looks like an until now unexplained cronic inflammation, which is why I'm not competent to talk about the effects of Ionto on Peyronies Disease. what I do note is improvement of my glans, lesioned 5 yrs ago (increased sensibility and more fullness - flaccid as well as in erect state). furthermore a fuller hang and slightly better erections, but the thing with the erections is, that the improvement is noticeable mostly only the same day that i received treatment. this observation actually made me get another blood-test including CRT-levels among other things (results haven't arrived yet), because I figured having some kind of infect that requiered antibiotica. sorry to get off topic here and hypothetical once more ... I know that these kind of infects and inflammations, like epididymis or orchitis, cannot cause ED, my theory is the following: bending penis sharply in my pants caused some trauma in my penis, lesions that would maybe heal on it's own normally, however, the healing process was prevented by inflammation/infect.

to everyone applying to me once more to see a doctor instead of doing self-diagnosis, please reread, cause I did see a doctor. the rareness of my symptomts leaves them perplexed, making me feel forced to investigate on my own.

[dahc]

As part of the 3 pronged treatment plan I got my first Verapamil injection today. The numbing agent injection was less painful than Novocaine injections I've gotten at my dentist. I really couldn't feel the Verapamil injections. The worst part was before the injection when the nurse squirted my crotch full of cold Betadine. It's about 5 hours since the injections and my penis feels a bit sore. I was told I could resume using the stretching device tomorrow.

Last week I had the Doppler ultrasound and other measurements performed. Blood flow to the tip was still good which the doctor said is a problem with P.D. I know what degree my curve is now. This was done at prestigious university clinic which is good, but I had an audience. There was the nurse that did the ultrasound, my doctor and two urology residents. A liver ultrasound is one thing, but having an induced erection for about 45 minutes in front a small group of people was pretty embarrassing.  

[Hawk]

having an induced erection for about 45 minutes in front a small group of people was pretty embarrassing.  

Depends entirely on the group of people

[jon]

having an induced erection for about 45 minutes in front a small group of people was pretty embarrassing.  

Depends entirely on the group of people

true that

[Old Man]

Hey guys:

Try this one on for size.

During the early days of my prostate cancer battle, I agreed to let my urologist give me the sono gram and biopsy tests while naked in front of about 25 urologists which included many women.

Kind of embarassing at first, but then again, I did agree to do it in the interest of teaching others the procedure.  

So, whatever it take in the interest of helping others.

Old Man

[dahc]

Yesterday was my second set of shots, very slight bruising at the base of the penis. Again, the numbing shots weren't really painful & I couldn't feel the Verapamil injections at all.

I like my doctor a lot, but I'm still not crazy about being nekkid from the waist down in front of people. I had a different nurse sterilize me while a new resident watched and he looked on as my doctor did the injection procedure. I'm sure it means nothing to them but I wish they would at least ask if I was OK with it. Maybe I would charge per resident viewing or at least negotaite a discount on my bill.  

[Hawk]

Chad, I see what you mean.  You do look a little embarrassed.  I was just looking at a few pictures of you during the procedure that someone posted on the internet.  Musta had a camera phone.




Relax, just a little sick humor  

[voulezvous]

Here's one for you...

My girl friend text messaged me while I was getting my 8th shot:

"Is the dick dr. needling your noodle?"

Everyone had a good laugh....even Dr. Dick (his actual 1st name)

[needasolution]

i had 5 injections spaced roughly every two weeks. absolutely no positive change, but i did get worse.

ps- i'm new to posting things here and i'm just trying to figure out how this whole message board works, so if this doesn't go where it's supposed to, forgive me!

[Hawk]

NAS,

You are posting just fine.  Welcome to the ranks of those that actively contribute to the PDS by actually posting comments and questions.  It is the only thing that makes a support forum work.

Regards

Hawk

[Tim468]

I found the title misleading to say the least. More get worse than get better is the bottom line that I see. Moreover, without a control group to say how many would have gotten worse anyway (or better - sorry Liam), it is hard to say that Verapamil does anything to help Peyronies Disease.

Tim
**********************************

AU Bennett NE.  Guhring P.  Mulhall JP.
FA Bennett, Nelson E.  Guhring, Patricia.  Mulhall, John P.
IN Department of Urology, Weill Medical College of Cornell
 University, New York, New York 10021, USA.
TI Intralesional verapamil prevents the progression of Peyronie's
 disease.
SO Urology.  69(6):1181-4, 2007 Jun.
AB OBJECTIVES: To define the impact of intralesional verapamil
 injection therapy on penile deformity in men with Peyronie's
 disease. METHODS: Patients underwent a total of 6 intralesional
 injections of verapamil. Penile deformity was assessed at baseline
 and 3 months after the last intralesional injection of verapamil
 during penile erection after the administration of intracavernosal
 medication. Measurement was recorded using a goniometer at maximum
 penile rigidity. Endpoints included change in magnitude of
 curvature, stretched penile length, penetration ability, and
 resolution of pain. RESULTS: Ninety-four consecutive patients met
 all inclusion criteria. Mean (+/- standard deviation) patient age
 and duration of Peyronie's disease at time of baseline deformity
 assessment were 44 +/- 18 years and 5.2 +/- 2.7 months,
 respectively. At baseline 86% had dorsal and 14% lateral curvature.
 The mean curvature and stretched flaccid length were 50 degrees +/-
 28 degrees and 12.6 +/- 3.1 cm, respectively. At the follow-up
 evaluation, patients were 5.2 +/- 1.8 months after their last ILV
 injection and were 11.7 +/- 4.2 months after the onset of Peyronie's
 disease. Eighteen percent of patients had improvement of curvature,
 60% were unchanged, and 22% worsened. Pain resolved in 100% of
 patients. CONCLUSIONS: In response to intralesional verapamil, a
 minority of men experienced improvement in penile deformity;
 however, the majority of patients had stabilization of their
 deformity. This information may permit clinicians to give realistic
 expectations to patients considering intralesional verapamil
 therapy.

[Hawk]

The fact that an attempt would be made to draw positive conclusions where:

Only the minority of cases showed improvement
More got worse than improved
change in magnitude of curvature or penile length of the improved or worsened category were not reported
a small majority had no change
Pain was a reported factor - resolution of pain is so universal that it always seems used to skew results.
there was no randomized control group for comparison

I find this study and the conclusions (actually the biased heading) somewhat astounding.

These results are not much better than our unscientific patient survey assessing VI http://www.peyroniessociety.org/survey_ilv2.htm  

Keep in mind there are several drawbacks to such surveys
1. Patient self-assessment usually favors inflated reports of improvement
2. Those surveyed belong to a forum dedicated to fighting a disease (diminished reports of improvement)
3. A survey is not a study.  As items 1 & 2 indicate, such a survey has no controls, nothing is randomized.

[Liam]

I imagine the results woul be the same.  The title was very misleading.

You know, that report kinda makes me upset.  These doctors know better.

[dahc]

I had my 6th Verapamil injection 2 weeks ago and today my urologist will induce an erection and measure my curve. The doctor has the previous measurement from the Doppler Ultrasound so we'll see. If there is a change in curve it must be very small. So it will be my decision today whether to move forward or quit. I know how people on this forum feel about Verapamil, but I'm really torn. Maybe my condition would be worse if I hadn't started the injections? The doctor always said his goal was to make the plaque like swiss cheese, could 6 more help?  

D

[Hawk]

The doctor always said his goal was to make the plaque like swiss cheese, could 6 more help?  

D

Answer: Yes it could help, it may do nothing, yes it could make things worse.

I know that answer is almost useless but asking a bunch of guys does not do much to change the limited data you have to go on.  I wish there was more certainty in either direction.  

I take it you have seen the Mulhall study and our PDS survey

[Tim468]

The interim analysis is good - your doc is thinking. If there is no progress, then you have your decision already (perhaps). If you are better you may decide to go for it and see if more is better.

Tim

[dahc]

I have read the PDS survey and Dr. Mulhall's study, not very incouraging. I read the PDS survey before I started with the shots. I guess I wanted to believe that it would be different for me.  

Tim, I had to ask my urologist to check things out after 6 shots before proceeding. He usually gives 10 injections in a 20 week period.

[dahc]

I had my evaluation yesterday and my curve went from 44 degrees when the doctor originally measured to 26 degrees. I would have guessed little to no change. To be honest my really firm erections are few and far between these days so it's really difficult for me to check things out. When I am erect what I notice more than anything is a loss in length from my healthy penis size.(Still less than 1 year ago so I remember it well)

I've had 6 Verapamil treatments, used the FastSize for at least 4 hours a day and taken 500mg of l-arginine twice a day. I was supposed to have been taking Pentox also, I tried on 3 separate occasions and couldn't handle the side effects.

The doctor made the choice to wait 12 weeks and re-evaluate me and decide whether to continue with more Verapimil treatments.

D

P.S. I questioned my doctor again about the effectiveness of Verapamil and he told me that he has seen
      men go from having a pronounced curve to no curve and everwhere in between. I'm not trying to  
      advocate Verapamil, but maybe there is some skill that some doctors have in doing the treatments.  
      My doctor always says that he is making Swiss Cheese out of my plaque.

[Hawk]

Don't apologize for reporting your results or what the doctor said.  We don't filter evidence to support our conclusions here.  We assess evidence to reach conclusions.

I am happy for your results.  I do doubt that your uro is more skilled at VI than those preforming the study, and who have taught many other urologist how to administer VI.

[Liam]

I remember Hawk's rumination that the needle may be responsible as opposed to the drug.

[dahc]

Could be just the needle. I guess there would need to be double blind test to know for sure. Can you imagine anyone volunteering for that one.

D

[flexor]

dahc

If the doc is using the needle to make swiss cheese of your plaque, he may be accidentally doing the Leriche technique, and the verapamil may only be incidental.

[soxfan]

dahc

If the doc is using the needle to make swiss cheese of your plaque, he may be accidentally doing the Leriche technique, and the verapamil may only be incidental.

That Leriche technique has always intigued me. Does anyone have any further information about it?

Cheers.

[Liam]

I emailed 2 doctors known for using the LeRiche technique.  One responded and said to contact the other.  The other has not responded.

Use the search to find their name.  Maybe you will have better luck than me.  A copy of my email is in the forum.

[tman]

Has anyone tried topical Alprostadil?

[Tim468]

Not sure this belongs in this area, as topical Alprostadil is designed for treating ED. IT causes genital burning, so it has not exactly caught on as a treatment of choice for ED.

Tim

[Old Man]

tman:

Alprostadil was also used in the penile injections for erections. The ED injections have caused many of us to have more Peyronies Disease symptoms. So, IMHO and bottom line advice, don't use it in any form.

Old Man

[Liam]

 

Kimo
Voting Member

     Re: Open Questions on Peyronies Disease (That won't fit under any of our current topics)
« Reply #549 on: Yesterday at 11:18:51 PM » Quote Modify Remove Split Topic  

--------------------------------------------------------------------------------
Steve,,,,I used the Topical Verapamil and it worked great for me. I know that no one wants to believe me, but i'm the one who used it and it worked...

When i first got Peyronies i was twisted and bent like a ugly donut and my plaque was the size of a quarter..I started using the TV and it took about 3 months before i noticed any change and then it was all of a sudden and by the end of the 5th month i was almost straight but left slightly bent up..My plaque was softend up or broken up but still there...A year later i went back on the topical V to see if it would do anymore for me..I was on it for a whole year, using it 2 times a day, faithfully...At the end of a year my plaque was all gone and no more pain when getting an erection....I could always feel it penetrating the skin [ tunica ] and i know that it really did help me...

Now i know that it doesn't help everyone, but it does help some..I have talked to other men over the past 10 yrs who have used it with success. If i hadn't seen any results after 6 months to a year then i would agree with you, but i was willing to go for the long term to give it a try and i'm glad i did....I have no reason to promote this product or tell a lie other than it really did help me and i'm grateful for it....

This is just my humble opinion and all i want is to be a help to others.....

Kimo  

I forgot you had that much improvement.  In another post you mentioned a deep nodule that TV would not reach.  Has ther been any change in that?

Thanks for the post!

[Kimo]

Liam,,,,,that nodual came on a few months ago, it was recessed back behind my pubic region and it did hurt a lot for awhile, usually during intercourse...It has stopped hurting and doesn't bother me anymore..It is still there and because it doesn't seem to be doing anything i'm not worried about it, ,,it didn't cause any bending i guess because of where its located...

My first plaque area was about half way up my shaft and that is gone, only a little scar tissue remains and i'm slightly bent upwards, kinda nice for sex, it hits the right spot...The corona or tip of my penis used to be kinda numb for a long time, but after the second round of TV when the plaque all dissolved then thats when my feeling all came back too....

Kimo

[dahc]

Kimo,

Have you had a chance to see Dr. Levine's webcast "Non-Surgical Treatments for Peyronie's Disease"?
Scroll down on home page: http://webcasts.prous.com/AUA2007/article.asp?AID=87&CID=YY&CLID=2

I'm just trying to wrap my head around what he has to say about Topical Verapamil and your account of severe Peyronie's deformity almost being healed by TV. I have no doubt that your story is true, I just wonder if there could be any other explanation of your correction. Were you doing VED or supplements at the same time?

Not trying to be an a**hole, just confused and also happy that you've had such a significant correction.

D

[phil]

I reviewed the Levine presentation and was wondering if anyone knows anything about liposomal superoxide dismutase gel?

[phil]

Also,  anyone using ionto and what kind of results are you getting?

[Kimo]

Dahc,,,,The only other thing i was talking was 800 iu of a natural vita-E which i bought at GNC.....My URO said it was his belief that it would help the TV to do it's job better, so i took it for a long time, about 4 to 5 yrs...One thing i will say about the vita-E , after being on it for so long i started having a lot of dizzy spell's and i finally heard that it was a blood thinner, so i quit taking it and my dizzy spells went away.....I think i just took it for too long...

I have a VED but have never used it, only maybe practised with it...I stated that i used to TV for 5 months the first round and it brought me back to about 85% straight but still left the quarter size plaque which was really hard to the feel..The second round which went for 12 months broke up the plaque and dissolved it and it is all gone...

I have another plaque recessed way back behind the pubic area the size of a dime,this came on about a year ago,,,was very painful for awhile during intercourse but finally stopped hurting and it doesn't bother me anymore..It cannot be reached by a topical so i just don't worry about it and it didn't make me bend any..

When i was using the TV i could feel it penetrating the skin and i know that's what helped me,,It didn't correct it's self, i was twisted and bent too bad and in a lot of pain all the time for quite sometime.....I had the bad bend and pain for about 6 months before i started using the topical...My URO recomended that i try it and i'm glad i did.....

Yes i viewed Dr Levine's webcast,, very interesting, i willl try to read into it more.....

YOur not being an a**hole,,,the only ones i know who fit that catagory are the one's who have treated my children and grandchildren badly..You are quite welcome to ask any questions you want....

Kimo

[amigo]

I'm with Phil... is there anyone out there who has used ionto recently?  I remember reading the first reports years ago and watching scientific studies go back and forth on the issue.  Obviously, Dr. Levine's most recent study into ionto was disheartening to say the least. I've got a doc who's willing to write my prescriptions for the treatment, but i am somewhat apprehensive about spending the $1300 that Physion's U.S. distributor charges for the Physionizer 2.0 machine and enough electrodes and verapamil mix for a full treatment cycle.  It doesn't help that the successful studies (and Dr. Levine's unsuccessful study) all used the Physionizer 3.0 which can produce the 2.4 mA current while the Physionizer 2.0 available here through the U.S. physion reps only produces 2.0 mA maximum.  Still, desperate men do desperate things, and I would gladly pay $1300 for a cure... I'd just like it to come with a guarantee.  Is that really so much to ask?  

--amigo

[Hawk]

I am not certain, but I think if you read back on the topic, that both Tim and Comebackid posted quite a bit about ionto within the last year.

Do a search on "ionto" without the "", put Tim468 in as the member and be sure to check "Show results as messages"

[j]

Amigo, I'm a technical guy and if I thought iontophoresis worked I'd be doing it.  I've followed the posts here and elsewhere for years and as far as I know, no one has ever gotten any benefit from it.  It's pretty much a shot in the dark because no quantitative research has been done - i.e. no one knows how much, for how long, or what current and polarity might be expected to do anything.

I could be wrong, and of course I hope I am.