Intracavernous Self-injection of Papaverine Plus Chlorpromazine (Bimix) for the Treatment of Erectile Dysfunction

Erectile dysfunction (ED) affects the physical and psychological health of a patient and his partner and can have a significant negative impact on their quality of life. Second-line therapies for ED include intracavernosal injections of vasoactive drug (ICIVAD) among others.

The aim of this study was to assess the efficacy of combination of papaverine and chlorpromazine (bimix) for the treatment of ED in patients who are unresponsive to 5-Phosphodiestrase inhibitors (PDE5-I).

This is a combined retrospective and prospective study to clinically assess the efficacy of the bimix for the treatment of ED unresponsive to PDE5-I who presented to our hospital from January 2017 to June 2024. All patients' demographic information, risk factors for ED, severity of the ED, dose of the drug used, duration of erection achieved and complications were retrieved/recorded.

A total of 167 patients were recruited into the study. Their age ranged from 23 to 84 years, with a mean of 42 ± 9.7 years. Most patients were married (89.2%). The International Index of Erectile Function scores were 1-10 (18.6), 11-16 (43.7%), 17-21 (27.5) and 22-25 (10.2%). The duration of erection achieved at the office test was significantly associated with the severity of ED and the dose used; however, only 67.1% achieved strong at home and mostly at high doses (0.5-1 ml). About 4.2% reported some complications.

Intracavernous injection of bimix for the treatment of ED is effective in majority of patients unresponsive to PDEI; it is more effective in higher dose and in mild and moderate ED.