The Substitution of Phentolamine with an Equal amount of Chlorpromazine as an Alpha-Blocker in Vasoactive Cocktails used for Intracavernous Injection Therapy for the Treatment of Erectile Dysfunction

Introduction: This brief report describes the replacement of phentolamine mesylate with an equal amount of chlorpromazine HCl in vasoactive drug mixtures used as intracavernous (IC) injection therapy for treating erectile dysfunction (ED). Phentolamine; amongst other drugs; had been used in drug injection therapy for the treatment of ED; but was replaced as single drug therapy by more effective drugs; such as alprostadil (prostaglandin E1). It has; however; still widely been used as alpha-blocking agent in vasoactive drug cocktails. Phentolamine has a synergistic effect with alprostadil; papaverine and atropine in drug combination cocktails. These injection mixtures are very effective for treating ED and are commonly known as bimixtures; trimixtures and quadmixtures. The vasoactive drug; phentolamine; was withdrawn from the market in South Africa. Chlorpromazine (a phenothiazine) was suggested as an alternative alpha-blocking agent to be used in drug cocktails for the IC treatment of ED.Methods: Three hundred and sixty-four (364) patients were questioned and evaluated during follow-up visits to an ED clinic after phentolamine mesylate was replaced with an equal amount of chlorpromazine HCL in their regular IC injection preparations. The collected data is based on results from self-administration at home.Results: No significantly unusual adverse effects or altered efficacy of the new preparations were reported. The patients noted a change in the colour of the drug mixtures that contain chlorpromazine and papaverine. Despite this slight change in colour; the effectiveness of the mixtures remained the same if a use-before date of three months was adhered to.Conclusion: The results indicate that phentolamine mesylate can effectively be replaced with an equal amount of chlorpromazine HCL in IC drug cocktails for the treatment of ED

Pharmacotherapy for Chronic Heart Failure

Background : Heart failure is a chronic and progressive disorder which results due to inability of the heart to pump adequate blood to meet up the metabolic demands of the body. Detecting patients with heart failure could be simple but rather complex of clinical decisions as presentation could be classical or non-specific with minimal symptoms and or signs. Management is aimed at relieving symptoms; improving quality of life; preventing hospitalisation and arresting disease progression thus prolonging survival. In addition to pharmacologic measures; non-pharmacologic ones are also employed. Method : Relevant literature was reviewed using medical journals and also via internet. The key words employed were: Heart failure; Chronic heart failure; Diuretics; Vasodilators; Angiotensin receptor blockers (ARBS) and Angiotensin converting enzyme inhibitors (ACEI). The National Heart; Lung and Blood Institute; Canadian Cardiovascular Society; American College of Cardiology websites were also used in the course of this review. Results: This review was able to support the use of beta- blockers; ACEI; ARBS; digitalis; diuretics; vasodilators and aldosterone antagonists in the management of chronic heart failure. Conclusion : The objectives of drug therapy in heart failure includes the short-term goals of stabilising the patient; improving haemodynamic function and conferring symptomatic improvement; as well as the long-term goal of limiting disease progression; decreasing hospital re-admission rates and improving survival. The cause needs to be established and aggravating factors identified (and where possible treated). Most of the drugs; if not all; are used in combination with one another to achieve maximal therapeutic goal. Use of some drugs could be entertained as an add-on therapy depending on any co-existing medical condition.1

Attitude therapeutique devant l'insuffisance cardiaque congestive aux Cliniques Universitaires de Kinshasa

Les auteurs analysent l'attitude therapeutique des medecins au Departement de Medecine Interne devant l'insuffisance cardiaque congestive. 26 patients des 30 patients insuffisants cardiaques admis ont ete retenus dans cette etude retrospective allant de janvier a decembre 1989. L'analyse du type de traitement prescrit; de la mortalite au cours de l'hospitalisation et de l'impact financier de chaque association medicamenteuse montre une tendance elevee de prescrire les vasodilateurs veineux qui levent plus tot l'insuffisance cardiaque congestive; un impact financier moins important avec ces vasodilateurs; une lourde mortalite en presence du SIDA. Les femmes (65;4 pour cent) sont plus nombreuses que les hommes (34;6 pour cent). La cardiomyopathie idiopathique est l'etiologie couramment rencontree avec 54;2 pour cent