I recently discovered an interesting Sicilian trial on sub-lingual apomorphine (Uprima & Zyprima) published in ‘Urology’ in November 2003.
Savatore Caruso headed a team from the University of Catania School of Medicine, to study patients with mild to moderate ED, and mild hyperprolactinaemia, who were non-responders to ‘on demand’ apomorphine. 34 patients were screened and twenty patients started taking apomorphine on demand (at least twice a week) for four weeks, and eighteen completed the course. Only three patients reported benefits, and the fifteen who remained ‘non-responders’ then took the apomorphine daily for four weeks. Thirteen of the fifteen patients (86%) reported satisfaction with the treatment. (Those twenty patients tended to have idiopathic dysfunction, and were younger than is usually found on such trials.)
The baseline IIEF-EF score of the initial twenty patients was 19.3 , which increased slightly to 19.4 in the eighteen patients remaining after four weeks of ‘on-demand’ treatment. However a fortnight of daily 2mg apomorphine increased the average IIEF-EF score to 23, and a further fortnight of daily 3mg apomorphine increased the score to 25.1 (no dysfunction!) in those, initially non-responding, patients. As those patients were initially non-responders, you might surmise that the few who responded to an ‘on demand’ regimen would have done better still.
Adverse events were of mild or moderate severity, either during the ‘as required’ drug intake (four patients) or during daily use (three patients) and were mainly nausea, dizziness, or headache.
The report opined that previous trials of apomorphine have a poor success rate probably because it is used ‘on demand’, - in the manner of Viagra. They stated that in the ‘daily dosing’ trial “we observed a significant improvement in both subjective and objective aspects scored with the IIEF. …and it cannot be excluded that a subgroup of men with ED may have an impairment of central dopaminergic function.
A daily regimen of apomorphine would have another big advantage over an ‘on demand’ regimen (apart from efficacy) and that is: you wouldn’t be desperately letting the Zyprima dissolve slowly under your tongue whilst attempting to carry on a conversation in a nonchalant manner, and pretending you don’t have a problem. (It’s difficult.)
However, I started on 3mg of Zyprima on 19th December 2013 and I detected improved erections and orgasms. But after the Day 3 my mouth become very sore, huge ulcers developed, I felt unwell, and I discontinued the experiment. (Uprima, unlike Zyprima didn’t give me a sore mouth.) I’ve always been prone to mouth ulcers, but perhaps those with a less sensitive mouth than I might find this worth a try.