Medication Summary
Most of the following treatments for Peyronie disease are only temporizing. In December 2013, the FDA approved the first drug treatment, collagenase clostridium histolyticum (Xiaflex), for Peyronie disease.
The efficacy of Potassium p-aminobenzoate has not been established. [41]
Anti-inflammatory agents, such as colchicine, may help patients with Peyronie disease by reducing inflammation. [42]
Only anecdotal evidence for use exists for estrogen receptor antagonists such as tamoxifen. [14, 43]
Proteinase
Class Summary
Proteinase hydrolyzes collagen.
Collagenase clostridium histolyticum (Xiaflex)
Collagenase clostridium histolyticum hydrolyzes collagen in its native triple-helical conformation, resulting in lysis of collagen deposits. It is indicated in men with a palpable plaque and penile curvature deformity of at least 30 degrees at the start of therapy. It is available for treatment of Peyronie disease only through a restricted Risk Evaluation and Mitigation Strategy (REMS) program called the XIAFLEX REMS Program.
Vitamins
Class Summary
The antioxidant properties of vitamin E may limit the extent of inflammation. Vitamin E is inexpensive, has few adverse effects, and has anecdotal usefulness.
Vitamin E (Amino-Opti-E, Aquasol, E-Vitamin)
Vitamin E protects polyunsaturated fatty acids in membranes from attack by free radicals and protects red blood cells against hemolysis.
Nutrients and nutritional agents
Class Summary
These agents may improve pain and lessening of penile curvature. Their efficacy is not clearly established.
Potassium p-aminobenzoate (Potaba)
Potassium p-aminobenzoate may enhance monoamine oxidase activity and thereby lower the local level of serotonin that is thought to be a stimulant for fibrosis.
Antihistamines
Class Summary
The initial stage of a Peyronie disease plaque involves histamine-mediated inflammation. Anecdotal evidence suggests that an antihistamine may limit this inflammation.
Fexofenadine (Allegra)
Fexofenadine competes with histamine for H1 receptors in the GI tract, blood vessels, and respiratory tract, reducing hypersensitivity reactions. It does not cause sedation.
Anti-inflammatory agents
Class Summary
These agents may help patients with Peyronie disease by reducing inflammation.
Colchicine
Colchicine decreases leukocyte motility and phagocytosis in inflammatory responses.
Estrogen receptor antagonists
Class Summary
These agents inhibit TGF-beta actions and inflammatory reactions. TGF-beta and inflammatory mediators are involved in the production of Peyronie disease plaques in animal studies. Only anecdotal evidence for use of these agents exists.
Tamoxifen (Nolvadex)
Tamoxifen competitively binds to estrogen receptors, producing a nuclear complex that decreases DNA synthesis and inhibits estrogen effects.
Calcium channel blockers
Class Summary
Anecdotal evidence shows some lessening of the scarring process after intralesional injections. The theory is based on the known action of verapamil in decreasing the production and secretion of extracellular matrix macromolecules by fibroblasts while increasing collagenase production in the same area.
Verapamil (Calan, Covera-HS, Verelan)
Verapamil relaxes smooth muscles and increases oxygen delivery during vasospasms.
Nonsteroidal anti-inflammatory agents (NSAIDs)
Class Summary
These agents have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well; these include the inhibition of the following: leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Aspirin (Anacin, Ascriptin, Bayer Aspirin, Bayer Buffered Aspirin)
Aspirin is used to treat mild to moderate pain. It inhibits prostaglandin synthesis, which prevents the formation of platelet-aggregating thromboxane A2.
Acetaminophen (Tylenol, Feverall, Tempra, Aspirin Free Anacin)
Acetaminophen is the drug of choice for the treatment of pain in patients with documented hypersensitivity to aspirin or NSAIDs or upper GI disease and who are taking oral anticoagulants.
Ibuprofen (Motrin, Ibuprin)
Ibuprofen is the drug of choice for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Naproxen (Aleve, Naprelan, Naprosyn, Anaprox)
Naproxen is used for the relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of cyclo-oxygenase, which decreases prostaglandin synthesis.
Etodolac (Lodine)
Etodolac inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclo-oxygenase, which results in decreased formation of prostaglandin precursors, which, in turn, results in reduced inflammation.
Flurbiprofen (Ansaid)
Flurbiprofen may inhibit the cyclo-oxygenase enzyme, which, in turn, inhibits prostaglandin biosynthesis. These activities may result in analgesic, antipyretic, and anti-inflammatory effects.
Ketoprofen (Actron, Orudis, Oruvail)
Ketoprofen is for the relief of mild to moderate pain and inflammation. Small doses initially are indicated in small or elderly patients or those with renal or liver disease. Doses greater than 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe the patient for response.
Piroxicam (Feldene)
Piroxicam decreases the activity of cyclo-oxygenase, which, in turn, inhibits prostaglandin synthesis. These effects decrease the formation of inflammatory mediators.
Interferon intralesional injections
Class Summary
Interferon slows fibrogenesis, inhibits RNA synthesis, and inhibits oxidative stress
Interferon alfa-2b (Intron A)
Intralesional injections of interferon alfa-2a may be effective in decreasing plaques and scarring.
Nonselective phosphodiesterase inhibitors
Class Summary
These agents may reduce plaque size and penile curvature.
Pentoxifylline (Trental, Pentoxil)
This would be off-label use. Pentoxifylline may alter the rheology of red blood cells, which, in turn, reduces blood viscosity. It may be used, but with extreme caution for hemorrhage.
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Lateral view demonstrates vertical curvature.
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Superior view shows a full erection.
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Postoperative picture after surgical repair demonstrates a straight erection.
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Intraoperative picture of an artificial erection demonstrating lateral curvature.
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Intraoperative picture after penile plication demonstrating a straight erection.
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Medication
- Medication Summary
- Proteinase
- Vitamins
- Nutrients and nutritional agents
- Antihistamines
- Anti-inflammatory agents
- Estrogen receptor antagonists
- Calcium channel blockers
- Nonsteroidal anti-inflammatory agents (NSAIDs)
- Interferon intralesional injections
- Nonselective phosphodiesterase inhibitors
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