Sildenafil / Apomorphine Nasal Spray

What Is It?

A compounded nasal spray that combines sildenafil and apomorphine. Made by prescription for one patient.

How the Ingredients Work

Sildenafil by itself is a PDE5 inhibitor that acts in the penis by increasing the effect of nitric oxide. Apomorphine is a dopamine agonist that acts centrally, in the brain. One works locally; the other works centrally.

Is It FDA-Approved?

No. Sildenafil is FDA-approved as an oral pill, but this nasal spray combination is not. Apomorphine is not FDA-approved for ED in the U.S. Use is off-label and decided by the prescriber.

Important Safety Notes

Controlled trials of this drug combination are lacking, and combining a central and a peripheral agent may cause a serious drop in blood pressure. Sildenafil must not be used with nitrates. The prescriber decides if it is appropriate and monitors the patient. Mixwell makes no recommendation about its use.

Quality

Made only by prescription in Mixwell's USP <795>- and <800>-compliant lab. Mixwell is a non-sterile pharmacy and does not make injectables. Not FDA-reviewed. No result is promised, and this is not claimed to be better than commercial products.

References

1. Goldstein I, Lue TF, Padma-Nathan H, et al. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med. 1998;338(20):1397–1404.
2. Simonsen U, Comerma-Steffensen S, Andersson KE. Modulation of Dopaminergic Pathways to Treat Erectile Dysfunction. Basic Clin Pharmacol Toxicol. 2016;119(Suppl 3):63–74.