Xialla and ED Medication

Contents

• How ED medications work
• ED medication effectiveness
  • Oral medication for ED
  • Injection medication for ED
  • Urethral pellets for ED
• Effectiveness of ED medication over time
• Combining ED therapies
  • Combining Xialla and ED medication

Xialla can be used alongside common ED medications — oral pills, intraurethral pellets, and intracavernosal injections. This article summarizes how those three medication types work, where they fall short, and how pairing them with a device that slows venous outflow can change the result.

How ED medications work

Medications for erectile dysfunction advanced rapidly in the 1990s. Within a few years, the first oral PDE5 inhibitors were approved, followed by medications that could be inserted into the urethra or injected into the penis.

These formulations differ, but they share a mechanism: they are vasodilators. They relax blood vessels and increase blood inflow to the penis.

Increasing inflow does not always produce a usable erection. A sustained erection also requires reduced venous outflow. When outflow remains high, blood leaves as fast as it arrives.

Xialla is designed to slow that outflow. In a clinical trial, 14 of 21 men with moderate to severe ED had improved erectile function; some used Xialla alone and some used it with medication or injections (Littlemore, Laing, and Bella, Journal of Sexual Medicine, 2017). Xialla does not replace a prescribing physician's advice about dose changes.

ED medication effectiveness

Oral medication for ED

In a meta-analysis of randomized trials of sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor, 79% of 517 men on a dose-adjusted regimen reported improved erections, compared with 21% of 524 men on placebo (Moore, Edwards, and McQuay, BMC Urology, 2002).

PDE5 inhibitors tend to be less effective — and sometimes ineffective — for men with the most severe erectile dysfunction, including those with nerve damage from diabetes or prostate cancer surgery. Side effects can include vision changes, muscle pain, low blood pressure, headache, flushing, and gastrointestinal symptoms. In a four-year extension study of 979 men who had completed earlier sildenafil trials, 3.8% needed a dose change or stopped because of side effects, and 6.3% stopped because the drug did not work well enough (McMurray et al., Therapeutics and Clinical Risk Management, 2007).

Injection medication for ED

Injectable medications were approved by the FDA in 1995. In a six-month self-injection study of 683 men, men reported being able to have sexual activity after 94% of injections (Linet and Ogrinc, New England Journal of Medicine, 1996). In a study of 105 men who had used injections for an average of 8.4 years, men rated their penile rigidity at an average of 41% before treatment and 90% on treatment (Bearelly et al., International Journal of Impotence Research, 2020).

Side effects can include fainting, dizziness, and low blood pressure. Pain, infection, bruising, and scarring can occur when the injection is difficult to administer. In the Linet and Ogrinc study, 50% of men had penile pain, usually mild, at some point, after 11% of injections. In a survey of 1,116 men who had chosen injection therapy (72.5% responded), about 40% had stopped, most within six months. The main reasons were inadequate rigidity, cost, penile discomfort, and lack of spontaneity (Purvis, Egdetveit, and Christiansen, International Journal of Impotence Research, 1999).

Urethral pellets for ED

Pellet medication was approved by the FDA in 1996. A Medicated Urethral System for Erection (MUSE) inserts a suppository into the urethra, where the drug is absorbed. In a placebo-controlled trial of 1,511 men, 65.9% had an erection sufficient for intercourse during clinic testing. At home, 64.9% of these responders given alprostadil had intercourse at least once, compared with 18.6% given placebo (Padma-Nathan et al., New England Journal of Medicine, 1997).

In the same trial, mild penile pain followed 10.8% of treatments, and 3.3% of men had low blood pressure during clinic testing. Bleeding or spotting can occur.

Effectiveness of ED medication over time

Long-term research on how ED medication effectiveness changes over years is limited. Some men find that results fade, or that they need a higher dose, as their condition progresses. In the McMurray study of 979 men, more than 94% said at each yearly assessment that they were satisfied with the effect of treatment on their erections. In a two-year telephone follow-up of 82 men taking sildenafil, 20% had needed a higher dose to get the same effect, and 17% had stopped because the drug lost its effect (El-Galley et al., Journal of Urology, 2001).

Combining ED therapies

For men with more advanced ED, combining therapies under a physician's guidance can work better than one therapy alone. Some men who do not respond to oral or injection medication alone respond to both together. Combination therapy also raises the risk of adverse effects.

A review of smaller studies of combination ED therapies found that combining oral and non-oral therapy was an increasingly common approach for men who do not respond to a single therapy, or whose response fades as the condition worsens.

Combining Xialla and ED medication

Combining Xialla with ED medication under a physician's guidance may improve results for men who no longer get a satisfactory response from medication alone. It may also allow some men who do respond to medication to use a lower dose and reduce side effects. Any dose change should be decided with the prescribing clinician.

Clinical trial data and customer reports indicate that some men get a stronger result and can reduce dose when they add Xialla. One customer wrote on Trustpilot: "I wish I discovered this years ago! Instead of a highest strength [medication] that sometimes failed, I can get by with the minimum dose and guaranteed results."

For the mechanism behind the device, see How Xialla Works.

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