Vasoactive Intestinal Peptide (VIP) + Alpha-Adrenoceptor Antagonist (Intracavernosal Erectile Dysfunction)

Aviptadil with Phentolamine Mesilate

Brand names: Invicorp

Adult dose

Dose: 25 mcg aviptadil / 1 mg phentolamine mesilate per dose (1 mL); may titrate. Maximum 1 injection per day, max 2 per week

Route: Intracavernosal injection

Frequency: As needed (max once daily, twice weekly)

Clinical pearls

Second-line intracavernosal therapy for erectile dysfunction when alprostadil is ineffective or not tolerated
Unique dual mechanism: VIP (aviptadil) causes arterial vasodilation and corpus cavernosum relaxation; phentolamine blocks alpha-adrenergic vasoconstriction
Less penile pain than alprostadil (VIP has low pain-fibre activity) — relevant where alprostadil causes significant discomfort
First-dose always under medical supervision (hypotension risk)
Priapism risk: advise A&E if erection >4 hours
Not as widely used as alprostadil but a valid alternative in refractory cases

Contraindications

Sickle cell anaemia, leukaemia, polycythaemia (priapism risk)
Penile implant
Penile deformity
Recent MI or severe cardiovascular disease
MAOIs within 14 days (phentolamine)

Side effects

Facial flushing (vasoactive intestinal peptide effect — very common)
Hypotension
Tachycardia
Pain at injection site
Prolonged erection / priapism

Interactions

Antihypertensives — additive hypotension
MAOIs — phentolamine interaction; avoid
PDE5 inhibitors — do not combine

Monitoring

Blood pressure (first dose clinic setting)
Erection response and duration
Injection technique and site care
Priapism risk awareness

Reference: BNF; NICE CKS Erectile dysfunction (2023); EAU Guidelines on Sexual and Reproductive Health (2024); https://bnf.nice.org.uk/drugs/aviptadil-with-phentolamine-mesilate/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways