What is the administration route and dosage for verapamil (inj) in treating Peyronie's disease?

Intralesional Verapamil for Peyronie's Disease

Intralesional verapamil may be offered for Peyronie's disease treatment, but its evidence is weak and clinicians should carefully consider whether its use is appropriate given substantial uncertainty regarding efficacy and the availability of more effective treatments. 1

Administration Protocol and Dosage

The administration of intralesional verapamil for Peyronie's disease follows these parameters:

• Injection technique: Direct injection into the main plaque using a single-puncture approach
• Dosage: 15 mg verapamil diluted in 6 mL solution per session 2
• Frequency: One injection every 3 weeks 2
• Duration: Minimum of 6 sessions, though most patients require at least 12 injections for optimal improvement 2

Patient Selection

Intralesional verapamil is most appropriate for:

• Patients with non-calcified plaques 3
• Patients with penile curvature less than 30 degrees 3
• Younger patients (younger age is the only predictor of success in both univariate and multivariate analyses) 2

Expected Outcomes

Clinical results from studies show:

• Plaque softening in most patients 3
• Decreased plaque volume in 57% of treated patients (vs. 28% in control groups) 3
• Improvement in plaque-associated penile narrowing 3
• Improvement in erectile function quality in 42.87% of patients (vs. none in control groups) 3
• Global improvement reported by 78% of patients 2

Adverse Events

Patients should be counseled about potential adverse events including:

• Penile bruising
• Dizziness
• Nausea
• Pain at the injection site 1
• Occasional ecchymosis at the injection site 3

Treatment Algorithm

1. Confirm stable disease: Treatment is most appropriate after the disease has stabilized (typically 12-18 months after symptom onset) 1
2. Assess curvature severity:
   • If <30°: Consider intralesional verapamil 3
   • If >30°: Consider other options like collagenase clostridium histolyticum (Xiaflex) or interferon α-2b 1, 4
3. Evaluate plaque characteristics: Non-calcified plaques respond better 3
4. Treatment course:
   • Begin with injection every 3 weeks
   • Evaluate response after first 3 months (non-responders within 3 months are unlikely to benefit) 3
   • Continue for at least 6 sessions if responding 5
   • May require up to 12 injections for optimal results 2

Comparative Efficacy

When considering treatment options:

• Collagenase clostridium histolyticum (Xiaflex) is FDA-approved with stronger evidence (Grade B) showing average curvature reduction of 17° vs. 9.3° with placebo 4
• Interferon α-2b shows curvature reduction of 13.5° vs. 4.5° with placebo (Evidence Strength Grade C) 1
• Verapamil has weaker evidence (Grade C) with less consistent results 1

Important Caveats

1. The evidence for intralesional verapamil is weak and conflicting, making it difficult to predict individual outcomes 1
2. Response to treatment should be evaluated after the first 3 months; patients who don't respond within this timeframe are unlikely to benefit from continued treatment 3
3. Patients with curvature greater than 30 degrees at presentation are more likely to benefit from surgical intervention rather than intralesional verapamil 3
4. Younger patients have better response rates to intralesional verapamil treatment 2

Intralesional verapamil represents a conservative approach with minimal side effects but uncertain efficacy compared to other available treatments for Peyronie's disease.