Does apomorphine enhance the sexual experience?

Apomorphine Does Not Significantly Enhance Sexual Experience

Apomorphine is not recommended for enhancing sexual experience as it has limited efficacy compared to other medications and is associated with significant side effects. 1

Evidence on Apomorphine for Sexual Function

Efficacy in Erectile Dysfunction

• Sildenafil (a PDE-5 inhibitor) has been shown to be more effective than apomorphine in improving erectile function, frequency of penile penetration, erection maintenance, and percentage of successful intercourse attempts 1
• In clinical trials, apomorphine showed only modest improvement in erectile function compared to placebo (6-27% more successful intercourse attempts than placebo) 2
• Apomorphine is less effective in specific populations, including patients with diabetes and those who have undergone radical prostatectomy 2

Side Effect Profile

• The most common side effect of apomorphine is nausea (reported in 11.7% of patients), which is dose-related 3
• Other reported side effects include dizziness and potential for syncope 3, 4
• These side effects significantly limit the clinical usefulness of apomorphine for sexual enhancement 5

Mechanism of Action

• Apomorphine is a dopamine agonist that acts on areas of the central nervous system believed to mediate penile erection 3
• It works through central D2-type dopamine receptor stimulation and oxytocin release from the paraventricular nucleus of the hypothalamus 6

Recommended Alternatives for Sexual Enhancement

First-Line Treatments for Erectile Dysfunction

• PDE-5 inhibitors (sildenafil, vardenafil, tadalafil, mirodenafil, and udenafil) are the recommended first-line pharmacological treatments for erectile dysfunction 1
• These medications have demonstrated high efficacy rates (73-88%) compared to placebo (26-32%) 1
• PDE-5 inhibitors can be used on-demand or as daily low-dose treatment 1

For Problems with Orgasm

• Vibratory therapy may improve problems with orgasm intensity or achievement 1
• PDE-5 inhibitors can also be used for problems with male orgasms (less intensity, difficulty achieving) 1
• Cabergoline, a dopamine agonist, has shown subjective improvement in orgasm but is preferred over apomorphine 1

For Ejaculation Issues

• SSRIs (paroxetine, sertraline, citalopram, fluoxetine) dosed daily or clomipramine dosed on-demand are recommended for ejaculation problems 1
• Pelvic physical therapy may help with various sexual function issues 1

Clinical Considerations

Patient Selection

• Apomorphine might only be considered in patients who cannot take PDE-5 inhibitors (e.g., those using nitrates) 2
• However, even in these cases, other options should be explored before considering apomorphine due to its limited efficacy and side effect profile 1

Dosing Considerations

• If apomorphine must be used, starting with lower doses (2-3 mg) may help minimize side effects 2, 4
• Sublingual formulation provides more rapid absorption and potentially fewer side effects than other routes 5

Adjunctive Approaches

• Lifestyle modifications (smoking cessation, weight loss, increased physical activity, reduced alcohol consumption) can improve sexual function 1
• Treatment of underlying psychosocial problems and referral to sex and couples therapy when appropriate can alleviate symptoms of sexual dysfunction 1

In conclusion, while apomorphine has some limited efficacy for erectile dysfunction, its overall impact on enhancing sexual experience is minimal compared to PDE-5 inhibitors, and it comes with significant side effects that limit its clinical utility.