Uprima (discontinued in the UK - January 2006)

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How does it work?

Uprima sublingual tablets contain the active ingredient apomorphine hydrochloride, which is a type of medicine known as a dopamine agonist. It works by enhancing the nerve signals that cause an erection. An erection is produced via a complex chain of events. The process is started with sexual stimulation from sight, smell, sound or touch. This causes nerve signals to be sent from the brain to the penis, which in turn cause the blood vessels in the penis to relax and widen. This allows the penis to fill with blood and makes it become erect. Apomorphine works by enhancing the nerve signals that are sent from the brain to the penis during sexual stimulation. It does this by mimicking the action of dopamine, which is a natural chemical called a neurotransmitter. Neurotransmitters are involved in sending signals along nerves. They act on special receptor sites in the nervous system to produce their effects. Dopamine acts on receptors called dopamine receptors, and this causes nerve signals with various effects to be sent. When dopamine acts on receptors in an area of the brain called the hypothalamus, it causes the nerve signals that produce an erection to be sent to the penis. Apomorphine mimics the erection-producing effect of dopamine by stimulating the same dopamine receptors in the hypothalamus. This enhances the effect of natural dopamine that is produced as a result of sexual stimulation. The nerve signals to the penis are enhanced, and this results in blood entering the penis, ultimately causing it to become rigid and erect. As apomorphine enhances the action of dopamine in producing an erection, it will only work once sexual stimulation has occurred. It does not increase sex-drive (libido) and is not an aphrodisiac. The sublingual tablet dissolves under the tongue, where it immediately enters the bloodstream, causing an erection in most sexually stimulated men in about 20 minutes.

What is it used for?

- Impotence (erectile dysfunction)

Warning!

- January 2006: Abbott have discontinued Uprima sublingual tablets for commercial reasons. Stocks are expected to be exhausted by the end of April 2006. If you are using this medicine you should make an appointment with your doctor so that your treatment can be reviewed and an alternative medicine prescribed.
- There should be a minimum of eight hours between doses of this medicine.
- You should drink a small amount of water before taking this medicine to help it to dissolve under the tongue. The tablet should then be placed under the tongue and allowed to dissolve. If any of the tablet remains after 20 minutes it may be swallowed.
- This medicine may uncommonly cause fainting. People normally experience warning symptoms of this, such as nausea, vomiting, pallor, sweating, hot flushes and dizziness or lightheadedness. If you experience these symptoms, you should not attempt to stand up - lie down and raise your legs until the symptoms pass.
- This medicine may cause dizziness and lightheadedness. For this reason you should not drive or operate machinery for at least two hours after taking the medicine, or until any symptoms pass.
- If this medicine is taken with alcohol there is an increased risk of a drop in blood pressure that might make you feel dizzy. In addition, alcohol can impair sexual performance.

Use with caution in

- Decreased kidney function
- Decreased liver function
- Elderly people
- History of drops in blood pressure when moving from sitting to standing, which causes dizziness (postural hypotension)
- Low blood pressure (hypotension)
- Physical abnormality of the penis, such as severe curvature, scarring or Peyronie's disease
- Uncontrolled high blood pressure

Not to be used in

- Children
- Conditions in which sexual activity is not advisable, for example severe heart disorders
- People who have recently had a heart attack
- Severe angina not controlled by medical treatment
- Severe heart failure
- Very low blood pressure (severe hypotension)
- Women

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

- Headache
- Nausea
- Sweating
- Mouth ulcers
- Dizziness
- Inflammation of the throat (pharyngitis)
- Flushing
- Alteration in taste
- Yawning
- Sleepiness (somnolence)
- Inflammation of the lining of the nose (rhinitis) causing a blocked or runny nose
- Cough
- Fainting (syncope)
- Pain

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

Apomorphine can be taken by men taking nitrate medications, but the combination may cause dizziness. Nitrate medications include the following: - glyceryl trinitrate - isosorbide mononitrate - isosorbide dinitrate - amyl nitrate, also known as "poppers". This medicine can be taken safely with the antisickness medicines domperidone, ondansetron and prochlorperazine, but other antisickness medicines are not recommended as they have not yet been studied with this medicine. This medicine should not be taken with other medicines that affect dopamine activity in the brain and nervous system (dopamine agonists or antagonists). These medicines include the following: - certain treatments for Parkinson's disease, eg bromocriptine, cabergoline, apomorphine, amantadine, levodopa, entacapone, pergolide, lisuride, pramiprexole, ropinirole, selegiline. - quinagolide - antipsychotic medicines. If this medicine is taken with alcohol there is an increased risk of a drop in blood pressure. In addition, alcohol can impair sexual performance. It is recommended that apomorphine should not be taken with other treatments for erectile dysfunction.

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