Contact UsTransdermal Verapamil 15% Gel is a painless, non-invasive, treatment for fibrotic tissue disorders such as Peyronie's disease that was developed and patented by PDLabs. Since 1998 PDLabs Transdermal Verapamil 15% Gel has been prescribed for over 13,000 patients. It is a prescription compounded medication that is applied directly to the skin twice a day. Verapamil belongs to the class of medications known as calcium channel blockers. The gel has been designed to carry the verapamil through the skin and deliver it to the Peyronie's plaque. The proprietary formula allows for minimal absorption into the blood, while maximizing the concentration of verapamil in the plaque and surrounding tissue.
It is important to understand that there are no "quick fix" treatments for Peyronie's disease. This is because remodeling tissue is a slow process. Patients should expect to use Transdermal Verapamil 15% Gel for a minimum of six months and should realistically expect to use the medication for 9 to 12 months to complete their treatment. Patients who are experiencing painful erections typically see this as the first symptom to be resolved, usually within 90 days. Also by 90 days, patients typically can feel a reduction or softening of the plaque. Once the plaque has started to remodel, the curvature and deformities begin to decrease. Transdermal Verapamil 15% Gel is not a life long treatment and it is not necessary to use the medication periodically as a maintenance or preventative treatment.
As with any medication, Transdermal Verapamil 15% Gel will not help everyone; however, PDLabs wants to make every effort to maximize the results patients receive. Patients that are not responding tend to fall into one of two categories. First are patients that do not improve at all and patients that have responded but seem to have reached a plateau and no longer improving. All patients are started on a regimen of one dose twice a day since this is effective for the majority of patients. If you are not responding at this dose, a PDLabs pharmacist will contact your doctor to discuss alternative doses that have proven effective in other patients that might be appropriate for you.
The most common side effect reported with Transdermal Verapamil 15% Gel, affecting 3-5% of patients, is varying degrees of skin irritation. Some patients using the medication for the first time may experience mild itching/irritation during the first few days of treatment. This is normal and usually resolves within 3-4 days. Other patients may experience more severe skin irritation, including itching, burning, redness, or swelling. More persistent or severe irritation can usually be treated with over-the-counter topical corticosteroids such as 1% hydrocortosone or with Aquaphor® to treat the dryness of the affected skin. Based on the individual symptoms, PDLabs will work with the patient and prescribing physician to determine the best course of treatment to resolve irritation.
The most important advantage to Transdermal Verapamil 15% Gel is that it is non-invasive. This eliminates the possibility of worsening your condition as often happens with invasive treatments.
Due to the density of the plaque, injection therapies such as verapamil, corticosteroid, and interferon injections are unable to effectively dispense enough medication to the entire primary plaque in one injection. Therefore, multiple injections must be made which may cause additional trauma to the surrounding tissue and worsen the condition. Additionally, since injection therapy only pinpoints the palpable plaque, any non-palpable plaque in the penile shaft is left untreated, resulting in a less effective treatment.
Iontophoresis (electromotive) treatment, like injections, only pinpoints the palpable plaque. Any non-palpable plaque of the penile shaft is left untreated, resulting in a less effective treatment. This treatment is typically not recommended in more severe cases.
Surgery poses risk of additional trauma to penile tissue and is only able to remove the primary plaque; any other fibrosis in the shaft is left untreated. Surgery can have negative post-operative side effects, including significant decrease in penile length and/or girth, erectile dysfuntion, or the return of the condition.
Oral medications (vitamin E, colchicine, para-amino benzoate (Potaba®), etc.) are unable to sufficiently concentrate in the plaque due to systemic absorption and metabolization in the first pass through the liver.
To get the most from Transdermal Verapamil 15% Gel it is critical that you use it correctly. In order to maintain a steady level of the collagenase enzyme that is responsible for remodeling the plaque, the medication must be applied very consistently. Patients that skip doses or days of application, typically see very slow or no improvement in their condition. Transdermal Verapamil 15% Gel should be applied twice a day, approximately 12 hours apart. Remember to allow a few days to get your prescription refilled so that you do not run out of medication.
It is important to keep your appointments with your doctor. Since improvements in your condition occur over time with Transdermal Verapamil 15% Gel, it is often difficult to objectively determine how much your condition has improved. Your doctor will keep notes that can be objectively compared at each exam. You will also want to print out a copy of the symptom checklist for each visit so that you can talk to your doctor about the progress you are making. This will also be helpful in determining if a change in your regimen is necessary to obtain the best possible results.
As with many medications, the exact way Transdermal Verapamil 15% Gel helps Peyronie's disease is not entirely understood. It is proposed that two different processes are taking place. The first allows for the progression of Peyronie's disease to be slowed or stopped and second for the Peyronie's plaque to actually be reduced, which allows for the symptoms of the condition to be reduced or eliminated. Both of these processes are effected by verapamil's ability as a calcium channel blocker to block calcium.
Cells known as fibroblasts are responsible for the production of the primary components of the Peyronie's plaque such as collagen, fibronectin and glycosaminoglycans. Research has shown that the process by which these components are released out of the fibroblast requires calcium. It has been found that calcium channel blockers have the ability to decrease the production of collagen and fibronectin and their release from the fibroblast*. A study has also shown that the large increase of Peyronie's fibroblasts is markedly impaired by verapamil, even at low doses*. This research is the basis of why it is thought that using Transdermal Verapamil 15% Gel in the inflammatory or early stages of Peyronie's disease, may prevent the condition from being as severe as it might have been without any treatment*.
Fibroblasts are also responsible for the production of an enzyme called collagenase. This enzyme is responsible for breaking down or remodeling the excess collagen that makes up Peyronie's plaque. Research has demonstrated that calcium channel blockers such as verapamil have the ability to increase the activity of collagenase, which enhances the remodeling of scars in burn victims. It was also found in experiments with bovine fibroblasts that exposure to verapamil increased collagenase activity*. Peyronie's disease is thought to be similar to other wound disorders such as keloids and hypertrophic scars*. Research on the use of verapamil in keloids has suggested that it may increase procollagenase production, meaning that verapamil may be capable of increasing collagen breakdown. Although this research was not done on fibroblasts from Peyronie's plaque, it is theorized that fibroblasts from Peyronie's plaque will respond in a similar way*. This theory is supported by improvements seen in plaque size when verapamil has been introduced into the Peyronie's plaque. The increase in collagenase activity after exposing the fibroblasts to verapamil helps to explain how Transdermal Verapamil 15% Gel can remodel an already formed and stable Peyronie's plaque into more healthy and elastic tissue. The remodeling of the tissue and return of the elasticity allows for the symptoms of Peyronie's disease to be reduced or eliminated.
The illustration below shows the two proposed mechanisms of action, magnified to the level of the fibroblast.
