Does apomorphine for ED work?

If you’re scouring the internet for alternatives to common erectile dysfunction (ED) treatment options, you may have read about apomorphine for ED. 

Apomorphine is a synthetic (lab-made) version of morphine, the opioid painkiller. But it works completely differently in the body. So, what is it? Keep reading for answers to this and other questions about the drug in general as well as apomorphine for ED.

Apomorphine is a prescription medication that belongs to the dopamine agonist drug class. It works by mimicking the effects of dopamine, a brain chemical involved in voluntary movement, mood, and reward-related behaviors, among other functions.

Apomorphine is mainly used to treat Parkinson's disease (PD), a progressive brain condition that affects movement. It’s a subcutaneous injection approved by the US Food and Drug Administration (FDA) to treat “off” episodes of PD; these are when the effectiveness of a medication starts to wear off and symptoms (e.g. poor mobility, tremors) may worsen. 

Currently there is only one brand-name apomorphine drug for PD on the market in the US, but the FDA has approved two options over the years: 

• Apokyn, a subcutaneous injection that’s also available as a generic. 

• Kynmobi, a sublingual film that dissolved under the tongue. This medication was discontinued in 2023 “due to limited utilization,” according to the drug’s manufacturer Sunovion. 

While Kynmobi is no longer sold in the US,  most of the research on apomorphine for ED involves sublingual apomorphine (vs. the available injection version)—just keep this in mind as we continue to discuss apomorphine for ED. 

Apomorphine is thought to work for ED by stimulating parts of the brain involved in sexual arousal. More specifically, it activates dopamine receptors in the brain, which play a role in “reward” responses involving pleasure and motivation. When these receptors are fired up, they can help kickstart the physical response that results in an erection. Unlike other ED medications that boost blood flow to the penis (e.g. Viagra, Cialis), apomorphine affects the brain’s role in getting an erection. 

This mechanism may be beneficial when psychological issues are the underlying cause (psychogenic ED). But, again, apomorphine doesn’t help with physical blood flow issues, which are the dominant underlying cause of ED. As such, the drug’s effectiveness can vary among individuals, and it may not be as impactful or consistently helpful for ED. Still, apomorphine could be worth a discussion with your healthcare provider if other ED treatments aren’t a good fit or don’t work well, according to some researchers.

In a word: Possibly. 

Apomorphine may have some effectiveness for ED. A meta-analysis of 9 studies concluded that sublingual apomorphine can be safe and well-tolerated in low doses (2–3 mg) as well as more effective at improving erectile function compared to a placebo. However, some of the studies within this analysis found that apomorphine was not significantly better than a placebo for ED in participants who had diabetes or had undergone prostate removal surgery—both of which (especially diabetes) can be true in people with ED.  

That being said, apomorphine isn’t a popular treatment option for ED due to low efficacy. It’s not mentioned in ED treatment guidelines from experts at the American Urological Association. In fact, the FDA denied approval of apomorphine for ED in 2003.  We also know that apomorphine doesn’t work as well as phosphodiesterase type 5  (PDE5) inhibitors for ED. A 2008 study found that sildenafil (brand name Viagra)—a type of PDE5 inhibitor—works better than sublingual apomorphine for getting an erection and feeling satisfied. 

Still, sublingual apomorphine could be worth considering for individuals with mild-to-moderate psychogenic ED who can’t take PDE5 inhibitors due to contraindications, such as nitrate use. Then again, as explained above, sublingual apomorphine isn’t available in the US. 

So, what about apomorphine injections for ED? Do those work for treating the condition? Unfortunately, there is little-to-no research on apomorphine injections for ED. Only the sublingual form of the drug has been studied for ED. 

Apomorphine injections may cause various side effects, including nausea, vomiting, constipation, headache, yawning, and weakness. Serious side effects can include prolonged painful erections (priapism), rash, difficulty breathing, fainting, fast heartbeat, hallucinations, depression, and chest pain. The drug labeling also includes safety warnings for potential drowsiness and falling asleep during daily activities as well as problems with impulsive behaviors. And older adults (65+) are more likely to experience certain side effects than younger adults. 

Keep in mind that side effect data for apomorphine injections is based on its use (and dosage) for PD. Again, this formulation of the drug has not been studied as a treatment for ED. 

Sublingual apomorphine gets mixed reviews for safety. Some clinical research suggests that sublingual apomorphine may be easier to tolerate, with reports of mild nausea that eases with continued use. (But, as mentioned, sublingual apomorphine isn’t available in the US. It was also discontinued in Canada for business reasons.)

Apomorphine likely isn’t a safe option if you have certain conditions, such as low blood pressure or cardiovascular problems. It may not be safe for people taking certain medications, such as specific antiemetics like ondansetron (Zofran). 

Apomorphine may cause other side effects and carry additional warnings. Talk to a healthcare provider about your situation and whether apomorphine may be an option for you, that is, of course, if it’s available where you live.

When talking about apomorphine for ED, you end up using a lot of hypotheticals. In other words, it’s hard to confidently say whether the formulation available in the US (injections) can be effective at and safe for treating ED. The good news, however, is that there are plenty of other options that have been proven to be safe and reliable, starting with PDE5 inhibitors.

Largely considered first-line treatment for ED, PDE5 inhibitors are FDA-approved oral medications that work in part by increasing blood flow to the penis, which promotes stronger, longer-lasting erections. Common PDE5 inhibitors, all of which require an Rx from a healthcare provider, include:

• Viagra (sildenafil)

• Cialis (tadalafil)

• Vardenafil (previously available as brand name Levitra)

• Stendra (avanafil) 

Can’t take pills? Or simply not a fan of doing so? You can reap the rewards of PDE5 inhibitors through other formulations. Ro Sparks, for example, is a sublingual, fast-acting treatment containing both sildenafil and tadalafil (the active ingredients in Viagra and Cialis). There’s also Ro’s Daily Rise Gummies, which feature 7 mg of tadalafil in each fruit-flavored gummy.

Certain lifestyle modifications can also help reduce ED symptoms and optimize sexual function. These include: 

• Exercising regularly. Engaging in physical activity can enhance cardiovascular health, which plays a crucial role in maintaining healthy blood pressure and circulation—both of which are essential for supporting erections. Exercise can also increase the production of nitric oxide, which also contributes to erectile function and overall sexual health.

• Eating a healthy, balanced diet. A nutritious eating pattern can help lower various risk factors for ED, including type 2 diabetes, high blood pressure, high cholesterol, and obesity. This involves consuming plenty of fruits, vegetables, and whole grains while limiting the intake of processed foods, sugars, salt, and red meat.

• Getting enough sleep. Research indicates that consistently getting 6 or fewer hours of sleep per night may raise the risk of ED. Sleep deprivation can also contribute to obesity, high blood pressure, heart disease, and diabetes—conditions that impair blood flow and boost the chances of ED. To reduce this risk, aim for 7-9 hours of quality sleep each night by improving your sleep habits and going to bed earlier.

• Taking care of your mental health. Stress and mental health issues such as anxiety and depression can disrupt sexual function. Practicing stress management techniques (e.g. meditation, deep breathing, mindfulness) may help ameliorate ED. If these strategies aren’t sufficient, or if you need additional support, consider consulting a therapist or mental health professional.

While apomorphine has been explored as a potential treatment for ED, its effectiveness is limited. Plus, the form that’s been researched in regards to ED (sublingual) is not available in the US. If you’re seeking treatment for ED, your best course of action is to consult a healthcare provider about other, more effective options, such as PDE5 inhibitors, and explore lifestyle changes that can support your sexual health.

---

How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

August 30, 2024

Written by

Patricia Weiser, PharmD

Fact checked by

Raagini Yedidi, MD

---

About the medical reviewer

Raagini Yedidi, MD

Raagini Yedidi, MD, is an internal medicine resident and medical reviewer for Ro.