The first steps leading to a better remedy for ED—an oral one—were taken by Dr. Adrian Zorgniotti. By 1990, I was referring all of my ED palients to this pioneering physician who had dedicated the bulk of his medical career to unraveling the mysteries of erectile dysfunction. Dr. Zorgniotti believed that ED had an overwhelming physical cause. With penile implants as the only viable treatment, even for men with minimal ED, his goal had been to find a way to get the short-circuited penis fully functional, quickly and easily. It was Dr. Zorgniotti who was one of the first doctors to combine the use of two drugs, phentolamine and papaverine, into an intercavernous injection that would help open up the blood vessels of the penis.
Dr. Zorgniotti was aware of the specific side effect of a drug which had been commonly used in the United States for over forty years to regulate high blood pressure. Regitine, or phentolamine mesylate, was known to stimulate erections in many of the men who took it. However, no one had been able to develop an oral medication with phentolamine that could aid men with ED.
In 1993, Dr. Zorgniotti administered 50 mg of his phentolamine tablets to eighty-five men whose ED had various causes. The results were extremely promising. Comparing them to a group of men taking 5 mg of phenoxybenzamine capsules, Dr. Zorgniotti found that 42 percent of the patients using the phentolamine were able to achieve erections sufficient for vaginal penetration. The major drawback, however, was that the drug took at least ninety minutes to work, thereby putting a severe crimp on the possibility of spontaneity in lovemaking.
Undeterred, Dr. Zorgniotti developed a new delivery system the following year using a buccal, or oral, solution of 20 mg of phentolamine mesylate. This medication in pill form was held in the mouth until fully dissolved. In yet another study, he formulated a filter strip soaked with the liquid drug, which was then placed between the cheek and gum, where the medication was absorbed quickly into the bloodstream. Tested on sixty-nine men, along with a placebo group, the outcome was significant: more than 32 percent of the men responded to the phentolamine mesylate with a full erection. Even more impressive was the fact that the reaction took place within twenty minutes. While this drug was costly and not easily obtainable, it was yet another of Dr. Zorgniotti’s breakthroughs in the development of a new kind of treatment for ED.
Sadly, Dr. Zorgniotti died in 1994 from the complications of severe adult onset diabetes before he was able to finish the final phase of his work. He was sixty-eight years old. “He was a mentor to me,” said Dr. Lizza. “I lost his friendship and counsel. The medical world lost a giant.”
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