The current recommended regimen for verapamil injections is an injection of 10 mg of verapamil diluted in 10 mL of fluid. This is administered with a standard syringe with a 5/8 inch 25-gauge needle. I have found that using a smaller gauge needle may not allow adequate distribution of the drug into the plaque and a smaller needle is at higher risk for breaking. Using a 25-gauge needle, in more than 10,000 injections, I have never had a needle fracture. These injections are done no more frequently than every 2 weeks, but can be done every 2-6 weeks depending upon the patient’s and physician’s schedule. The goal is to perform a total of six treatments, and then determine whether the patient notes some improvement of his penile deformity including diminished curvature, enhanced girth, softening of the plaque and better erectile function. If there is evidence of improvement following six injection treatments, then I recommend continuing for another 6 treatments for a total of 12 visits.
It is worth noting that not all experts agree with this latter plan. Recently, researchers in Texas have suggested increasing the dose to 20 mg of verapamil in 10 cc’s of solution if there is no improvement after six injections. I have initiated this with great caution as a higher dose of verapamil could possibly have some cardiovascular side effects (i.e. lower blood pressure). None have been reported with the 10 mg dose in my experience or the 20 mg dose from the Texas group.
The concern that direct needle trauma could result in worsening of the plaque is a real one; as it is assumed that Peyronie’s disease is triggered by trauma to the penis. Yet, I have only seen 6-8% of patients with a measured worsening of curvature following verapamil injection. I believe this is a result of the anti-fibrotic mechanism of the verapamil therapy. I am unaware of any studies which have looked at dry needling (where the plaque is simply needled, but no drug is injected) to know whether just needling the plaque itself would cause worsening of scar or potentially improvement of curvature. It should be recognized that during the injection process, the plaque itself may become larger with a change in shape. My experience has shown that over time, once the treatment has been completed, the plaque will tend to reduce in size and in some men the plaque becomes virtually nonpalpable. This may take one or more years to occur.