EMDA (verapamil) Clinical Evidence

Clinical governance statement

All treatments undertaken by MansMatters (Shockwave Clinics Ltd) are subject to clinical review before they are introduced into practice and at regular intervals thereafter. This review considers the safety profile of each intervention, including contraindications and adverse effects as specified in the manufacturer's instructions for use or the Summary of Product Characteristics; the regulatory status of each medical device and medicinal product; the position of current UK and European clinical guidance, including the European Association of Urology (EAU), the National Institute for Health and Care Excellence (NICE) and the British Association of Urological Surgeons (BAUS); the qualifications and scope of practice of the treating clinicians; the stage and severity of the condition being treated; and the requirements for informed consent. Each patient is assessed individually, and treatment is offered only where it is clinically appropriate.

The basis of clinical evidence

Clinical evidence is derived from several sources, which carry different weight. Systematic reviews and meta-analyses pool the results of multiple studies and provide the highest level of evidence. Randomised controlled trials, including sham-controlled trials, compare a treatment against a control group under defined conditions. Prospective and retrospective cohort studies, published in peer-reviewed journals, describe outcomes in defined groups of patients over time, and the replication of results by independent research groups in different countries strengthens confidence in a finding. Laboratory and mechanistic studies explain how a treatment is thought to act. In-clinic observational studies and structured outcome audits record the results achieved in routine practice and contribute to the developing evidence base, particularly for newer and combined treatments. Long-term follow-up establishes the durability of results and the safety of a treatment over time.

The evidence relevant to this treatment is summarised below. All citations are hyperlinked to the original source.

Is it safe?

Verapamil and dexamethasone are long-established, UK-licensed medicines. For Peyronie's disease they are used outside their licensed indications, and they are delivered together through the skin by electromotive drug administration (EMDA), using a CE-marked Class II medical device. This route avoids injection into the penis, and treatment by EMDA has been described as safe in Peyronie's disease (Sokolakis & Hatzichristodoulou 2020; Milenkovic & Albersen 2020). Side effects are usually mild and short-lived, such as temporary redness or tingling of the skin beneath the electrode. As set out in the verapamil safety information, verapamil is not suitable for men with low blood pressure, a slow heart rate or heart-rhythm disorder, or heart failure, and needs care alongside certain heart medicines, including beta-blockers. As set out in the dexamethasone safety information, dexamethasone is not suitable for men with a systemic infection or an infection at the treatment site, and needs care in men with diabetes, high blood pressure, a stomach ulcer or glaucoma. Treatment is prescribed by our independent prescribers and given by our registered clinicians.

What the evidence shows

Intralesional verapamil is supported by international recommendations for Peyronie's disease (ICSM 2024), and a review of 13 studies found that it can reduce plaque size and curvature, ease pain and improve sexual function, with benefits typically apparent within three months (Asali & Asali 2020). The combination we use, verapamil with dexamethasone delivered by EMDA, has been assessed in a randomised controlled trial of 96 men in Italy (Di Stasi et al. 2004). In that trial, median curvature reduced from 43 to 21 degrees and plaque volume by more than half over six weeks, while the control group remained unchanged. The only side effect was temporary skin redness at the electrode site. Results vary between studies and between men.

Guidelines and regulation

Intralesional verapamil is supported by international recommendations for Peyronie's disease, which also favour combining treatments (ICSM 2024). Verapamil and dexamethasone are UK-licensed medicines. Their use for Peyronie's disease is outside their licensed indications, so they are prescribed by our independent prescribers in line with professional guidance on off-label prescribing. The EMDA device is CE-marked as a Class II medical device. Treatment is given by registered clinicians in a clinic registered with the Care Quality Commission.

Independent research

Verapamil for Peyronie's disease has been studied by independent university teams over more than two decades and published in peer-reviewed journals. These include the randomised controlled trial of verapamil and dexamethasone delivered by EMDA, carried out at the University of Rome Tor Vergata in Italy (Di Stasi et al. 2004), and a critical review of 13 studies of intralesional verapamil (Asali & Asali 2020). The evidence has also been assessed by an international expert panel, which supports its use (ICSM 2024).

How EMDA (verapamil) compares

In the randomised trial of verapamil and dexamethasone delivered by EMDA, median curvature improved by 22 degrees over six weeks (Di Stasi et al. 2004). For comparison, a randomised trial of penile traction reported an average improvement of 11.7 degrees over three months (Ziegelmann et al. 2019), and studies of vacuum therapy report improvements of between 6.6 degrees (Mortensen et al. 2021) and 23 degrees (Wang et al. 2025). Unlike intralesional injection, EMDA delivers verapamil through the skin without needles. In line with international recommendations favouring combined treatment (ICSM 2024), it is used alongside other treatments, including within our PD360 programme.

How EMDA (verapamil) is thought to work

Verapamil is a calcium channel blocker. In Peyronie's disease it is thought to reduce the activity of the fibroblast cells that form the plaque and to limit the build-up of scar tissue, supporting plaque remodelling (Asali & Asali 2020). Dexamethasone is a corticosteroid that reduces local inflammation. With EMDA, a low-level electrical current carries both medicines through the skin into the affected tissue, delivering them directly to the plaque without injection (Di Stasi et al. 2004).

Long-term results and our experience

Studies of verapamil in Peyronie's disease report benefits becoming apparent within three months, with optimal results when treatment continues for around six months in men who respond (Asali & Asali 2020). EMDA (verapamil) has been part of our clinical practice since 2022. It also forms part of our PD360 programme, in which patients are being followed up at 12 months so that longer-term outcomes can be reported.

Who is most likely to benefit

Verapamil has shown the best response in men with a well-defined, localised plaque (Asali & Asali 2020). The anti-inflammatory action of dexamethasone makes the combination particularly relevant in the active phase of Peyronie's disease, when inflammation and pain are present. EMDA (verapamil) is usually given as part of a combined treatment programme. Suitability is assessed individually at consultation, taking into account the phase and severity of the condition and the characteristics of the plaque. It is not suitable for men with the conditions listed under "Is it safe?". Men with severe or complex deformity may be referred to a specialist urologist for surgical assessment.

Before your treatment

Before treatment, your clinician will assess your suitability, review your medical history and current medicines, explain what EMDA (verapamil) involves, and answer any questions. This information is given verbally at consultation, and you will be asked to give your consent before treatment begins. During each session, a small electrode pad is placed on the skin and a gentle electrical current delivers the medicines to the plaque. You can return to normal activities straight afterwards.