Alprostadil for erectile dysfunction

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Important: if you have a prolonged or painful erection lasting for more than four hours, contact your doctor immediately.

Your doctor will arrange to see you to check your progress regularly - it is important that you keep these appointments.

Type of medicineProstaglandin E1 vasodilator
Used forErectile dysfunction in adult men
Also calledCaverject®, MUSE®, Viridal® Duo, Vitaros®
Available asInjection, urethral application, urethral cream

Erectile dysfunction (sometimes called impotence) means that you cannot get or maintain a proper erection. There are several causes, the most common being due to a narrowing of the arteries that take blood to the penis. Alprostadil is a vasodilator, which means that it works by widening (dilating) blood vessels to improve the flow of blood. When administered to the penis, blood flow to this area is increased, resulting in an erection usually within 10-15 minutes.

Alprostadil is available as an injection treatment, which is where you inject alprostadil into the base of your penis. It is available as a urethral application, which is where you place a small pellet containing alprostadil into your urethra (the tube which your urine passes through and which opens at the end of your penis). It is also available as a cream which is applied to the opening of the urethra on the tip of the penis. You will be taught how to use the preparation you have been prescribed.

Alprostadil is available on prescription but it is only prescribed on the NHS under certain circumstances.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start using alprostadil it is important that your doctor knows:

  • If you have any disease, injury, or any abnormality of your penis, or if you have been told you have a problem in your urethra.
  • If you have been advised for medical reasons not to have sex.
  • If you have any problems with feeling dizzy or faint.
  • If you have sickle cell disease.
  • If you have had bone marrow cancer or leukaemia.
  • If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines. It is particularly important that you tell your doctor if you are using any other product to help treat erectile dysfunction.
  • If you have ever had an allergic reaction to a medicine.
  • Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about the specific brand of alprostadil you have been given, diagrams to remind you how to use it, and a full list of the side-effects which may occur.

If prescribed alprostadil injection (Caverject® or Viridal® Duo)

  • The injection is administered at the base of your penis. When starting the treatment, your doctor will give you a small dose and then gradually increase the dose if necessary. This is to make sure that you have the dose that helps your condition and avoids any unwanted symptoms. Your first injection will be given to you by a doctor or nurse, although after proper training and instruction you will be able to do it yourself at home. It is important that you ask if you are unsure about any of the instructions you are given.
  • Each time you inject alprostadil, try to use a slightly different site as this will help to prevent any skin problems.
  • After using alprostadil injection, you must leave at least 24 hours before using another. You must not use alprostadil injection more than three times a week.

If prescribed alprostadil urethral application (MUSE®)

  • It is recommended that you pass urine just before inserting a pellet, as this moistens your urethra and makes the insertion more comfortable.
  • Your first dose may be given to you by a doctor or nurse. This is to show you how to use the applicator, and also to make sure you have the dose that helps your condition and avoids any unwanted symptoms. Your doctor or nurse will train you to use the applicator before suggesting you do it yourself at home. It is important that you ask if you are unsure about any of the instructions you are given.
  • If your partner is pregnant, it is important that you use a barrier method of contraception (such as a condom) during sex. This is to help guard against any harm to the unborn baby. It will also help avoid any irritation of the vagina of your partner.
  • You must not use more than two doses in any 24-hour period, and you must not use more than seven doses a week.

If prescribed alprostadil urethral cream (Vitaros®)

  • Vitaros® cream is available in one strength - 300 micrograms. The cream is supplied in a container which looks like a syringe (although it must not be inserted into your penis or injected in any way). Each container is to be used once only.
  • Your first dose may be given to you by a doctor or nurse. This is to show you how to use the cream correctly before you do it yourself at home. It is important that you ask if you are unsure about any of the instructions you are given.
  • It is usual for the cream to start to work within 5-30 minutes and for its effects to last an hour or two, although this can vary from person to person.
  • If your partner is pregnant, it is important that you use a barrier method of contraception (such as a condom) during sex. This is to help guard against any harm to the unborn baby. It will also help avoid any irritation of the vagina of your partner.
  • You must not use more than one dose in any 24-hour period, and you must not use more than three doses a week.
  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
  • Discuss with your doctor whether you can make any lifestyle changes that may help your condition. For example, reducing stress in your life, stopping smoking if you are a smoker, or cutting back on drinking lots of alcohol.
  • Injections of alprostadil may cause a small amount of bleeding at the site of the injections. This could increase the risk of sexually transmitted diseases. If you are concerned about this, ask your doctor for advice about 'safe sex'.
  • Make sure you follow the instructions you have been given for disposing of used injections or applicators.
  • If you buy any medicines, always check with a pharmacist that they are suitable to take with your other medicines.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with alprostadil. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve after an hour or so, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Very common alprostadil side-effects (these affect more than 1 in 10 men)What can I do if I experience this?
Painful penis, or a burning sensationThis should soon pass, but if troublesome, speak with your doctor for advice
Common alprostadil side-effects (these affect less than 1 in 10 men)What can I do if I experience this?
Prolonged and painful erectionIf this lasts for more than four hours, you must contact a doctor straightaway. If it lasts for more than one hour but less than four hours, make an appointment with your doctor to discuss reducing your dose
Headache, feeling dizzy or light-headedGetting up more slowly may help, but these feelings should soon pass. Do not drive or use tools or machines while dizzy
Bleeding from the site of application (injection only), bruisingThis should not last long
Testicular pain, leg crampsIf troublesome, speak with your doctor for advice

If you experience any other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.
  • If you have been prescribed MUSE® or Vitaros®, your supply should be stored in a refrigerator. Pouches of MUSE® can be kept out of the fridge for up to 14 days before use, if required. Sachets of Vitaros® can be kept out of the fridge for up to three days before use. If they remain unused after these times, they should be disposed of.

Never use more than the prescribed dose. If you suspect that you or someone else might have had an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking.

This medicine is for you. Never give it to other people, even if their condition appears to be the same as yours.

If you have any questions about this medicine ask your pharmacist.

Further reading & references

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Helen Allen
Current Version:
Peer Reviewer:
Dr Adrian Bonsall
Document ID:
3373 (v24)
Last Checked:
22/08/2014
Next Review:
21/08/2017
The Information Standard - certified member

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