Alprostadil

Alprostadil injection is used to treat men who have erectile dysfunction (also called sexual impotence). Alprostadil should not be used as a sexual aid by men who do not have erectile dysfunction. If the medicine is not used properly, permanent damage to the penis and loss of the ability to have erections could result.

Product dosage: 500mcg
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Alprostadil is a synthetic prostaglandin E1 analog used primarily in the treatment of erectile dysfunction (ED). As a vasodilator, it works by relaxing smooth muscle tissue and dilating cavernosal arteries, thereby increasing blood flow into the penis to facilitate an erection. This medication is available in several administration forms, including intracavernosal injection, intraurethral pellet, and topical cream, offering flexibility based on patient preference and clinical suitability. It represents a well-established, effective second-line therapy for men who do not respond to or cannot use oral phosphodiesterase type 5 inhibitors.

Features

• Synthetic prostaglandin E1 analog with potent vasodilatory properties
• Available in multiple formulations: intracavernosal injection, intraurethral suppository, and topical cream
• Onset of action typically within 5–15 minutes for injection, 5–10 minutes for intraurethral administration
• Duration of effect ranges from 30–60 minutes
• Does not depend on sexual stimulation for efficacy
• Can be used in patients with various etiologies of ED, including neurogenic, vasculogenic, and psychogenic causes

Benefits

• Provides a reliable and predictable erectile response, suitable for planned sexual activity
• Effective in patients who have failed or cannot use oral ED medications such as sildenafil or tadalafil
• Allows for dose titration to achieve optimal efficacy with minimal side effects
• Can be used in men with diabetes, hypertension, or other comorbidities where other ED treatments may be contraindicated
• Helps restore sexual confidence and improve quality of life for patients and their partners
• Does not interact with food or alcohol consumption

Common use

Alprostadil is primarily indicated for the diagnosis and treatment of erectile dysfunction. It is often employed as a second-line therapy when oral phosphodiesterase type 5 inhibitors are ineffective, poorly tolerated, or contraindicated. The medication is also used in diagnostic settings to assess vascular integrity in patients with ED. In neonatal medicine, alprostadil is used to maintain patency of the ductus arteriosus in certain congenital heart defects until surgical correction can be performed, though this application is distinct from its use in erectile dysfunction.

Dosage and direction

Intracavernosal injection:
Initial dose is typically 2.5 mcg, which may be titrated upward in 2.5–5 mcg increments to a maximum of 60 mcg per injection based on response and tolerability. Administration should be into the lateral aspect of the penis, alternating sides with each injection. The recommended frequency is no more than once daily and no more than three times weekly.

Intraurethral pellet:
The typical dose is 125–1000 mcg administered as a single pellet inserted into the urethra. The dose should be titrated starting from the lowest available strength. Urination before administration is recommended to moisten the urethra and facilitate absorption.

Topical cream:
Applied in a measured dose to the tip of the penis and urethral meatus. Dosage varies by formulation and should be used as directed, typically 15–30 minutes before sexual activity.

Proper technique training with a healthcare provider is essential for all administration routes to ensure efficacy and minimize complications.

Precautions

• Priapism (prolonged, painful erection lasting more than 4 hours) requires immediate medical attention to prevent permanent tissue damage
• Patients should be monitored for fibrosis or plaque formation at injection sites with long-term use
• Use with caution in patients with anatomical penile deformities (e.g., Peyronie’s disease), bleeding disorders, or those taking anticoagulants
• May cause hypotension; caution advised in patients with cardiovascular disease
• Not recommended for use in women or children except for specific neonatal cardiac indications under specialist care
• Proper hygiene must be maintained during administration to prevent infection

Contraindications

• Hypersensitivity to alprostadil or any component of the formulation
• Conditions that predispose to priapism (e.g., sickle cell anemia, multiple myeloma, leukemia)
• Anatomical deformities of the penis that make injection or intraurethral administration unsafe
• Use in men for whom sexual activity is inadvisable due to cardiovascular risk
• Concurrent use with other treatments for erectile dysfunction unless specifically directed by a physician

Possible side effect

• Penile pain (common with injection and intraurethral forms)
• Prolonged erection (priapism)
• Minor bleeding or hematoma at injection site
• Urethral burning or discomfort (with intraurethral administration)
• Dizziness or hypotension
• Fibrosis or nodules at injection sites with repeated use
• Headache
• Upper respiratory tract infection (reported with some formulations)

Drug interaction

• May potentiate the hypotensive effects of antihypertensive medications
• No significant interactions with phosphodiesterase inhibitors, but concomitant use is generally avoided due to increased risk of priapism and hypotension
• Anticoagulants (e.g., warfarin, apixaban) may increase risk of bleeding or hematoma formation with injectable forms
• No known interactions with food or alcohol

Missed dose

Alprostadil is used on an as-needed basis prior to sexual activity. There is no scheduled dosing regimen, so the concept of a “missed dose” does not apply. Patients should not attempt to compensate by taking extra medication if they miss a planned administration.

Overdose

Overdose may manifest as prolonged erection (priapism), severe hypotension, or syncope. Priapism lasting more than 4 hours constitutes a medical emergency requiring immediate urological consultation. Treatment may include aspiration of blood from the corpus cavernosum or irrigation with sympathomimetic agents such as phenylephrine. Hypotension should be managed with appropriate supportive measures including supine positioning and intravenous fluids if necessary.

Storage

• Store at controlled room temperature (20–25°C or 68–77°F)
• Protect from light
• Do not freeze
• Keep all formulations in their original packaging until use
• Discard any unused medication according to package instructions or pharmacist guidance
• Keep out of reach of children and pets

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual patient needs may vary. Always consult with a qualified healthcare provider for diagnosis and treatment recommendations. Do not initiate or modify any treatment regimen without professional medical supervision. The manufacturer’s prescribing information should be consulted for complete details regarding administration, warnings, and precautions.

Reviews

“After trying multiple oral medications with limited success, alprostadil injection has restored my ability to have satisfactory sexual intercourse. The initial apprehension about self-injection was overcome with proper training, and the results have been consistently reliable.” - Patient, 58

“As a urologist, I find alprostadil to be an invaluable option for patients who cannot use PDE5 inhibitors. The ability to titrate the dose provides excellent control over therapeutic response, though patient education about proper technique and priapism management remains crucial.” - Healthcare Provider

“The intraurethral system provides an effective alternative for patients who are needle-averse. While some report ureth discomfort, most find the trade-off acceptable for the efficacy provided.” - Clinical Nurse Specialist