Alprostadil

DEA Class; Rx

Common Brand Names; Caverject, Edex, Muse, PGE1, Prostaglandin E1, Viridal

• Prostaglandins, Genitourinary

Hypersensitivity

Predisposition to priapism (eg, sickle cell anemia, sickle cell trait, multiple myeloma, leukemia)

Anatomical deformation of the penis, such as cavernosal fibrosis or Peyronie’s disease

Penile implants

Sexual intercourse with pregnant woman unless condom barrier used (intracavernosal implant)

>10%

Urethral suppository

• Penile pain (32%)

• Urethral burning (12%)

Intracavernous injection

• Penile pain (37%)

1-10%

Urethral suppository

• Urethral bleeding/spotting (5%)

• Testicular pain (5%)

• Headache (3%)

Intracavernous injection

• Prolonged erection, 4-6 hr (4%)

• Penile fibrosis (3%)

• Injection site hematoma (3%)

• Injection site echymosis (2%)

• Penile rash (1%)

• Penile edema (1%)

Discontinue therapy if signs of penile fibrosis develop

The preservative benzyl alcohol contained in the intracavernosal dosage form has been associated with serious adverse events, including the “gasping syndrome”, and death in pediatric patients; this dosage form is not indicated for pediatric patients

Syncope reported within 1 hr of using urethral suppository (pellet)

The risk of breakage with superfine needles is high; needle breakage, with a portion of the needle remaining in the penis, requiring hospitalization and surgical removal reported; careful instruction in proper patient handling and injection techniques may minimize potential for breakage

Patients with bleeding disorders or on anticoagulants, such as warfarin or heparin may have increased propensity for bleeding after intracavernosal injection; use caution; compress site of injection with alcohol swab or sterile gauze for 5 min

Diagnose and treat underlying treatable medical causes of erectile dysfunction before initiating therapy

Safety and efficacy of combinations of drug and other vasoactive agents injected intracavernosally not established in clinical studies; risks of prolonged erection, priapism, and hypotension may be increased

Injections can lead to increased peripheral blood levels of alprostadil, especially in patients with significant corpora cavernosa venous leakage; avoid use in patients with known cavernosal venous leakage; may cause hypotension

Counsel patients about protective measures necessary to guard against sexually transmitted disease including human immunodeficiency virus (HIV)

Pregnancy: Alprostadil not indicated for use in females

Lactation: Alprostadil not indicated for use in females