alprostadil (intracavernosal)

Contraindicated in:

Penile implants;
Penile abnormalities;
Balanitis;
Men for whom sexual activity is not advisable;
Conditions predisposing to priapism (e.g., sickle cell anemia/trait, multiple myeloma, leukemia).

Use Cautiously in:

Severe coagulation abnormalities or thrombocytopenia;
Patients taking anticoagulants or antihypertensive agents.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, hypotension

GU: penile pain, penile edema, penile fibrosis, penile rashes, priapism

Local: bleeding, ecchymosis, hematomas, irritation

MS: back pain

Neuro: dizziness, headache

Resp: cough

Interactions ⬆ ⬇

Drug-drug:

Should not be used with other vasoactive agents.
↑risk of bleeding at injection site with anticoagulants.

Availability ⬆ ⬇

Powder for injection (Caverject): 20 mcg/vial; 40 mcg/vial
Powder for injection (prefilled syringe/cartridge) (Caverject Impulse and Edex): 10 mcg; 20 mcg; 40 mcg (Edex only)

Route/Dosage ⬆ ⬇

Intracavernosal(Adults ): 1.25–2.5 mcg initially; dose titrated as needed. Should not be used more than 3 times/wk. There should be ≥24 hr between doses. Doses >40 mcg (Edex) or >60 mcg (Caverject) should not be used.

US Brand Names ⬆ ⬇

Caverject, Caverject Impulse, Edex

Action ⬆ ⬇

Relaxes trabecular smooth muscle and dilates cavernosal arteries.

Therapeutic effects:

Penile erection sufficient to allow intercourse.

Classifications ⬆ ⬇

Therapeutic Classification: erectile dysfunction agents

Pharmacologic Classification: prostaglandins

Pharmacokinetics ⬆ ⬇

Absorption: Action is primarily local following intracavernosal injection.

Distribution: Unknown.

Metabolism/Excretion: Mostly metabolized locally; any systemically absorbed alprostadil is metabolized in the liver.

Half-Life: 5–10 min.

Time/Action Profile ⬆ ⬇

(erection)

ROUTE	ONSET	PEAK	DURATION
Intracavernosal	5–10 min	within 20 min	1 hr

Patient/Family Teaching ⬆ ⬇

Instruct patient in correct technique for use of medication.
Caution patient to report priapism (erection lasting 4 hr or longer) to health care professional immediately. Priapism is a medical emergency that can result in penile tissue damage and permanent loss of potency if not treated promptly.
- Caution patient about rapid change in position, especially within an hr of administration.
- Caution patient that use of alprostadil offers no protection against sexually transmitted infections (STIs). Injection of alprostadil may cause a small amount of bleeding at injection site, increasing risk of transmission of bloodborne diseases. Advise patient to use protective measures to prevent spread of STIs, including HIV.
Intracavernosal Injection: Instruct patient on correct technique for preparation, injection, and disposal of equipment. Caution patient not to reuse or share needle with other persons. Desirable dose is determined with first injection in health care professional’s office. Advise patient not to increase dose without consulting health care professional. Injections should be administered no more than 3 times/wk, with 24 hr between injections. Advise patient to notify health care professional if nodules or hard tissue in the penis; redness, swelling, or tenderness; or curvature of the erect penis occurs. Advise patient to read Patient Information before starting therapy and with each Rx refill in case of changes.
- Emphasize the importance of follow-up exams every 3 mo to assess efficacy and safety of therapy and to adjust dose as needed.

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Indications ⬇

Contraind./Precautions ⬆ ⬇