Alprostadil, Caverject/Edex/Muse/Prostin VR
Description: Prostaglandin Vasodilator
“ALERT: US Boxed Warning
Apnea (Prostin VR Pediatric):
Apnea is experienced by about 10% to 12% of neonates with congenital heart defects treated with alprostadil pediatric sterile solution. Apnea is most often seen in neonates weighing less than 2 kg at birth and usually appears during the first hour of drug infusion. Therefore, monitor respiratory status throughout treatment, and use alprostadil pediatric injection where ventilatory assistance is immediately available.”
CSA NA – FDA Approved – REMS (N) – Can Ship
How Does It Work
Relaxes the trabecular smooth muscle of the cavernosal arteries which causes vasodilation allowing an increase in blood flow to and entrapment in the lacunar spaces of the penile shaft.
Indications For Use
Use cautiously if operating machinery or driving following administration because of the risk of hypotension/syncope.
Do not use in men who have or develop penile angulation or cavernosal fibrosis.
Can cause a painful and prolonged erection lasting longer than 4 hours known as priapism. Discontinue use and seek immediate medical assistance.
Do not use in patients who have conditions that predispose them to priapism (i.e. sickle cell anemia, multiple myeloma, leukemia).
Intracavernous (Caverject, Edex/Alprostadil)
The initial dose must be determined and titrated by a healthcare provider. The patient must stay in the health clinic setting until complete detumescence occurs; if there is no response to the intracavernous injection then a higher dose can be given within one hour; if there is still no response, then a higher dose can be given at a one-day interval. Individualized dosing is required and careful done by titration; doses > 40mcg (Edex) and >60mcg (Caverject) are not recommended.
Suggested Dosing Regimen
Vasculogenic, psychogenic or mixed etiology: Initiate dose at 2.5mcg.
If there is a partial response, increase the dose by 2.5mcg to a dose of 5mcg and then in increments of 5 to 10mcg (depending on the erectile response) until you have reached a dose that produces an erection lasting up to a duration of 1 hour or less.
If there is no response to the initial 2.5mcg dose, the second dose can be increased to 7.5mcg and administered within 1 hour, followed by increments of 5 to 10mcg (depending on the erectile response).
If there is a response, then a 24-hour interval should be given before the next dose is given.
Neurogenic etiology: Initiate dosage titrations at 1.25mcg.
If there is a partial response, increase the dose to 2.5mcg within 1 hour and if required to a dose of 5mcg. You may increase the dose further in increments of 5mcg (depending on the erectile response) until you have reached a dose that produces an erection lasting a duration of 1 hour or less.
Note: No more than 2 doses should be given within a 24-hour period during the initial titration.
Maintenance: self administer injections no more than 3 times weekly with at least 24 hours between doses.
Intraurethral (Muse Pellet)
Initial: Insert 125mcg to 250mcg intraurethral, you can increase or decrease the dose in a stepwise manner until a sufficient erectile response is reached producing an erection lasting a duration of 1 hour or less.
Maintenance: Insert intraurethral as needed; do not use more than 2 doses in a 24-hour period.
Pharmacist Tips On Using
How to Use Caverject, Edex/Alprostadil: Use as instructed by your doctor before sexual activity. Do not shake the vial/prefilled syringe prior to injection. Attach a new needle before each dose and make sure to only use a straight needle. After the dose is given, press lightly on the injection site to prevent bruising. Do this for 5 minutes and until bleeding stops. Throw away needles in a sharp disposal container. Never reuse any of the needles. Do not use the solution if it is cloudy, leaking or has particles. Rotate the injection sites on the penis with each dose.
Do not use more than 3 times weekly with at least 24 hours between doses.
How to Use Muse/Alprostadil: Use as instructed by your doctor before sexual activity. Pass urine before inserting the intraurethral pellet.
If Your Penile Erection Does Not Go Down Caverject, Edex/Alprostadil: Painful erections lasting > 6 hours is known as priapism and is rare. However, if your erection lasts longer than > 4 hours, seek a medical condition. Certain medical conditions such as sickle cell anemia, multiple myeloma and leukemia have been associated with a higher risk of priapism.
If Your Penile Erection Does Not Go Down Muse/Alprostadil: Painful erections lasting > 6 hours is known as priapism and is rare. However, if your erection lasts longer than > 4 hours, seek medical condition. Certain medical conditions such as sickle cell anemia, multiple myeloma and leukemia have been associated with a higher risk of priapism.
Do Not Use with Pregnant Women Muse/Alprostadil: Use a condom barrier during sexual intercourse with a pregnant woman.
Be Careful When Using Caverject, Edex/Alprostadil: needle breakage (a portion of the needle remaining in the penis) has been reported; surgical removal may be necessary.
Be Careful When Using Muse/Alprostadil: urethral abrasion and bleeding can occur from improper insertion.
Most of the side effects are mild to moderate in nature. The most common side effects include:
Genitourinary: Penile pain
1% to 10%
Central nervous system: Dizziness, headache
Genitourinary: Prolonged erection (>4 hours, 4%), penile disease, penile rash, penile swelling, Peyronie’s disease
Local: bruising, hematoma at the injection site
Genitourinary: Penile pain, urethral burning
2% to 10%
Central nervous system: Dizziness, headache, pain
Genitourinary: Testicular pain, urethral bleeding (minor), vulvovaginal pruritus (female partner)
Frequently Asked Questions
Is Muse/Alprostadil safe to use?
If your partner can get pregnant, make sure to use birth control to prevent pregnancy. Furthermore, if you are having sex with a pregnant woman while using Muse make sure to use a condom.
Can Caverject, Edex/Alprostadil protect you against sexually transmitted diseases?
Neither Caverject and Edex stop the spread of sexually transmitted diseases like HIV or hepatitis which are spread through bodily fluids during sex.
Can Muse/Alprostadil protect you against sexually transmitted diseases?
Muse cannot stop the spread of sexually transmitted diseases like HIV or hepatitis which are spread through bodily fluids during sex.
What if you miss a dose?
This drug is intended to be used only on an as-needed basis.
Any sign of a serious allergic reaction such as a rash, hives, itching, swollen, blistered or peeling skin with or without fever; tightness in the chest or throat; trouble breathing; swallowing; swelling of the mouth, face, lips, tongue or throat; chest pain, pressure, fast heart rate; shortness of breath; unexplained bruising or bleeding; swelling of leg veins; painful hard erection or an erection lasting longer than 4 hours.
How quickly will Caverject, Edex/Alprostadil work?
Caverject and Edex are fast-acting medications with an onset of action of 5 to 20 minutes with a duration of less than 1 hour.
How quickly will Muse/Alprostadil work?
Muse is a fast-acting medication with an onset of action of 5 to 20 minutes with a duration of less than 1 hour.
How should Caverject, Edex/Alprostadil be stored?
Caverject and Edex can be stored at room temperature away from children.
How should Muse/Alprostadil be stored?
Store the unopened foil pouch in the refrigerator. Muse can be stored at room temperature for up to 2 weeks before use.