Erectile Dysfunction
Alprostadil to Treat ED

Alprostadil is a type of medicine that causes blood vessels to expand, increasing blood flow throughout the body. By increasing blood flow to the penis, alprostadil helps facilitate an erection.

Alprostadil can be given either by injection or as a suppository. When given as a suppository, the medicine is placed into the opening at the tip of the penis. When injected, a needle and syringe is used to inject the medicine in the penis.

If you receive the injection-form, alprostadil is sold under the brand names Caverject, Edex, and Prostin VR. Suppository-form of alprostadil is sold under the brand name MUSE.

Alprostadil should only be used in men with erectile dysfunction. If this medicine is not used properly, permanent damage to the penis can occur.

Does Injection Therapy Work?

Alprostadil delivered via the injection method causes an erection firm enough for sexual intercourse in approximately 80% of men with erectile dysfunction, regardless of their age or the cause of their problem. Alprostadil delivered via a suppository is not as effective as when it is delivered by penile injection; it produces an erection in approximately 30% of men with ED.

How Quickly Will It Work?

Alprostadil usually begins to work in about 5 to 10 minutes. Intercourse should be attempted within 10 to 30 minutes after using the medication. An erection may continue after ejaculation.

Who Should Not Take Alprostadil?

This medicine is not right for everyone. Before taking alprostadil, tell your doctor:

If you have ever had an allergic reaction to alprostadil
If you are allergic to any other substances such as medicine, foods, preservatives, or dyes
If you are taking any prescription or over-the-counter medicine including herbal and dietary supplements
If you have a penile implant
If you have a history of priapism
Also, tell your doctor if you have any medical problems, especially:

Abnormalities to your penis such as curvature or birth defects
Bleeding problems
Penile infection
Red or itchy penis
Conditions that cause thickened or slower blood flow such as leukemia (cancer of the blood), sickle cell disease or thrombocythemia (large number of platelets)
If alprostadil is not safe for you to take, your doctor can recommend other treatment options that are appropriate based on your health and medical history.

How Does the Suppository-Form of Alprostadil Work?

Called MUSE, a small pellet of alprostadil is placed inside the urethra (the small opening on the end of the penis) to dissolve inside the penis causing blood vessels to expand so that more blood can flow into the penis allowing for an erection to occur.

Before using the suppository-form of alprostadil, be sure that you fully understand how to administer it. Do not insert more than two doses of alprostadil within a 24-hour period and do not use any more than the doctor-recommended dose during a single usage. This could result in permanent damage to the penis.

Also, when using the suppository-form of alprostadil, use a condom if having sexual intercourse with a pregnant woman. The effects of this medicine on early pregnancy are unknown.

How Do I Insert the Suppository?

Before inserting the pellet of medicine, urinate; the small amount of urine left in the urethra will help dissolve the suppository after it has been inserted.
Push the medicine through the urethra.
To help dissolve the suppository once inside, roll your penis between your hands for 10 seconds. If you feel any stinging, continue this motion to help the stinging stop.
Sitting, standing or walking for 10 minutes while an erection is developing helps increase the blood flow to your penis to gain a proper erection.
If you have any questions, be sure to ask your doctor or pharmacist.

How Does the Injection-Form of Alprostadil Work?

When using the injection-form of alprostadil, the medicine is inserted through the wall of the penis using a needle and syringe. The needle goes into the spongy tissue on the side of the penis. Once inside, the medicine works the same way as the suppository form works - blood vessels dilate (enlarge) allowing for blood flow to the penis to increase and an erection to occur.

How Do I Inject the Medicine?

There are several alprostadil products that can be injected. The injection method for these products is the same, however the methods for preparing the mixtures are different. Be sure you know which product you are using and that you fully understand the proper way to mix the medicine. As with the suppository-form of medicine, the injection-form of alporstadil should not be used more often than prescribed or in larger amounts as this could result in permanent damage to the penis.

Before drawing the medicine into the syringe, be certain that you have washed your hands with soap and water and set the bottles on a clean surface. It is also important to wipe the tops of the injection bottles with an alcohol swab. Do not wipe the needle with the same alcohol swab

After a single-use injection is mixed, alprostadil must be used immediately. Throw away any unused mixture in the syringe. It cannot be stored for later injection. Do not reuse your needles.

If you have any questions about how to use this medication, ask your doctor or pharmacist.

How Do I Know Which Method of Delivery Is Right for Me?

It's a personal choice that should be made with the help of your doctor and your partner. There are pros and cons of each mode of delivery. For example, the injection may be more painful, but it tends to be more effective than the suppository-form.

Condom Use

When using alprostadil, either by suppository or injection, use a condom if having intercourse with a pregnant woman. The effects of alprostadil on the fetus are still unknown.

Storing Your Medicine

Alprostadil should be kept in its original container and out of the reach of children. The suppository-form of alprostadil can be stored at room temperature, away from excess heat or moisture (such as the bathroom) for up to 14 days. Otherwise store it in the refrigerator, but be sure to keep it from freezing.

While in powder form, alprostadil can be stored at room temperature, away from excess heat or moisture (such as the bathroom) for up to three months.

Do not keep outdated medicine or medicine that you no longer need.

What Are the Side Effects of Alprostadil?

Side effects with alprostadil are not common, but they do occur. Contact your doctor if you notice severe and prolonged:

Bleeding or spotting from the urethra (mild bleeding can be expected)
Stinging of the urethra
Penile pain
Side effects associated with injection include:

Bleeding at the site of injection
Pain at the site of injection (common)
Painful erection
Bruising or clotted blood in the area of the injection. This is usually caused by an incorrect injection.
If any of the above listed side effects are severe and prolonged, call your doctor.

Contact your doctor immediately if the following side effects occur:

Curving of the penis with pain during an erection
Erection continues for four to six hours with severe and continuing pain in the penis
Swelling in or pain of the testes
Dizziness
Faintness
Pelvic pain
Flu-like symptoms

Reviewed by the doctors at the Glickman Urological Institute at The Cleveland Clinic.

Edited by Charlotte Grayson, MD, WebMD, May 2004
Portions of this page © The Cleveland Clinic 2000-2004

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