Alprostadil

Alprostadil Brand Names

Caverject | Caverject Impulse | Edex | Muse | Prostin VR

What is Alprostadil

Alprostadil is used to treat erectile dysfunction (ED) in adult males.

The efficacy of alprostadil in treating ED varies with the cause; response rate is generally lower in patients with ED due to mixed etiologies compared to those with ED due to neurogenic, psychogenic, or vasculogenic causes.

Two dosage forms are marketed for treating ED: a transurethral product (Muse) which uses a medicated pellet administered into the urethra and an injection (Caverject or Edex) that is directly injected into the corpus cavernosa.

Other dosage forms such as a topical gel and a non-invasive liposomal delivery system are under investigation.

According to ED treatment guidelines, oral phosphodiesterase type 5 inhibitors (PDE5 inhibitor) are considered first-line therapy.

Second-line treatment options include intracavernous injection and intra-urethral therapy.

Intracavernous injection therapy is the most effective nonsurgical treatment for ED, with predictable and sustained response. However, it is invasive and caries notable side-effects including priapism and penile fibrosis.

FDA approvals are as follows: Caverject in July 1995, MUSE in October 1996, and Edex in June 1997.

Indications

  • ductus arteriosus maintenance
  • erectile dysfunction (ED)

For the treatment of neonates with congenital heart defects to maintain the patency of the ductus arteriosus (ductus arteriosus maintenance) until palliative or corrective surgery can be performed

Side Effects

  1. anemia
  2. anuria
  3. apnea
  4. back pain
  5. bleeding
  6. bradycardia
  7. cardiac arrest
  8. diaphoresis
  9. diarrhea
  10. disseminated intravascular coagulation (DIC)
  11. dizziness
  12. ecchymosis
  13. edema
  14. erythema
  15. fever
  16. flushing
  17. gastroesophageal reflux
  18. headache
  19. heart failure
  20. hematoma
  21. hematuria
  22. hyperbilirubinemia
  23. hypercholesterolemia
  24. hyperemia
  25. hyperglycemia
  26. hyperkalemia
  27. hypertension
  28. hypertriglyceridemia
  29. hypoesthesia
  30. hypoglycemia
  31. hypotension
  32. hypothermia
  33. increased urinary frequency
  34. injection site reaction
  35. irritability
  36. lethargy
  37. muscle cramps
  38. mydriasis
  39. myocardial infarction
  40. nausea
  41. penile edema
  42. penile fibrosis
  43. penile pain
  44. perineal pain
  45. peripheral edema
  46. peripheral vasodilation
  47. phimosis
  48. priapism
  49. pruritus
  50. rash
  51. respiratory depression
  52. rhinitis
  53. seizures
  54. sinus tachycardia
  55. supraventricular tachycardia (SVT)
  56. syncope
  57. tachypnea
  58. testicular pain
  59. thrombocytopenia
  60. urethral pain
  61. urinary retention
  62. urinary urgency
  63. vaginal irritation
  64. ventricular fibrillation
  65. visual impairment
  66. weakness
  67. wheezing
  68. xerostomia

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • anticoagulant therapy
  • apnea
  • balanitis
  • benzyl alcohol hypersensitivity
  • bleeding
  • breast-feeding
  • cardiac disease
  • children
  • coagulopathy
  • contraception requirements
  • driving or operating machinery
  • females
  • geriatric
  • GI obstruction
  • hypospadia
  • hypotension
  • infants
  • labor
  • leukemia
  • multiple myeloma
  • neonates
  • penile implants
  • penile structural abnormality
  • Peyronie’s disease
  • polycythemia
  • pregnancy
  • premature neonates
  • priapism
  • renal impairment
  • requires a specialized care setting
  • respiratory depression
  • respiratory distress syndrome
  • sexually transmitted disease
  • sickle cell disease
  • syncope
  • thrombocytosis
  • urethral stricture
  • urethritis

Interactions

  • Acebutolol
  • Angiotensin II receptor antagonists
  • Angiotensin-converting enzyme inhibitors
  • Atenolol
  • Atenolol; Chlorthalidone
  • Bendroflumethiazide; Nadolol
  • Beta-blockers
  • Betaxolol
  • Bisoprolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Brimonidine; Timolol
  • Calcium-channel blockers
  • Carteolol
  • Carvedilol
  • Central-acting adrenergic agents
  • Dorzolamide; Timolol
  • Doxazosin
  • Eplerenone
  • Epoprostenol
  • Esmolol
  • Heparin
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Ibuprofen lysine
  • Iloprost
  • Labetalol
  • Levobetaxolol
  • Levobunolol
  • Loop diuretics
  • Mecamylamine
  • Metoprolol
  • Nadolol
  • Nebivolol
  • Nebivolol; Valsartan
  • Penbutolol
  • Phenoxybenzamine
  • Pindolol
  • Potassium-sparing diuretics
  • Prazosin
  • Propranolol
  • Reserpine
  • Sotalol
  • Terazosin
  • Thiazide diuretics
  • Timolol
  • Treprostinil
  • Vasodilators
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