ERECTILE DYSFUNCTION MEDICATIONS

PDE-5I = Phosphodiesterase type 5 inhibitors
PRICING INFO


References:
PHARMACOKINETICS



Drug Dosage form Dosage Generic/Price Other / Pharmacokinetics Mechanism of Action FDA-approved indications Side Effects Drug Interactions Precautions / Contraindications
Avanafil

Stendra®
Tablet
  • 50 mg
  • 100 mg
  • 200 mg
Erectile dysfunction
  • Starting: 100 mg as early as 15 minutes before intercourse
  • Maintenance: 50 - 200 mg before intercourse
  • Do not take more than once a day
  • When using 50 mg dose, take 30 minutes before intercourse
NO/$$$$ Other
  • May take without regard to food

Pharmacokinetics
  • Tmax: 30 - 45 minutes
  • Half-life: 5 hours
  • Inhibits PDE-5 which leads to an increase in intracellular cGMP. cGMP decreases calcium concentrations which causes smooth muscle relaxation.

  • See ED drug mechanism of action
  • Erectile dysfunction
NOTE: P = % of patients on placebo who reported side effect. Side effects presented here are for 100 mg dose.

  • Headache - 7%, P - 1.7%
  • Flushing - 4.3%, P - 0%
  • Nasal congestion - 3%, P - 1.1%
  • Nitrates - DO NOT COMBINE. May cause dangerously low blood pressure. When nitrates are deemed medically necessary in a patient who has taken avanafil, at least 12 hours should elapse after the last dose of avanafil before giving a nitrate.
  • Riociguat (Adempas®) - DO NOT COMBINE. May cause severe hypotension.
  • Strong CYP3A4 inhibitors - DO NOT COMBINE. Avanafil is a CYP3A4 sensitive substrate.
  • Moderate CYP3A4 inhibitors - dose of avanafil should not exceed 50 mg once every 24 hours. Avanafil is a CYP3A4 sensitive substrate.
  • CYP3A4 inducers - CYP3A4 inducers may decrease the effectiveness of avanafil. Concomitant use is not recommended.
  • Alpha blockers - use caution. May cause low blood pressure resulting in fainting, lightheadedness, etc. Initiate avanafil at a dose of 50 mg.
  • Amlodipine - amlodipine increased the exposure to avanafil by 70% in one study. Use caution.
  • Blood pressure medications - avanafil lowers blood pressure (SBP -8 mmHg, DBP -3.3 mmHg one hour after 200 mg dose) This may potentiate the effects of blood pressure agents.
  • Alcohol - alcohol and avanafil both act as vasodilators. When taken with alcohol, avanafil may cause an increase in heart rate, decreased blood pressure, dizziness, and headache.
  • Alprostadil - combination has not been studied. Concomitant use is not recommended.
  • Cardiovascular disease - patients with significant cardiovascular disease may be at increased risk of cardiac events during sexual activity. The BP lowering-effect of PDE-5Is may increase this risk.
  • Hypotension (low blood pressure) - avanafil lowers blood pressure. In studies, average SBP decreased by 8 mmHg and DBP decreased by 3.3 mmHg one hour after a 200 mg dose. Susceptible patients may experience symptoms of hypotension.
  • Prolonged erection - if an erection lasts longer than 4 hours, patients should seek medical help
  • Sickle cell disease - may increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Multiple myeloma - may increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Leukemia - may increase risk of priapism (painful erection lasting 6 hours)
  • Penile deformities - use caution in patients with angulation, cavernosal fibrosis, or Peyronie's disease
  • Vision loss - in rare cases, PDE-5Is have been associated with a condition known as non-arteritic anterior ischemic optic neuropathy (NAION) which can cause sudden, permanent vision loss (incidence 2.5 - 11.8 cases per 100,000 males ≥ 50 years old)
  • Hearing loss - PDE-5Is have been associated with rare cases of sudden hearing loss
  • Bleeding disorders - PDE-5Is may inhibit platelet aggregation and worsen bleeding disorders
  • Kidney disease
    • CrCl ≥ 30 ml/min: no dose adjustment necessary
    • CrCl < 30 ml/min: has not been studied. Do not use.
  • Liver disease
    • Child Pugh A and B: no dose adjustment necessary
    • Child Pugh C: has not been studied. Do not use.
Drug Dosage form Dosage Generic/Price Other / Pharmacokinetics Mechanism of Action FDA-approved indications Side Effects Drug Interactions Precautions / Contraindications
Sildenafil

Viagra®
Tablet
  • 25 mg
  • 50 mg
  • 100 mg
Erectile dysfunction
  • Starting: 50 mg taken 1 hour before intercourse
  • Maintenance: 25 - 100 mg before intercourse
  • Elderly (≥ 65 years) - consider starting dose of 25 mg
  • Do not take more than once a day
  • May be taken anywhere from 30 minutes to 4 hours before intercourse
Viagra®
YES/$$$$

Sildenafil 20 mg
YES/$ (see Other)
Other
  • May take without regard to food
  • Sildenafil is also the active ingredient in another medication called Revatio® that is approved to treat pulmonary artery hypertension
  • Revatio® has a cheap generic version that comes in a 20 mg tablet

Pharmacokinetics
  • Tmax: 60 minutes
  • Half-life: 4 hours
  • Inhibits PDE-5 which leads to an increase in intracellular cGMP. cGMP decreases calcium concentrations which causes smooth muscle relaxation.

  • See ED drug mechanism of action
  • Erectile dysfunction
NOTE: P = % of patients on placebo who reported side effect. Side effects presented here are for 50 mg dose. Only side effects that occurred at an incidence of ≥ 2% and ≥ 2% more than placebo are presented.

  • Headache - 21%, P - 7%
  • Flushing - 19%, P - 2%
  • Upset stomach - 9%, P - 2%
  • Nasal congestion - 4%, P - 2%
  • Back pain - 4%, P - 2%
  • Nausea - 3%, P - 1%
  • Dizziness - 4%, P - 2%
  • Nitrates - DO NOT COMBINE. May cause dangerously low blood pressure. The AHA says that nitrates should not be given within 24 hours of sildenafil.
  • Riociguat (Adempas®) - DO NOT COMBINE. May cause severe hypotension.
  • Alpha blockers - use caution. May cause low blood pressure resulting in fainting, lightheadedness, etc. Initiate sildenafil at a dose of 25 mg.
  • Ritonavir - maximum dose of sildenafil is 25 mg every 48 hours when taken with ritonavir. Ritonavir is a strong CYP3A4 inhibitor.
  • Strong and Moderate CYP3A4 inhibitors - may increase sildenafil levels. Consider a starting dose of 25 mg when taken with strong or moderate CYP3A4 inhibitors.
  • Amlodipine - when sildenafil 100 mg was taken with amlodipine, average SBP decreased by 8 mmHg and DBP decreased by 7 mmHg. Use caution.
  • CYP3A4 inducers - CYP3A4 inducers may decrease the effectiveness of sildenafil
  • Blood pressure medications - sildenafil lowers blood pressure (average maximum decrease: SBP -8.4 mmHg, DBP -5.5 mmHg) This may potentiate the effects of blood pressure agents.
  • Alcohol - alcohol can lower blood pressure. Sildenafil may potentiate this effect.
  • Alprostadil - combination has not been studied. Concomitant use is not recommended.
  • Cardiovascular disease - patients with significant cardiovascular disease may be at increased risk of cardiac events during sexual activity. The BP lowering-effect of PDE-5Is may increase this risk.
  • Hypotension (low blood pressure) - sildenafil lowers blood pressure (average maximum decrease: SBP -8.4 mmHg, DBP -5.5 mmHg). Susceptible patients may experience symptoms of hypotension.
  • Prolonged erection - if an erection lasts longer than 4 hours, patients should seek medical help
  • Sickle cell disease - may increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Multiple myeloma - may increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Leukemia - may increase risk of priapism (painful erection lasting 6 hours)
  • Penile deformities - use caution in patients with angulation, cavernosal fibrosis, or Peyronie's disease
  • Vision loss - in rare cases, PDE-5Is have been associated with a condition known as non-arteritic anterior ischemic optic neuropathy (NAION) which can cause sudden, permanent vision loss (incidence 2.5 - 11.8 cases per 100,000 males ≥ 50 years old)
  • Hearing loss - PDE-5Is have been associated with rare cases of sudden hearing loss
  • Bleeding disorders - PDE-5Is may inhibit platelet aggregation and worsen bleeding disorders
  • Kidney disease
    • CrCl ≥ 30 ml/min: no dose adjustment necessary
    • CrCl < 30 ml/min: clearance is reduced. Consider starting dose of 25 mg.
  • Liver disease - clearance is reduced. Consider a starting dose of 25 mg in patients with any degree of liver disease.
Drug Dosage form Dosage Generic/Price Other / Pharmacokinetics Mechanism of Action FDA-approved indications Side Effects Drug Interactions Precautions / Contraindications
Tadalafil

Cialis®
Tablet
  • 2.5 mg
  • 5 mg
  • 10 mg
  • 20 mg
Erectile dysfunction - as needed
  • Starting: 10 mg before intercourse
  • Maintenance: 5 - 20 mg before intercourse
  • Do not take more than once a day
  • Has been shown to improve ED up to 36 hours after dosing
Erectile dysfunction - daily use
  • Starting: 2.5 mg once daily
  • Maintenance: 2.5 - 5 mg once daily

Benign Prostatic Hyperplasia (BPH)
  • Dosing: 5 mg once daily
NO/$$$$ Other
  • May take without regard to food

Pharmacokinetics
  • Tmax: 2 hours
  • Half-life: 17.5 hours
Erectile dysfunction
  • Inhibits PDE-5 which leads to an increase in intracellular cGMP. cGMP decreases calcium concentrations which causes smooth muscle relaxation.
  • See ED drug mechanism of action

Benign Prostatic Hyperplasia
  • The effect of PDE5 inhibition on cGMP concentration in the corpus cavernosum and pulmonary arteries is also observed in the smooth muscle of the prostate, the bladder, and their vascular supply. The mechanism for reducing BPH symptoms has not been established.
  • Erectile dysfunction

  • Benign Prostatic Hypertrophy (BPH) - approved for treatment up to 26 weeks. Incremental benefit decreases from 4 weeks until 26 weeks. After 26 weeks, benefit is unknown.
NOTE: P = % of patients on placebo who reported side effect. Side effects presented here are for 10 mg dose. Only side effects that occurred at an incidence of ≥ 2% and ≥ 2% more than placebo are presented.

  • Headache - 11%, P - 5%
  • Upset stomach - 8%, P - 1%
  • Back pain - 5%, P - 3%
  • Muscle aches - 4%, P - 1%
  • Nasal congestion - 3%, P - 1%
  • Flushing - 3%, P - 1%
  • Pain in limb - 3%, P - 1%
  • Nitrates - DO NOT COMBINE. May cause dangerously low blood pressure. The AHA says that nitrates should not be given within 48 hours of tadalafil.
  • Riociguat (Adempas®) - DO NOT COMBINE. May cause severe hypotension.
  • Alpha blockers - use caution. May cause low blood pressure resulting in fainting, lightheadedness, etc. Initiate tadalafil at lowest recommended dosage. Tadalafil should not be combined with alpha blockers to treat BPH.
  • Strong CYP3A4 inhibitors - may increase tadalafil levels. Maximum recommended as needed dose is 10 mg every 72 hours when taken with strong CYP3A4 inhibitors. Maximum recommended daily dose is 2.5 mg when taken with strong CYP3A4 inhibitors.
  • Blood pressure medications - tadalafil lowers blood pressure slightly (average maximum decrease after 20 mg: SBP -1.6 mmHg, DBP -0.8 mmHg) This may potentiate the effects of blood pressure agents.
  • Alcohol - alcohol can lower blood pressure. Tadalafil may potentiate this effect.
  • CYP3A4 inducers - CYP3A4 inducers may decrease the effectiveness of tadalafil
  • Alprostadil - combination has not been studied. Concomitant use is not recommended.
  • Cardiovascular disease - patients with significant cardiovascular disease may be at increased risk of cardiac events during sexual activity. The BP lowering-effect of PDE-5Is may increase this risk.
  • Hypotension (low blood pressure) - tadalafil lowers blood pressure (average maximum decrease after 20 mg: SBP -1.6 mmHg, DBP -0.8 mmHg). Susceptible patients may experience symptoms of hypotension.
  • Prolonged erection - if an erection lasts longer than 4 hours, patients should seek medical help
  • Sickle cell disease - may increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Multiple myeloma - may increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Leukemia - may increase risk of priapism (painful erection lasting 6 hours)
  • Penile deformities - use caution in patients with angulation, cavernosal fibrosis, or Peyronie's disease
  • Vision loss - in rare cases, PDE-5Is have been associated with a condition known as non-arteritic anterior ischemic optic neuropathy (NAION) which can cause sudden, permanent vision loss (incidence 2.5 - 11.8 cases per 100,000 males ≥ 50 years old)
  • Hearing loss - PDE-5Is have been associated with rare cases of sudden hearing loss
  • Bleeding disorders - PDE-5Is may inhibit platelet aggregation and worsen bleeding disorders
  • Kidney disease
    • As-needed dosing
      • CrCl ≥ 30 - 50 ml/min: starting dose is 5 mg once daily, maximum dose is 10 mg every 48 hours
      • CrCL < 30 ml/min: maximum dose is 5 mg every 72 hours
      Once daily dosing
      • CrCl ≥ 30 - 50 ml/min: starting dose is 2.5 mg once daily, increase to 5 mg if tolerated
      • CrCL < 30 ml/min: DO NOT USE
  • Liver disease
    • As-needed dosing
      • Child Pugh A or B: - maximum dose is 10 mg a day
      • Child Pugh C: DO NOT USE
      Once daily dosing
      • Child Pugh A or B: - has not been studied. Use caution
      • Child Pugh C: DO NOT USE
Drug Dosage form Dosage Generic/Price Other / Pharmacokinetics Mechanism of Action FDA-approved indications Side Effects Drug Interactions Precautions / Contraindications
Vardenafil

Levitra®
Staxyn®
Levitra®
Tablet
  • 2.5 mg
  • 5 mg
  • 10 mg
  • 20 mg

Staxyn®
Orally disintegrating tablet
  • 10 mg
  • Comes in blister card with 4 tablets
Levitra
    Erectile dysfunction
    • Starting: 10 mg taken 60 minutes before intercourse
    • Maintenance: 5 - 20 mg before intercourse
    • Elderly (≥ 65 years): Consider starting dose of 5 mg
    • Do not take more than once a day

Staxyn
    Erectile dysfunction
    • Dosing: 10 mg taken 60 minutes before intercourse
    • Do not exceed one tablet per day
    • Place tablet under the tongue where it will disintegrate. Do not take with liquid.
    • Take immediately upon removal from blister
    • Staxyn is not interchangeable with Levitra because it provides higher systemic exposure
Levitra
NO/$$$$

Staxyn
NO/$$$$
Other
  • May take Levitra and Staxyn without regard to food

Pharmacokinetics
Levitra
  • Tmax: 60 minutes
  • Half-life: 4 - 5 hours
Staxyn
  • Tmax: 90 minutes
  • Half-life: 4 - 6 hours
  • Inhibits PDE-5 which leads to an increase in intracellular cGMP. cGMP decreases calcium concentrations which causes smooth muscle relaxation.

  • See ED drug mechanism of action
  • Erectile dysfunction
NOTE: P = % of patients on placebo who reported side effect. Side effect data is combined data from trials using all different doses of Levitra. Only side effects that occurred at an incidence of ≥ 2% and ≥ 2% more than placebo are presented.

  • Headache - 15%, P - 4%
  • Flushing - 11%, P - 1%
  • Nasal congestion - 9%, P - 3%
  • Upset stomach - 4%, P - 1%
  • Sinusitis - 3%, P - 1%
  • Nitrates - DO NOT COMBINE. May cause dangerously low blood pressure. A suitable time interval following dosing of vardenafil for the safe administration of nitrates or nitric oxide donors has not been determined.
  • Riociguat (Adempas®) - DO NOT COMBINE. May cause severe hypotension.
  • Alpha blockers - use caution. May cause low blood pressure resulting in fainting, lightheadedness, etc. Initiate vardenafil at a dose of 5 mg.
  • Ritonavir - vardenafil dose should not exceed 2.5 mg every 72 hours when taken with ritonavir
  • Atazanavir - vardenafil dose should not exceed 2.5 mg every 24 hours when taken with atazanavir
  • Strong CYP3A4 inhibitors - vardenafil dose should not exceed 2.5 mg every 24 hours when taken with strong CYP3A4 inhibitors
  • Moderate CYP3A4 inhibitors - dose of vardenafil may need to be reduced
  • CYP3A4 inducers - CYP3A4 inducers may decrease the effectiveness of vardenafil
  • CYP2C9 inhibitors and inducers - may affect blood levels of vardenafil
  • Ketoconazole - vardenafil dose should not exceed 5 mg every 24 hours when taken with ketoconazole 200 mg once daily. Vardenafil dose should not exceed 2.5 mg every 24 hours when taken with ketoconazole 400 mg once daily.
  • Itraconazole - vardenafil dose should not exceed 5 mg every 24 hours when taken with itraconazole 200 mg once daily. Vardenafil dose should not exceed 2.5 mg every 24 hours when taken with itraconazole 400 mg once daily.
  • Indinavir - vardenafil dose should not exceed 2.5 mg every 24 hours when taken with indinavir
  • Erythromycin - vardenafil dose should not exceed 5 mg every 24 hours when taken with erythromycin
  • Blood pressure medications - vardenafil lowers blood pressure (average maximum decrease after 20 mg dose: SBP -7 mmHg, DBP -8 mmHg) This may potentiate the effects of blood pressure agents.
  • Drugs that prolong the QT interval - vardenafil may prolong the QT interval. Avoid concomitant use with medications that are known to prolong the QT interval. (examples include quinidine, procainamide, amiodarone, and sotalol)
  • Alcohol - alcohol lowers blood pressure. Vardenafil may potentiate this effect.
  • Alprostadil - combination has not been studied. Concomitant use is not recommended.
  • Cardiovascular disease - patients with significant cardiovascular disease may be at increased risk of cardiac events during sexual activity. The BP lowering-effect of PDE-5Is may increase this risk.
  • Hypotension (low blood pressure) - vardenafil lowers blood pressure (average maximum decrease after 20 mg dose: SBP -7 mmHg, DBP -8 mmHg). Susceptible patients may experience symptoms of hypotension.
  • Prolonged erection - if an erection lasts longer than 4 hours, patients should seek medical help
  • Sickle cell disease - may increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Multiple myeloma - may increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Leukemia - may increase risk of priapism (painful erection lasting 6 hours)
  • Penile deformities - use caution in patients with angulation, cavernosal fibrosis, or Peyronie's disease
  • Vision loss - in rare cases, PDE-5Is have been associated with a condition known as non-arteritic anterior ischemic optic neuropathy (NAION) which can cause sudden, permanent vision loss (incidence 2.5 - 11.8 cases per 100,000 males ≥ 50 years old)
  • Prolonged QT syndrome - vardenafil may prolong the QT interval. Avoid use in patients with prolonged QT syndrome.
  • Hearing loss - PDE-5Is have been associated with rare cases of sudden hearing loss
  • Bleeding disorders - PDE-5Is may inhibit platelet aggregation and worsen bleeding disorders
  • Kidney disease - no dose adjustment necessary. Avoid use in hemodialysis.
  • Liver disease
    • Levitra
      • Child Pugh B: use starting dose of 5 mg. Maximum dose is 10 mg.
      • Child Pugh C: DO NOT USE
      Staxyn
      • Child Pugh A: okay to use
      • Child Pugh B/C: DO NOT USE
Drug Dosage form Dosage Generic/Price Other Mechanism of Action FDA-approved indications Side Effects Drug Interactions Precautions / Contraindications
Alprostadil

Muse®
Urethral suppository
  • 125 mcg
  • 250 mcg
  • 500 mcg
  • 1000 mcg
Erectile dysfunction
  • Starting: 125 - 250 mcg inserted 5 - 10 minutes before intercourse
  • Maintenance: 125 - 1000 mcg before intercourse
  • The duration of effect is 30 - 60 minutes
  • Maximum use is 2 suppositories in 24 hours
NO/$$$$ Other
  • Patient should urinate immediately prior to use
  • Suppository dissolves in small amount of urine left in penis
  • Suppository is inserted into urethra with included device
  • Store in refrigerator
  • May be kept at room temperature for up to 14 days
  • Do not expose to temperatures above 86°F

Initiating therapy
  • The manufacturer recommends that Muse® dose titration be performed under physician supervision to insure proper technique and monitor for hypotension
  • Alprostadil stimulates PGE1 receptors which leads to an increase in intracellular cGMP. cGMP decreases calcium concentrations which causes smooth muscle relaxation.

  • See ED drug mechanism of action
  • Erectile dysfunction
NOTE: P = % of patients on placebo who reported side effect. Side effect data is combined data from trials using all different doses. Only side effects that occurred at an incidence of ≥ 2% and ≥ 2% more than placebo are presented.

  • Penile pain - 32%, P - 3%
  • Urethral burning - 12%, P - 4%
  • Urethral bleeding - 5%, P - 1%
  • Testicular pain - 5%, P - 1%
  • Flu symptoms - 4%, P - 2%
  • Symptomatic hypotension - 3% of patients
  • Female partner vaginal itching/burning - 5.8%, P - 0.8%
  • Following Muse® administration, blood levels of alprostadil are low to undetectable; therefore, systemic drug-drug interactions are unlikely
  • Penile abnormalities - DO NOT USE in patients with urethral stricture, balanitis (inflammation/infection of the glans of the penis), severe hypospadias and curvature, and in patients with acute or chronic urethritis.
  • Sickle cell disease - DO NOT USE. May increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Multiple myeloma - DO NOT USE. May increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Leukemia - DO NOT USE. May increase risk of priapism (painful erection lasting 6 hours)
  • Thrombocythemia - DO NOT USE. May increase risk of priapism (painful erection lasting 6 hours)
  • Polycythemia - DO NOT USE. May increase risk of priapism (painful erection lasting 6 hours)
  • Pregnant partner - only use with condom barrier
  • Cardiovascular disease - patients with significant cardiovascular disease may be at increased risk of cardiac events during sexual activity. The hypotensive effects of alprostadil may increase this risk.
  • Hypotension (low blood pressure) - in trials, 3% of patients experienced symptomatic hypotension after using Muse®
  • Prolonged erection - if an erection lasts longer than 4 hours, patients should seek medical help
  • Pulmonary disease - alprostadil is metabolized in the lungs. Significant pulmonary disease may increase the risk of systemic effects.
  • Kidney disease - manufacturer makes no recommendation
  • Liver disease - manufacturer makes no recommendation
Drug Dosage form Dosage Generic/Price Other Mechanism of Action FDA-approved indications Side Effects Drug Interactions Precautions / Contraindications
Alprostadil

Caverject®
Caverject Impulse®
Edex®
Caverject® vial
  • 5 mcg
  • 10 mcg
  • 20 mcg
  • 40 mcg
  • Comes in carton with 6 vials

Caverject® impulse
  • 10 mcg
  • 20 mcg
  • Single dose disposable syringe
  • One carton contains 2 syringes

Edex® cartridge
  • 10 mcg
  • 20 mcg
  • 40 mcg
  • Each cartridge contains one dose
  • Cartridge is loaded into Edex® injection device
  • Comes in carton with 2 or 6 cartridges
Erectile dysfunction
  • Starting: Dose should be titrated under physician supervision. See Caverject® PI for titration recommendations. In one study, the average dose at the end of the titration phase was 17.8 mcg
  • Maintenance: in studies, the average effective dose was around 20 mcg
  • Maximum: doses above 60 mcg are not recommended
  • Do not use more than 3 times a week
  • Allow at least 24 hours between each dose
Caverject
NO/$$$$

Caverject Impulse
NO/$$$$

Edex
NO/$$$$

Caverject vial
  • Vial must be reconstituted with sterile water
  • Reconstituted solution should be used within 24 hours. Do not refrigerate solution.

Caverject impulse
  • Store reconstituted and unreconstituted product at room temperature
  • Reconstituted solution should be used within 24 hours. Do not refrigerate solution.
  • 10mcg syringe can deliver 7.5, 5, and 2.5 mcg partial doses
  • 20 mcg syringe can deliver 15, 10, and 5 mcg partial doses

Edex
  • Store cartridges at room temperature
  • Use reconstituted product immediately
  • Syringe can be adjusted to deliver partial doses

Injection technique
  • Solution is injected into the corpus cavernosum from the side of the penis
  • Patients should alternate sides of the penis with each injection
  • A 27 - 29 ga half-inch needle is typically used
  • Alprostadil stimulates PGE1 receptors which leads to an increase in intracellular cGMP. cGMP decreases calcium concentrations which causes smooth muscle relaxation.

  • See ED drug mechanism of action
  • Erectile dysfunction
NOTE: No significant local adverse reactions were reported for placebo. Side effect data is combined data from trials using all different doses.

  • Penile pain - 37%
  • Prolonged erection - 4%
  • Penile fibrosis - 3% (up to 7.8% in some studies)
  • Injection site hematoma - 3%
  • Other penile complaints (numbness, sensitivity) - 3%
  • Injection site bruising - 2%
  • Penile rash - 1%
  • Penile edema - 1%
  • Following Caverject administration, blood levels of alprostadil are low to undetectable; therefore, systemic drug-drug interactions are unlikely
  • Penile abnormalities - DO NOT USE in patients with anatomical deformation of the penis, such as angulation, cavernosal fibrosis, or Peyronie's disease
  • Sickle cell disease - DO NOT USE. May increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Multiple myeloma - DO NOT USE. May increase risk of priapism (painful erection lasting ≥ 6 hours)
  • Leukemia - DO NOT USE. May increase risk of priapism (painful erection lasting 6 hours)
  • Prolonged erection - if an erection lasts longer than 4 hours, patients should seek medical help
  • Penile fibrosis - occurred in 7.8% of patients in an 18-month study. Discontinue if occurs.
  • Cardiovascular disease - patients with significant cardiovascular disease may be at increased risk of cardiac events during sexual activity. The hypotensive effects of alprostadil may increase this risk.
  • Pulmonary disease - alprostadil is metabolized in the lungs. Significant pulmonary disease may increase the risk of systemic effects.
  • Kidney disease - manufacturer makes no recommendation
  • Liver disease - manufacturer makes no recommendation