Trade Names:Caverject- Powder for injection, lyophilized 6.15 mcg (5 mcg/mL)- Powder for injection, lyophilized 11.9 mcg (10 mcg/mL)- Powder for injection, lyophilized 23.2 mcg (20 mcg/mL)
Trade Names:Edex- Powder for injection, lyophilized 6.225 mcg (5 mcg/mL)- Powder for injection, lyophilized 12.45 mcg (10 mcg/mL)- Powder for injection, lyophilized 24.9 mcg (20 mcg/mL)- Powder for injection, lyophilized 49.8 mcg (40 mcg/mL)
Trade Names:Muse- Pellet 125 mcg- Pellet 250 mcg- Pellet 500 mcg- Pellet 1,000 mcg
Trade Names:Prostin VR Pediatric- Injection 500 mcg/mL (in 1 mL dehydrated alcohol)Prostin VR (Canada)
Relaxes smooth muscle of ductus arteriosus. Produces vasodilation, inhibits platelet aggregation and stimulates intestinal and uterine smooth muscle. Induces erection by relaxation of trabecular smooth muscle and by dilation of cavernosal arteries.
About 80% absorbed within 10 min.
About 81% bound to albumin and about 55% bound to alpha-globulin IV-4.
About 80% metabolized in one pass through the lungs.Urethral suppository
Also rapidly metabolized locally by enzymatic oxidation.
Metabolites excreted by kidneys; about 90% of IV dose excreted in urine within 24 h and remainder is excreted in feces. T 1/2 is 0.5 to 10 min.
May have reduced capacity to clear the drug.
Palliative therapy to maintain patency of ductus arteriosus temporarily, until surgery can be performed, in newborns who have congenital heart defects (eg, pulmonary stenosis, tricuspid atresia) and who depend on patent ductus for survival. Treatment of erectile dysfunction caused by neurogenic, vasculogenic, psychogenic, or mixed etiology. Intracavernosal alprostadil ( Caverject only) may be useful adjunct to other diagnostic tests in the diagnosis of erectile dysfunction.
Conditions that might predispose patients to priapism (eg, sickle cell anemia or trait, multiple myeloma leukemia); patients with anatomical deformation of the penis (eg, angulation, cavernosal fibrosis, Peyronie disease); patients with penile implants; use in women, children or newborns; use in men for whom sexual activity is inadvisable or contraindicated.
IV 0.01 to 0.4 mcg/kg/min. Drug is infused for shortest time and at lowest effective dose.Impotence (Erectile Dysfunction of Vasculogenic, Psychogenic, or Mixed Etiology)
Intracavernosal Initiate dose titration at 2.5 mcg. If there is a partial response, the dose may be increased by 2.5 mcg to a dose of 5 mcg and then in increments of 5 to 10 mcg, depending on erectile response, until the dose that produces an erection suitable for intercourse and not exceeding a duration of 1 h is reached. If there is no response to the initial 2.5 mcg dose, the second dose may be increased to 7.5 mcg, followed by increments of 5 to 10 mcg. If there is no response, then the next higher dose may be given within 1 h. If there is a response, then there should be a 1-day interval before the next dose is given.Erectile Dysfunction of Pure Neurogenic Etiology (Spinal Cord Injury)
Initiate dosage titration at 1.25 mcg. The dose may be increased by 1.25 mcg to a dose of 2.5 mcg, followed by an increment of 2.5 mcg to a dose of 5 mcg, and then in 5 mcg increments until the dose that produces an erection suitable for intercourse and not exceeding a duration of 1 h is reached. If there is no response, then the next higher dose may be given within 1 h. If there is a response, then there should be at least 1-day interval before the next dose is given.Maintenance therapy
The first injections of alprostadil must be done at the health care provider's office by medically trained personnel. Self-injection therapy by the patient can be started only after the patient is properly instructed and well-trained in the self-injection technique. The health care provider should make a careful assessment of the patient's skills and competence with the procedure.
Intraurethral Administer as needed to achieve an erection. The onset of injection is 5 to 10 min after administration. Duration of effect is approximately 30 to 60 min. Titrate dose under the supervision of health care provider.CaverjectAdjunct to Diagnosis of Erectile Dysfunction Adults
Intracavernosal Monitor patients for occurrence of an erection after an intracavernosal injection of alprostadil. Extensions of this testing are the use of alprostadil as an adjunct to laboratory investigations (eg, duplex or Doppler imaging) to allow visualization and assessment of penile vasculature. For these tests, use a single dose of alprostadil that induces a rigid erection.
Store the 5, 10, and 20 mcg strengths at or below 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F). Store the 40 mcg strength at 2° to 8°C (36° to 46°F) until dispensed. After dispensing, the 40 mcg strength may be stored at or below 25°C (77°F) for 3 months or until expiration date, whichever occurs first. Use the reconstituted solution within 24 h when stored at or below 25°C (77°F). Do not refrigerate or freeze.Muse
Store unopened foil pouches in a refrigerator at 2° to 8°C (36° to 46°F). It may be kept at room temperature (below 30°C; 86°F).Prostin VR Pediatric
Refrigerate at 2° to 8°C (35° to 46°F).
After intracavernosal injection, risk of bleeding may be increased.
None well documented.
Flushing; bradycardia; hypotension; tachycardia; cardiac arrest; edema. Other rare, but serious, cardiovascular effects include CHF; hyperemia; second-degree heart block; shock; spasm of right ventricle infundibulum; supraventricular tachycardia; ventricular fibrillation.
Fever; seizures; cerebral bleeding.
Urethral pain; urethral burning; urethral bleeding/spotting; testicular pain ( Muse only).
Cortical proliferation of long bones; sepsis; penile pain; prolonged erection; penile fibrosis; injection-site hematoma; penis disorder; injection-site ecchymosis ( Caverject only); back pain; pain; pelvic pain; accidental injury ( Muse only).
Apnea is experienced by about 10% to 12% of neonates with congenital heart defects treated with Prostin VR Pediatric solution. Apnea is most often seen in neonates weighing less than 2 kg at birth and usually appears during the first h of drug infusion. Monitor respiratory status throughout treatment.
Category C .
Use cautiously in newborns with bleeding tendencies because alprostadil inhibits platelet aggregation.
Apnea has occurred in some newborns treated with alprostadil.
Prolonged erection has been known to occur following intracavernosal administration of vasoactive substances, including alprostadil. To minimize the chances of priapism, titrate slowing to the lowest effective dose. If priapism is not treated immediately, penile tissue damage and permanent loss of potency may result.
Discontinue treatment in patients who develop penile angulation, cavernosal fibrosis, or Peyronie disease.
Apnea, bradycardia, pyrexia, hypotension, flushing.
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