What is Alprostadil?

Alprostadil is a treatment for erectile dysfunction (ED), which can give an erection strong enough to have sex with the majority of men who try it.

Alprostadil is often given after all other medication for ED has been tried. Your GP will usually only recommend it if you have already tried other forms of treatment, such as PDE-5 inhibitors (like Viagra) or psychological therapies (like CBT).

Alprostadil is a synthetic (man made) version of the hormone prostaglandin E1 (PGE1) which occurs naturally in your body. It helps treat the symptoms of erectile dysfunction because it is a ‘vasodilator’, which means that it widens blood vessels. This improves blood flow to the penis, making it easier for you to get an erection.

Alprostadil will:

• Produce an erection in 5-15 minutes, depending on the method used to apply it
• Lasts for between 30 minutes and 2 hours, depending on the dose.
• Can only be sold with a prescription from a registered GP.

It comes in several different forms:

• As an injection into the base of the penis
• As a cream applied to the tip of the penis
• As a small pellet inserted into the tube inside the penis (urethra)

The European Association of Urology produced guidelines on male sexual dysfunction which stated that:

• PDE-5 inhibitors such as Viagra/sildenafil should be prescribed as the first-choice treatment.
• Alprostadil should only be prescribed when treatment with PDE-5 inhibitors is not acceptable.

This advice was given as Alprostadil treatment is more likely to cause prolonged painful erections as a side effect.

Below is a table comparing some of the other qualities of both types of medication:

Alprostadil is a prescription-only medication, so you'll need to get assessed by a doctor first. You can also get a prescription for Vitaros, which is an Alprostadil cream, with Superdrug Online Doctor. Alprostadil is not offered to everyone who wants treatment for ED. It is only prescribed under certain circumstances, usually after you have tried other forms of treatment, like PDE-5 inhibitors (like Viagra) or therapy.

Alprostadil is the generic (chemical) name of the treatment, but it is also known as:

• Caverject
• Viridal
• MUSE
• Prostin
• Edex
• Vitaros

These are all branded versions of the same drug, which do the same thing as the medicine called Alprostadil.

Who can’t use Alprostadil?

You can’t use Alprostadil if:

• You have had a recent heart attack or fainting episodes related to your heart
• You have an anatomical deformity or scarring of your penis such as Peyronie's disease
• You are at risk of priapism (a painful, prolonged erection)
• You have an increased risk of blood clots
• You have been told not to have penetrative sex because of the impact to your heart
• You suffer from sickle cell disease, leukaemia, or bone marrow cancer
• You are allergic to any of the ingredients in Alprostadil
• You can’t use the Alprostadil urethral pellet if:
• You have certain conditions that change the structure of your penis
• You have an infection of the penis, for example balanitis

Alprostadil comes as a cream, an injection, or in pellet form. There are benefits and drawbacks to each method, and working out the right one for you will be a personal choice, between you, your partner(s), and with the advice of your GP.

Using the injection:

• The injection is given at the base of the penis. Your nurse or doctor will give you your first injection, and show you how to do it later at home
• You will start with a small dose and gradually increase it if needed
• Try to inject in a slightly different place every time, to avoid getting any skin problems or bad bruising
• Never administer the Alprostadil injection more than once per day, and never use it more than three times in one week

Using the urethral pellet:

• The first time you insert a urethral pellet, your nurse or doctor will show you how to use the applicator and train you how to use it at home. Some doctors recommend that you urinate before inserting your pellet, because this lubricates your urethra, making it more comfortable to insert
• Never use more than two doses in one day, and never use more than seven doses in one week
• If you have a pregnant partner you should use a condom during sex to avoid any irritation to their vagina, and any harm to the unborn baby

Using the urethral cream:

• This topical cream is applied to the top of the penis, around the urethra. The cream version of Alprostadil comes in a strength of 300 micrograms in a one-use container
• Your nurse or doctor will show you how to use the cream the first time you do it, so that you can use it yourself at home in the future
• Never use more than one dose a day and never use more than 3 doses a week
• If your partner is pregnant, you should use a condom during penetrative sex to avoid irritation to their vagina, or any harm to the unborn baby

How long does each last?

• As a cream, Alprostadil takes between 5 and 30 minutes to work, and lasts for 1 to 2 hours
• As a pellet, Alprostadil takes around 10 minutes to work, and lasts for 30 minutes to 1 hour
• As an injection, it takes around 15 minutes to work, and lasts for about 1 hour

A very common side effect of using Alprostadil (affecting more than 1 in 10 users) is pain in the penis. This pain should soon pass. If this pain lasts for a long time, or if the pain is very severe, you should seek immediate medical attention.

Common side effects (affecting up to 1 in 10 users) can include:

• Bruising, scarring, or bending to the penis, particularly if you have been using the injection for a long time. Speak to your doctor if this happens, as they may recommend that you stop using it
• Prolonged and painful erections. If you ever have an erection that lasts for longer than 4 hours you should seek immediate medical attention. An ongoing erection of more than 6 hours is a serious medical condition, called ‘priapism’
• Swelling, changes to skin colour, or bruising where you have injected the medicine. This can happen the first few times you use the injection, but usually improves over time, as you get more practice with it
• Muscle spasms

Uncommon side effects (affecting up to 1 in 100 users):

• Swelling, inflammation, or irritation (with the injection) around the area you used it, which may itch or bleed
• Numbness
• Red, swollen, or painful testicles
• Lumps in the testicles called ‘spermatocele’, which are small cysts that contain sperm
• Painful, prolonged, or uncomfortable erections, or no erections at all
• Trouble urinating, such as needing to urinate more often than usual, pain or difficulty urinating, or blood in the urine (which can happen if you accidentally inject the medicine into the urethra, the tube that carries urine out of the penis)
• Yeast infection (thrush)
• Pain to the pelvis, weakness, sweating, nausea, or flu-like symptoms
• Changes to blood pressure and heart rhythm

If you ever experience any particularly unpleasant or painful side effects, you should seek immediate medical attention from your GP or by using the emergency services.