Alprostadil Cream: Is It Effective for ED?

Erectile dysfunction (ED) is a serious buzzkill that can affect guys everywhere. An estimated 30 million men struggle with the issue in the U.S. — and the longer you live, the higher your chances of dealing with this common form of sexual dysfunction.

The good news is that ED is treatable, with options ranging from prescription medications such as sildenafil (the active ingredient in Viagra®) to vacuum erection devices and injection therapy.

One medication that’s gained attention as a form of treatment for ED is alprostadil. It comes in several formulations, including an injectable solution, a urethral suppository, and a topical erectile dysfunction cream or gel. 

If you have erectile dysfunction and prefer not to take oral medication, the use of alprostadil cream is a popular alternative. 

Below, we’ll talk about what alprostadil cream is and how it works as a treatment for erectile dysfunction.

We’ll also discuss the potential side effects of alprostadil cream, as well as alternatives to consider if you’re one of the tens of millions of men affected by ED.

Alprostadil is a medication used to treat and manage ED. It belongs to a class of medications known as vasodilators, which relax blood vessels and improve blood flow throughout the body.

Currently, alprostadil cream for erectile dysfunction isn’t a first-line treatment, meaning your healthcare provider typically won’t prescribe it as the first thing to try if you have ED.

Instead, most men with ED are treated with phosphodiesterase-5 inhibitors (PDE5 inhibitors), which are also taken before sex. For men who haven’t found success with other ED medications, some turn to alprostadil as an alternative option.

As a vasodilator, alprostadil cream relaxes the muscles of the blood vessels supplying the penis, making it easier for blood to flow and stay in the penis long enough to get an erection.

Healthy, rigid erections are all about healthy, consistent blood flow. When you feel aroused, your blood vessels dilate, allowing blood to flow more easily into the corpora cavernosa — two cylindrical areas of erectile tissue inside your penis.

As blood pressure inside your penis builds, you’ll develop an erection firm enough for penetrative sex.

Our guide to erectile dysfunction creams goes into more detail about how these products work for the treatment of erectile dysfunction, as well as their unique advantages and disadvantages.

Whether alprostadil is applied topically, injected, or inserted into the urethra, the outcome is the same: more blood flow to the penis for better, longer-lasting erections.

If alprostadil cream isn’t a first-line ED treatment, how effective is it?

We’ll start off by saying that cream for ED doesn’t cure erectile dysfunction or increase sexual desire. With that out of the way, there are definitely benefits to this ED treatment. 

According to several studies, some of which were double-blind and placebo-controlled, alprostadil topical cream works well and is well tolerated in ED patients with mild-to-severe symptoms.

One of the main reasons alprostadil gels and creams aren’t first-line treatments for ED is that they don’t have approval from the Food and Drug Administration (FDA). However, alprostadil injections sold under the brand name Caverject® and alprostadil suppositories sold as MUSE® are FDA-approved to treat ED.

Based on its effectiveness, some in the scientific community think alprostadil topical creams have the potential to be first-choice alternatives for ED patients who don’t respond well to or can’t tolerate PDE5 inhibitors.

A 2016 review of Vitaros topical cream for erectile dysfunction found that it was 83 percent effective with a 300-microgram (mcg or μg) dose in patients with severe ED — significantly better than the placebo group. What’s more, systemic adverse effects were only reported in three percent of the treated population — not bad.

Another 2016 review found that clinical trials of topical alprostadil cream showed it to be effective, increasing the erectile function score on the International Index of Erectile Function (IIEF) by 13 points from baseline.

One popular brand of alprostadil cream is Vitaros®, but you won’t find Vitaros cream USA on the shelves of your local pharmacy because it’s currently only available in Europe. Vitaros cream is applied intraurethrally — meaning into the opening at the tip of the penis — shortly before sexual activity. This stimulates local blood flow and makes getting and staying hard easier.

Regarding alprostadil and Vitaros cream reviews, the product seems to be preferable to ED patients who haven’t found success in past treatments. In a survey of 152 patients with ED, 53 percent of patients who had tried at least two different ED treatment options reported that topical cream was their first choice compared to oral medications, injectables, and other intraurethral therapies.

Like all medications, side effects are always on the table.

Here are a few alprostadil erectile cream side effects:

• Penile burning sensation at the site of application

• Penile pain

• Prolonged erection (priapism)

• Painful erection (Peyronie’s disease)

• Vaginal burning or itching (for female partners)

A 2009 study looked at 1,161 male patients with ED. For the first four weeks, they used eight doses of 200-mcg topical alprostadil cream before sex, up to two times per week. Based on their response to the cream, they could stay the same, decrease to 100-mcg doses, or increase to 300-mcg doses for up to nine months, at two doses per week. The results were as follows:

• Twelve percent of patients stopped using the cream because they were either too sensitive to it or not sensitive enough. 

• Sixteen percent withdrew from the study for various reasons.

• Fewer than five percent stopped the treatment because of adverse events.

• Seventy-three percent of patients used 300-mcg.

• Seventy-four percent of patients experienced an overall improvement in erectile function using the cream.

In terms of side effects, the study found that:

• Roughly 12 percent of patients experienced burning at the application site. 

• Four percent experienced penis pain.

• About one percent experienced a prolonged or painful erection.

• Less than one percent reported a prolonged erection of four or more hours. 

• Around two percent of the patients’ sex partners reported vaginal burning or itching.

There are plenty of alternative alprostadil cream treatments for ED. The first place to start is typically with oral medication, often in conjunction with lifestyle changes and potentially therapy.

Medication

As noted, PDE5 inhibitors are typically first-line treatments for ED. The most common PDE5 treatment options include:

• Sildenafil (generic for Viagra®)

• Tadalafil (generic for Cialis®) 

• Avanafil (sold as Stendra®)

• Vardenafil (generic for Levitra®)

Viagra was the first PDE5 inhibitor. Introduced in 1998, it treated more than 20 million men during its first six years on the market. Levitra was approved in 2003, followed a few months later by Cialis. And in 2012, Stendra was introduced.

This class of drugs improves ED by relaxing arterial smooth muscles and increasing blood flow to the penis.

Common side effects of PDE5 inhibitors include:

• Headache

• Flushing

• Nasal congestion or runny nose

• Indigestion

• Visual abnormalities (less common)

If you don’t like swallowing pills, you could try chewable ED meds like our hard mints. Alternatively, certain foods and supplements may help increase blood flow to your penis.

Another medication option is the injectable form of alprostadil, although the route of administration may make men less likely to want to try this approach.

Other Treatments

Several other medical interventions can assist with ED. Eroxon is a non-prescription, non-medicated topical gel that was recently FDA-authorized for ED. Vacuum erection devices (with a constriction ring) and surgical implants are also options.

Counseling and Therapy

Anxiety and depression can play a role in developing ED. The brain and the body work together to get aroused, sending blood flow to the penis so you can get and maintain an erection. If you’re feeling low or nervous, as with sexual performance anxiety, you might experience ED.

Psychological ED (meaning the cause of ED is mental instead of physical) can be manageable. Therapy or sexual counseling are tools that can help you work through mental hurdles contributing to your ED.

Lifestyle Changes

Some of the latest ED treatments work in tandem with lifestyle changes. Lifestyle factors that could affect ED include:

• Excess body weight

• Lack of physical activity

• Poor diet

• Smoking

• Heavy alcohol use

• Substance use

• Chronic stress

According to a 2020 review of studies, lifestyle modifications play a significant role in improving sexual health.

If PDE5 inhibitors aren’t working for you, or you just don’t want to take them, alprostadil cream might be an effective alternative. Studies show this topical ED medication is effective in more than 80 percent of ED patients.

When looking for erectile dysfunction solutions, keep in mind:

• ED is common. It affects around 30 million men in the U.S. alone. 

• The first line of treatment is PDE5 inhibitors. These medications include Viagra® and Cialis®, among others.

• Alprostadil cream is the next option. If you don’t want to take PDE5 inhibitors or don’t tolerate them well, erectile dysfunction cream can serve as a secondary option.

• Alprostadil cream might have side effects. Potential erectile cream side effects include application site burning, penis pain, prolonged erections, painful erections, or burning in your partner’s genital area.

• Lifestyle factors can help improve ED. Maintaining a healthy weight, eating a nutritious diet, exercising, keeping low-stress levels, and avoiding drugs and excessive alcohol can help improve ED and sexual intercourse.

• Talk to a healthcare provider. Always consult a medical professional before starting any new medication for ED. They can discuss the side effects, potential drug interactions, and contraindications.

If you have ED and think a psychological issue might be at play, consider speaking with a mental health provider. 

Ready to take the next step? Schedule a call with a healthcare provider today to find the right ED treatment for your needs.