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From pills to creams, there are many treatments for erectile dysfunction (ED). So why would someone turn to an alprostadil injection if they can avoid a needle?
It turns out that there are a lot of reasons you might want to treat erectile dysfunction with a needle instead of a pill bottle: injections can be more effective and more convenient for some men and are perfectly safe when taken correctly.
How is alprostadil different from oral medications? How do you inject it — and where? Below, we’ve answered your most pressing questions, including the side effects to watch for and how injection alprostadil works.
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An alprostadil injection is a type of intracavernous injection or injection into the erectile tissue of the penis. It’s a treatment for erectile dysfunction, which is the inability to get or keep an erection during sexual activity.
Alprostadil is part of a group of medicines called vasodilators, which expand blood vessels to increase blood flow. This treatment can increase blood flow to the penis, which, in turn, can help you get an erection.
Popular ED medications like Viagra® and Cialis® also increase blood flow, but alprostadil does it through a different mechanism.
Alprostadil, commonly known as prostaglandin E1 (pge1), is an acidic lipid with various effects. It’s sold under several brand names, including Caverject®, Edex® and Prostin VR®.
Doing your own injection of alprostadil can seem intimidating, but it’s a fairly simple process — once you get past any fears of needles.
First things first with injections: make sure you properly prepare to use alprostadil safely.
This means washing your hands and placing the bottles on a clean surface before drawing the medicine into the syringe. You’ll also want to wipe the injection bottle tops with an alcohol swab, but be sure you don’t wipe the needle with the swab.
From there, you’ll want to follow healthcare professional guidance on injection dose, depth and location. Typically, this will mean an injection into the shaftof the penis on either side.
Different alprostadil medicines can be injected using the same process, but how these products are prepared and combined may differ. Be sure to talk with your healthcare provider about which products you’re using and how to mix the injection properly.
As an ED treatment, alprostadil injections should be used as needed before sexual activity. You may get an erection within five minutes to 20 minutes after injection.
ED injections are a viable option for about 70 percent of men experiencing erectile dysfunction, according to data from clinical trials.
Three studies by the New England Journal of Medicine found that alprostadil injections were more effective than a placebo. They also found that men were able to engage in sexual activity 94 percent of the time over six months of intracavernosal injections.
In addition, alprostadil injections have been found to cause an erection that’s firm enough for sexual activity in 80 percent of men.
As with any medication, an alprostadil injection may cause side effects, although they aren’t common.
You may experience:
Bruising or bleeding at the injection site
Redness of the penis
Skin problems
Headache
Back pain
Burning sensation at the urinary opening
Pain in the penis, testicles, legs or perineum (area between the penis and rectum)
Pain at the site of injection
If you experience any of the adverse events below, you should seek medical attention immediately:
Prolonged erection (priapism)
Curving of the penis during erection
A painful erection
Swelling of the testes
Dizziness
Pelvic pain
Flu-like symptoms
There are few known drug interactions and contraindications with alprostadil. Still, you should let your healthcare provider know about any medicines you’re currently taking — including over-the-counter medicines, herbal supplements or prescription medications — before taking alprostadil.
You should also let your healthcare provider know if you have penile implants, Peyronie’s disease, hypotension, leukemia, sickle cell anemia, a history of penile pain or painful erections, previous allergic reactions to alprostadil or conditions that cause slower blood flow or low blood pressure.
You can also talk to a urology specialist or healthcare provider for more medical advice about alprostadil injections. If you want more info before then, check out our more in-depth article about intracavernosal injections — or ED injections — and the possible risks.
Another thing to be aware of is that you shouldn’t take the following medications within 18 hours before or after an injection:
Levitra® (vardenafil): 10 mg to 20 mg
Viagra (sildenafil): 20 mg to 100 mg
Stendra® (avanafil): 50 mg to 200 mg
You also shouldn’t inject within 72 hours of taking 10mg or 20mg of Cialis (tadalafil). If you take 5mg of Cialis daily, ask your healthcare provider how you should use this medication along with your injections.
Don’t use more alprostadil or use it more often than your healthcare provider recommends — both could result in permanent damage to the penis. You also shouldn’t use an alprostadil injection more than three times per week.
If you’ve decided injection alprostadil isn’t for you, know that there are plenty of other options for the treatment of erectile dysfunction.
One option is psychotherapy or talk therapy. Many cases of erectile dysfunction are because of psychological reasons rather than physical ones. In therapy, you can reduce anxiety and stress related to sex.
Oral PDE5 inhibitors are another extremely popular treatment for ED. These medications work by blocking the enzyme phosphodiesterase type 5 — or PDE5 — which relaxes smooth muscle tissue and regulates blood flow to certain parts of the body, like the erectile tissue of the penis. This makes it easier to get and sustain an erection.
As of now, the Food and Drug Administration (FDA) has approved four PDE5 inhibitors for ED treatment: Viagra (sildenafil), Stendra (avanafil), Cialis (tadalafil) and Levitra (vardenafil).
Another way to treat erectile dysfunction is through the use of an alprostadil cream or suppository. As an intraurethral suppository, alprostadil can be administered into the urethra by inserting a pellet into the urethral meatus and allowing the absorption of the drug into the corpora cavernosa. However, this method can be costly and have more side effects than alprostadil injections.
A final and popularly recommended way to reduce or prevent erectile dysfunction is to make certain lifestyle changes. Limiting or stopping alcohol consumption and drug use, quitting smoking, getting regular exercise and eating a healthy diet are all good places to start.
You’re not alone in dealing with erectile dysfunction — about 30 million men also experience ED. But we know that probably doesn’t lessen your frustration, which may have you considering an alprostadil injection as a way to treat ED.
Alprostadil injections are a relatively safe and effective treatment for erectile dysfunction, with the possibility of minor side effects.
However, it does come with risks of injury and medication interactions, which make it a less safe option than oral medications like Viagra.
If you’re looking for other ways to treat ED, you should consider medication like sildenafil, avanafil, tadalafil and vardenafil — all of which are approved by the FDA and backed by science.
Regardless, your first step toward treating your erectile dysfunction should be scheduling a consultation with a healthcare provider — they’ll be able to help you figure out what the best ED treatment is for your individual needs.
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This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.
Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown was previously Medical Director of a male fertility startup where she lead strategy and design of their digital health platform, an innovative education and telehealth model for delivering expert male fertility care.
She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.
Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.
Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.
Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.
Education & Training
Andrology Fellowship, Medical College of Wisconsin
Urology Residency, University of California San Francisco
M.D. Northwestern University Feinberg School of MedicineB.S. in Radiologic Science, Chemistry Minor, University of North Carolina at Chapel Hill
Published as Kelly Walker
Cowan, B, Walker, K., Rodgers, K., Agyemang, J. (2023). Hormonal Management Improves Semen Analysis Parameters in Men with Abnormal Concentration, Motility, and/or Morphology. Fertility and Sterility, Volume 118, Issue 5, e4. https://www.sciencedirect.com/journal/fertility-and-sterility/vol/120/issue/1/suppl/S
Walker, K., Gogoj, A., Honig, S., Sandlow, J. (2021). What’s New in Male Contraception? AUA Update Series, Volume 40. https://auau.auanet.org/content/update-series-2021-lesson-27-what%E2%80%99s-new-male-contraception
Walker, K., Shindel, A. (2019). AUA Erectile Dysfunction Guideline. AUA Update Series, Volume 38. https://auau.auanet.org/content/course-307
Walker, K., Ramstein, J., & Smith, J. (2019). Regret Regarding Fertility Preservation Decisions Among Male Cancer Patients. The Journal of Urology, 201(Supplement 4), e680-e681. https://www.auajournals.org/doi/10.1097/01.JU.0000556300.18991.8e
Walker, K., & Smith, J. (2019). Feasibility Study of Video Telehealth Clinic Visits in Urology. The Journal of Urology, 201(Supplement 4), e545-e545. https://www.auajournals.org/doi/10.1097/01.JU.0000556071.60611.37