Alprostadil

Alprostadil is a prescription medication primarily used to treat erectile dysfunction (ED). It is a synthetic form of prostaglandin E1 (PGE1) and belongs to a group of medicines called vasodilators, which expand blood vessels to increase blood flow to targeted areas.

Different forms of alprostadil are injected directly into the penis, given as a suppository (a pellet inserted into the opening of the penis), or applied topically. Alprostadil injections, such as the brand-name drug Caverject, and alprostadil suppositories, previously sold as Muse, are approved by the United States Food and Drug Administration (FDA) to treat ED. Topical alprostadil gels and creams do not have FDA approval and are not available in the US to treat ED.

If someone can’t take oral ED medications like Viagra^® or these treatments don’t work for them, alprostadil may be the next option. It’s typically well-tolerated, with the most common side effect being penile pain. Other possible side effects, which may require medical attention, include prolonged erection (priapism), dizziness, hypotension (abnormally low blood pressure), the formation of scar tissue in the penis, or curvature of the penis. 

Alprostadil is the active ingredient in the brand-name medication Caverject^®, which is the focus of the information outlined below. According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.”

Caverject (alprostadil) is indicated:

• For the treatment of erectile dysfunction

• As an adjunct to other diagnostic tests in the diagnosis of erectile dysfunction

Prostaglandin E1 agonist

The most common (≥10%) adverse reaction is:

• Penile pain

The cost of alprostadil may vary depending on factors such as the brand, dosage, your insurance coverage, and where you buy it.

There is no generic version of injectable alprostadil available, but the medication is sold under a few different brand names, including Caverject and Edex^®. Without insurance, the average retail price of six doses of Caverject is about $1,000, while two doses of Edex costs about $290. Coupons and discount cards are available that may bring down the price of these medications, including an Edex savings card for eligible prescriptions. Insurance plans may cover all or some of the cost of these medications.

The suppository form of alprostadil was sold under the brand name Muse, but it is no longer available in the U.S. and there are no generic forms available.

You can get a prescription for alprostadil after being evaluated by your primary care provider or a specialist who can determine if the medicine is right for you based on factors like your symptoms and medical history. Your healthcare provider may prescribe alprostadil if you can’t take oral ED medications or they’re not effective for you.

• Men who have known hypersensitivity to the drug

• Men who have conditions that predispose them to priapism, such as sickle cell anemia or sickle cell trait, multiple myeloma, or leukemia

• Treatment of erectile dysfunction in men with fibrotic conditions of the penis, such as anatomical deformation, angulation, cavernosal fibrosis, or Peyronie's disease

• Men with penile implants

• Drug interactions: The potential for pharmacokinetic drug-drug interactions between alprostadil and other agents administered orally or intracavernosally has not been formally studied

• Prolonged erection and priapism have occurred in patients receiving Caverject

• Penile fibrosis has occurred in patients receiving Caverject

• Low blood pressure

• Injection site bleeding may occur in patients taking anticoagulants, such as warfarin or heparin

• Cardiovascular risk related to underlying medical conditions

• Risks of use in combination with other vasoactive medications injected intracavernosally

• Needle breakage

• Benzyl alcohol: Serious and fatal adverse reactions can occur in neonates and low birth weight infants treated with benzyl alcohol-preserved formulations in infusion solutions, including Caverject

• Counsel patients about sexually transmitted diseases

There are other prescription medications available to treat ED. Some of these drugs may be better suited to you than others. If you’re interested in finding an alternative to alprostadil, talk with your provider to learn more about other medications that may work well for you.

Other penile injection medications for ED include:

• Papaverine

• Phentolamine

• Combination medications such as Bimix, Trimix, and Quadmix

Oral medications that can treat ED include:

• Viagra^® (sildenafil)

• Cialis^® (tadalafil)

• Stendra^® (avanafil)

• Vardenafil

• Chewable ED meds available through Hims that contain one or more of the active ingredients in Cialis and Viagra

As an alternative or in addition to prescribing ED medications, your healthcare provider may suggest you consider trying therapy for mental health issues that may be contributing to your ED symptoms. They may also suggest you commit to certain lifestyle changes that can support sexual health, like following a healthy diet, exercising, and cutting back on alcohol.

Other treatments for ED include a topical gel, a penis pump with or without a constriction ring, penile implant surgery, and testosterone therapy (if you have low testosterone).

*This information is from the label for brand name Caverject^®. See the Full Prescribing Information for more complete information. Alprostadil, the active ingredient in Caverject, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient alprostadil.