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CARDIOVASCULAR SYSTEM › CARDIAC THERAPY › OTHER CARDIAC PREPARATIONS › Prostaglandins
alprostadil
C01EA01
Forms & Strengths
- Intracavernosal injection: 10 mcg, 20 mcg, 40 mcg vials
- Urethral suppository (MUSE): 125 mcg, 250 mcg, 500 mcg, 1000 mcg
- Intravenous infusion: 500 mcg/mL ampoules (Prostin VR Pediatric)
Adult Dosing
- Erectile dysfunction (Intracavernosal): Initial 2.5 mcg to 5 mcg intracavernosally; titrate by 2.5-10 mcg increments to max 60 mcg based on response
- Erectile dysfunction (Urethral): Initial 125 mcg or 250 mcg intraurethrally; titrate as needed up to 1000 mcg max per 24 hours
Pediatric Dosing
- Patent ductus arteriosus (Neonates): Initial continuous IV infusion of 0.05 to 0.1 mcg/kg/min
- Patent ductus arteriosus (Maintenance): Reduce to lowest effective dose (e.g., 0.01 to 0.05 mcg/kg/min) once therapeutic response is achieved
Indications
- Treatment of erectile dysfunction of neurogenic, vasculogenic, psychogenic, or mixed etiology
- Temporary maintenance of patency of the ductus arteriosus in neonates with congenital heart defects awaiting corrective surgery
Mechanism of Action
- Direct vasodilator of arterial and trabecular smooth muscle in the corpus cavernosum via stimulation of intracellular adenylate cyclase and increased cAMP
- Relaxes smooth muscle of the ductus arteriosus, maintaining patency by binding to specific prostanoid EP receptors
Contraindications
- Conditions predisposing to priapism (e.g., sickle cell anemia, multiple myeloma, leukemia)
- Anatomical deformation of the penis (e.g., angulation, cavernosal fibrosis, Peyronie's disease)
- Penile implants
- Severe underlying cardiovascular disease or hypotension (for systemic use)
- Respiratory distress syndrome in neonates (for IV use)
Adverse Reactions
- Penile pain, burning, or aching
- Prolonged erection (>4 hours) and priapism
- Penile fibrosis, curvature, or Peyronie's disease
- Urethral bleeding and burning (with suppository)
- Apnea, bradycardia, hypotension, and flushing (neonatal IV infusion)
- Fever and sepsis (neonatal IV infusion)
Drug Interactions
- Antihypertensives and vasodilators: potential additive hypotensive effects
- Anticoagulants and antiplatelet agents: increased risk of intracavernosal bleeding
- Sympathomimetics: may antagonize the erectogenic effects of intracavernosal alprostadil
Curated Content: Needs Vetting Before Put to Clinical Use