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GENITO URINARY SYSTEM AND SEX HORMONES › UROLOGICALS › UROLOGICALS › Drugs used in erectile dysfunction
alprostadil
G04BE01
Forms & Strengths
- Intracavernosal injection: 5 mcg, 10 mcg, 20 mcg, 40 mcg lyophilized powder
- Urethral suppository (MUSE): 125 mcg, 250 mcg, 500 mcg, 1000 mcg
Adult Dosing
- Intracavernosal erectile dysfunction: Initial 2.5 mcg, titrate by 2.5-5 mcg up to max 60 mcg based on response
- Urethral suppository erectile dysfunction: Initial 125-250 mcg, titrate up to max 1000 mcg based on response
- Ductus arteriosus patency (infusion): 0.05-0.1 mcg/kg/min, titrate to maintenance 0.01-0.02 mcg/kg/min
Pediatric Dosing
- Ductus arteriosus patency (neonates): Initial 0.05-0.1 mcg/kg/min continuous IV or intra-arterial infusion
- Maintenance for ductus arteriosus: Decrease to lowest effective dose (0.01-0.02 mcg/kg/min) once clinical improvement is noted
Indications
- Treatment of erectile dysfunction of vasculogenic, psychogenic, or mixed etiology
- Temporary maintenance of patent ductus arteriosus in neonates with congenital heart defects awaiting surgery
Mechanism of Action
- Direct vasodilator acting on vascular smooth muscle via stimulation of adenylate cyclase and intracellular cAMP elevation
- Relaxes trabecular smooth muscle in the corpus cavernosum, increasing arterial blood flow and venous outflow restriction
- Relaxes smooth muscle of the ductus arteriosus, maintaining patency in neonates
Contraindications
- Known hypersensitivity to alprostadil
- 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 where sexual activity is advised against
Adverse Reactions
- Penile pain
- Prolonged erection and priapism
- Penile fibrosis, curvature, and scarring
- Urethral bleeding and burning (urethral suppository)
- Apnea, flushing, bradycardia, and hypotension (neonatal IV infusion)
Drug Interactions
- Antihypertensives and vasodilators: potential for enhanced hypotensive effects
- Anticoagulants and antiplatelet agents: increased risk of bleeding at injection site
- Phosphodiesterase-5 inhibitors: concurrent use not recommended due to risk of prolonged erection and severe hypotension
Curated Content: Needs Vetting Before Put to Clinical Use