Intracorporal Prostaglandin E1

Aka: Intracorporal Prostaglandin E1, Intracorporal Alprostadil, Caverject

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II. Indications

  1. Psychogenic Impotence
  2. Neurogenic Impotence
  3. Vasculogenic Impotence

III. Contraindications

  1. Penile deformity (e.g Peyronie's Disease)
  2. Priapism risk
    1. Sickle Cell Disease or Sickle Cell Trait
    2. Leukemia
    3. Multiple Myeloma
    4. Polycythemia Vera
    5. Thrombocythemia
    6. Anticoagulant use

IV. Mechanism: Corporal Smooth Muscle relaxation

  1. Increases arterial inflow
  2. Decreases venous outflow

V. Preparations: Intracorporal Injection

  1. PGE1 or Alprostadil (Caverject)
    1. See also Intraurethral Alprostadil (MUSE)
  2. Papaverine
  3. Phentolamine
  4. Combinations: Alprostadil + papaverine + Phentolamine
    1. May be more effective with less pain

VI. Dosage Alprostadil (titrate in physicians office)

  1. Dose
    1. Start: 2.5 ug (1.25 ug in neurogenic Impotence)
    2. Next: 5 ug
    3. Increase: 5 ug increments
  2. Endpoint
    1. Erection adequate for intercourse (duration <1 hour)
    2. Maximum reached (see below)
  3. Maximum dosing
    1. Maximum dose: 60 ug
    2. Do not exceed more than 3 times per week
    3. Do not exceed more than once in 24 hours

VII. Technique:

  1. Inject at dorso-lateral aspect in penis proximal third
  2. Alternate sides and sites for each injection

VIII. Adverse Effects of Intracorporal Injection (41%)

  1. Hematoma
  2. Prolonged Erection exceeding 4 hours (4%)
    1. Patients should seek emergency attention for Erection lasting more than 4 hours
  3. Priapism with Erection exceeding 6 hours (1%)
    1. See Priapism Reversal Protocol
  4. Penile Plaques (10%)
  5. Penile fibrosis (5%)

IX. Efficacy (Caverject)

  1. Injectable alprostadil is more effective than Intraurethral Alprostadil
  2. Success Rates: 67 to 85%
  3. Compliance
    1. Discontinued therapy after 1 year: 56%
    2. Discontinued therapy after 2 years: 68%

X. References

  1. Viera (1999) Am Fam Physician 60:1159-72 [PubMed]
  2. Sundaram (1997) Urology 49:932-5 [PubMed]

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Related Studies

Cost: Medications

caverject (on 12/20/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
CAVERJECT IMPULSE 20 MCG KIT $100.38 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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