Alprostadil for Erectile Dysfunction

Is it the right medication for you?

Erectile dysfunction (ED) is common and the rate of incidence is increasing in men over the age of 40. Between the ages of 40-50, the prevalence of ED is estimated to be between 2-10%.

There are many medications available out there for ED. A common medication name is Viagra but what about Alprostadil? Alprostadil is another medication option that can help you combat ED but it is important to know more about it before using it. So here's everything you need to know.

What is Alprostadil?

Alprostadil works by improving the blood flow to the penis enabling it to maintain an erection. It belongs to the family of prostaglandins, which your body naturally produces. These prostaglandins increase blood flow to specific parts of the body. The application of Alprostadil improves erection time by increasing blood flow to the penis as the body receives signals to that specific area. Alprostadil works in about 5-20 minutes. After application, wait 10-30 minutes before having sex and your erection should last for about roughly an hour. It is available in 3 forms:

Injections: 

  • This method is injected into the penis, through its base
  • Found to work in 80% of men 

Urethral sticks:

  • Medication is delivered into the urethra (opening of the penis where semen and urine exits) 
  • Medication comes in a narrow stick and this is inserted into the urethra
  • Found to work in 50% of men 

Creams:

  • The medicine is applied to the head of the penis 
  • Found to work on 40% of men 

As ideal as Alprostadil sounds, it is not part of the first-line treatment for ED. Alprostadil is usually prescribed if other ED medications do not work. The usual first-line medications for ED are medicines that come from the family of PDE-5 inhibitors. PDE-5 inhibitors are preferred as the first choice as they are available to consume in tabler form. This allows patients more ease compared to the methods of Alprostadil application. PDE-5 inhibitors include:

  • Viagra (Sildenafil)
  • Cialis (Tadalafil)
  • Levitra (Vardenafil)

Alprostadil and PDE-5 inhibitors work using the same mechanism of action (increasing blood flow to the penis) and are both found to have roughly the same percentage of effectiveness. To get a better idea of which medication is suited for your body, make an appointment with your local doctors to talk through your treatment types. 

Alprostadil cannot be bought over the counter in pharmacies, however, if you have a prescription from your doctor is it available in more pharmacies. However, Alprostadil is only freely available on the NHS if ED is caused by certain medical conditions. These include: 

  • Diabetes
  • Kidney failure requiring dialysis
  • Kidney transplant
  • Multiple sclerosis
  • Parkinson's disease
  • Polio
  • Prostate cancer
  • Removal of the prostate gland (prostatectomy, including men who have had a transurethral resection of the prostate)
  • Radical pelvic surgery
  • Severe pelvic injury
  • Single-gene neurological conditions
  • Spinal cord injury
  • Spina bifida

If your ED is not a symptom of any of these conditions, you will need to get a private prescription from a doctor. 

Methods:

Cream:

  1. Wash and towel dry your hands before use 
  2. Do not insert the cream applicator into the penis, but make sure its close to the opening of the urethra as possible to allow the cream to flow into it when squeezed 
  3. Allow the medication time to work which means no urinating immediately after application as it may get washed out before the effects are experienced
  4. After use, throw the applicator away immediately. Do not use it again as there is an increased risk of infection

Injection:

  1. Wash and dry your hand with a towel before preparing the injection and once again before using the injection 
  2. Preparation of the injection can be done 24 hours before use 
  3. Ensure the needle is not bent, and if so, discard it safely. Do not try and straighten the needle as there is a higher chance it will break
  4. Use an alcohol swab to disinfect the area of injection
  5. After injection, safely dispose of the needed. Do not keep the injection for a second use as there is a higher chance of infection and needle breakage 
  6. After injection, massage the penis gently to allow the medication to spread

Urethral Stick:

  1. Wash and towel dry your hands before use
  2. Before application, make sure to urinate. (Having a wet urethra will make application of the medication easier)
  3. Do not touch the tip of the applicator at any point. This reduces the chance of having an infection 
  4. If you experience discomfort after inserting the applicator into the urethra, slowly remove the applicator and re-insert it carefully 
  5. Dispose of the applicator immediately, ensuring not to save it for a second use as this increases the risk of having an infection
  6. After application, roll your penis in your hands gently which helps the spread of the medication 

Side Effects:

The common side effects of Alprostadil usually occur as a result of the methods of application rather than the medication itself. The common side effect is a pain in the penis. Other side effects include dizziness, headache, or flu-like symptoms. Swelling, redness, pain, or a rash on the penis. Bleeding and burning from the urethra (the opening to the penis) and changes in blood pressure. 

If you experience any side effects, it is important to stop the medication and seek another doctor’s appointment. However, if you experience any of these rarer symptoms below, it is important to call your doctor immediately. Rarer symptoms include:

  • Pain and curving of the penis during erection 
  • Severe and continuing pain in the penis during an erection which lasts for 4-6 hours
  • Swelling or pain in the testes
  • Bleeding or spotting from the urethra
  • Stinging in the urethra
  • Swelling of the lips and tongue
  • Difficulty in breathing 
  • Collapsing 

No side effects have been linked to the long term use of Alprostadil. Even so, it is important to use it only when needed. 

Alprostadil should not be taken if you: 

  • Have an allergic reaction to alprostadil.
  • Are allergic to any other substances such as drugs, foods, preservatives, or dyes
  • Are taking any prescription or over-the-counter drugs 
  • Have a penile implant
  • Have a history of priapism (a painful and prolonged erection not linked to sexual stimulation)

 

References:

  • Cold, F, E Health, H Disease, L Disease, P Management, & S Conditions et al., "Alprostadil to Treat Erectile Dysfunction.". in WebMD, , 2020, <https://www.webmd.com/erectile-dysfunction/guide/alprostadil-treat-ed#1> [accessed 12 March 2020].
  • Excellence, N, "ALPROSTADIL | Drug | BNF content published by NICE.". in Bnf.nice.org.uk, , 2020, <https://bnf.nice.org.uk/drug/alprostadil.html> [accessed 12 March 2020].
  • Cuzin, B, "Alprostadil cream in the treatment of erectile dysfunction: clinical evidence and experience.". in Therapeutic Advances in Urology, 8, 2016, 249-256.

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