II. Indications

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

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%

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Cost: Medications

caverject (on 6/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
CAVERJECT 20 MCG VIAL $87.46 each
CAVERJECT 40 MCG VIAL $114.32 each

Ontology: Caverject (C0591238)

Concepts Eicosanoid (T111) , Pharmacologic Substance (T121)
MSH D000527
English caverject, Caverject, Pharmacia Brand 2 of Alprostadil, Sugiran