Alprostadil is a synthetic prostaglandin E1 analog used primarily in the treatment of erectile dysfunction (ED) and for maintaining patency of the ductus arteriosus in neonates with congenital heart defects. As a vasodilatory agent, it works by relaxing smooth muscle tissue and dilating blood vessels, facilitating increased blood flow to the corpus cavernosum. Available in injectable, intraurethral, and topical formulations, it offers a targeted, on-demand solution for patients seeking an effective pharmacological intervention. Its mechanism is independent of neural pathways, making it suitable for a broad range of etiologies, including neurogenic, vasculogenic, and psychogenic ED.

Features

• Synthetic prostaglandin E1 analog
• Multiple administration routes: intracavernosal injection, intraurethral pellet, topical cream
• Rapid onset of action, typically within 5–15 minutes
• Duration of effect ranges from 30 to 60 minutes
• Does not depend on nitric oxide pathway
• Available in pre-filled syringes or adjustable-dose pens for precision
• Stable at room temperature before reconstitution
• Well-established safety profile with decades of clinical use

Benefits

• Provides reliable, predictable erectile responses suitable for planned sexual activity
• Effective across various ED etiologies, including post-prostatectomy, diabetic neuropathy, and spinal cord injury
• Allows for dose titration to minimize side effects and maximize efficacy
• Avoids systemic effects common with oral PDE5 inhibitors
• Can be used in patients taking nitrates, unlike oral ED agents
• Supports physiological erectile mechanisms without central stimulation

Common use

Alprostadil is most frequently prescribed for the management of erectile dysfunction in adult males. It is also utilized in neonatal intensive care for temporary maintenance of ductus arteriosus patency in neonates awaiting surgery for congenital heart defects such as pulmonary atresia or transposition of the great arteries. In urology and andrology, it serves as both a therapeutic and diagnostic agent to assess vascular integrity in patients with ED.

Dosage and direction

For erectile dysfunction:

• Intracavernosal injection: Initial dose is 2.5 mcg; may be increased in increments of 2.5 mcg to a maximum of 60 mcg per administration. Dosing should be tailored to individual response and tolerability.
• Intraurethral pellet: Typically 125–1000 mcg administered into the urethra using an applicator.
• Topical cream: Applied in measured doses directly to the urethral meatus.

Administration should not exceed once per 24-hour period. Proper aseptic technique is essential for injectable forms. Patients must receive thorough training from a healthcare provider on correct administration to avoid injury or infection.

Precautions

• Priapism (erection lasting >4 hours) requires immediate medical attention to prevent permanent tissue damage.
• Use with caution in patients with penile anatomical deformities (e.g., Peyronie’s disease), bleeding disorders, or on anticoagulant therapy.
• Monitor for hypotension, especially in volume-depleted patients.
• Avoid use in conditions predisposing to fibrosis or plaque formation.
• Not recommended for use with other erectile agents unless under specialist supervision.
• Store away from light and excessive heat; reconstitute only before use.

Contraindications

• Hypersensitivity to alprostadil or any component of the formulation.
• Conditions that increase risk of priapism, such as sickle cell anemia, multiple myeloma, or leukemia.
• Anatomical penile deformities that may contraindicate injection.
• Use in women, children, or neonates except for specified cardiac indications.
• Concurrent use with other vasoactive agents unless clinically warranted and monitored.

Possible side effect

• Penile pain (up to 30% of users)
• Prolonged erection or priapism
• Local bleeding, bruising, or hematoma at injection site
• Urethral burning or discomfort (with intraurethral formulation)
• Dizziness or hypotension
• Fibrosis or nodules at injection sites with chronic use
• Headache
• Upper respiratory tract infection (rare)

Drug interaction

• Antihypertensives: enhanced hypotensive effects.
• Anticoagulants (e.g., warfarin, apixaban): increased risk of bleeding or hematoma.
• Other vasodilators: additive effects may cause significant hypotension.
• No known interactions with cytochrome P450 substrates.

Missed dose

Alprostadil is used on an as-needed basis; there is no scheduled dosing regimen. If a dose is missed, it may be administered when needed, ensuring at least 24 hours have passed since the last dose. Do not double the dose.

Overdose

Overdose may manifest as prolonged or painful erection, severe hypotension, dizziness, or syncope. Priapism is a medical emergency—seek immediate urological care. Symptomatic treatment for hypotension includes supine positioning and volume expansion if necessary. Specific antidotes are not available.

Storage

• Store unopened vials or pellets at controlled room temperature (20–25°C).
• Protect from light.
• Do not freeze.
• Reconstituted solutions should be used immediately; discard any unused portion.
• Keep out of reach of children and pets.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting any new medication or changing your treatment plan. Individual responses to alprostadil may vary.

Reviews

Clinical studies and patient reports consistently affirm alprostadil’s efficacy in treating erectile dysfunction, particularly in cases non-responsive to oral agents. In a 2021 meta-analysis, intracavernosal alprostadil achieved erection sufficient for intercourse in over 80% of patients. Users often report high satisfaction with the predictability and controllability of effects, though penile pain and administration anxiety remain noted drawbacks. Long-term safety data support its use under medical supervision.