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Alprostadil topical and urethral

Updated 2 Feb 2023 | Erectile dysfunction


Cream and urethral stick containing alprostadil

Drugs List

  • alprostadil 1000microgram urethral stick
  • alprostadil 3mg/g cream
  • alprostadil 500microgram urethral stick
  • MUSE 1000microgram urethral stick
  • MUSE 500microgram urethral stick
  • VITAROS 3mg/g cream
  • Therapeutic Indications


    Adjunct to other diagnostic tests in the diagnosis of erectile dysfunction
    Treatment of erectile dysfunction of primarily organic aetiology



    Treatment of erectile dysfunction
    Urethral stick
    The recommended starting dose is 500 micrograms.

    Dosage may be increased stepwise to 1000 micrograms or decreased to 250 micrograms under medical supervision until the patient achieves a satisfactory response.

    No more than 2 doses are recommended in any 24 hour period with a maximum of 7 doses in 1 week.

    The onset of effect is within 5 to 10 minutes after administration and lasts approximately 30 to 60 minutes.

    The recommended starting dose is 300 micrograms, especially in patients with serious erectile dysfunction, co-morbidity or failure to PDE-5 inhibitors.

    Patients who do not tolerate the 300 microgram dose due to local side effects can be transferred to the lower 200 microgram dose.

    No more than 1 dose is recommended in any 24 hour period with a maximum of 2 to 3 doses in 1 week.

    The onset of effect is within 5 to 30 minutes after administration and lasts approximately 1 to 2 hours.

    Adjunct to other tests in the diagnosis and management of erectile dysfunction
    Urethral stick
    A 500 microgram dose has a comparable effect on penile arterial dilation and peak systolic velocity flow to 10 micrograms of alprostadil given by intracavernosal injection.

    The erection should have subsided by the time the patient leaves the clinic.

    The cream is not licensed for this indication.


    (See Dosage; Adult)


    Urethral stick: to be inserted into the urethra.
    It is important for the patient to urinate before administration as a moist urethra makes administration easier and is essential to dissolve the drug.

    Cream: to be applied topically to the tip of the penis.


    Children under 18 years
    Patients in whom sexual activity is inadvisable
    Predisposition to priapism
    Predisposition to venous thromboembolism
    Acute urethritis
    Anatomical deformation of penis
    Cavernosal fibrosis
    Chronic urethritis
    Multiple myeloma
    Peyronie's disease
    Recent myocardial infarction
    Severe hypospadia
    Sickle cell disease
    Sickle cell trait
    Urethral stricture

    Precautions and Warnings

    Females of childbearing potential
    Cardiovascular disorder
    Cerebrovascular disorder

    Advise hypotension/syncope may affect ability to drive/operate machinery
    Not all formulations are licensed for all uses
    Not for use with other agents for erectile dysfunction
    Treat medical causes of erectile dysfunction before therapy
    Treatment for priapism should not be delayed more than 6 hours
    Review effectiveness of treatment & frequency of use in self administration
    Advise patient to report any erection lasting more than 4 hours
    Reduce dose or discontinue treatment if priapism develops
    Discontinue if cavernal fibrosis develops
    Discontinue if penile angulation develops
    Discontinue if Peyronie's disease develops
    Male: Use of condoms advised if partner pregnant or may become pregnant
    Male: Use of condom required to prevent local irritation to partner

    Pregnancy and Lactation


    Alprostadil is not indicated in females.
    Small amounts of alprostadil may be added to the naturally occurring prostaglandin E1 (PGE1) in the semen.

    Reproductive toxicity has been demonstrated in some animal studies.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Alprostadil is not indicated in females.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Decrease in blood pressure
    Ejaculation disorders
    Epididymal cysts
    Erectile dysfunction
    Erythema at application site
    Fibrotic changes in corpora cavernosa
    Genital pain
    Genital pruritus
    Increased frequency of micturition
    Increased heart rate
    Leg pain
    Leg vein swelling
    Muscle spasm
    Pain during erection
    Pelvic pain
    Penile angulation
    Penile oedema
    Perineal pain
    Peripheral vascular disorders
    Peyronie's disease
    Priapism (erection lasting 6 hours or longer)
    Prolonged erection (lasting 4-6 hours)
    Scrotal disorders
    Scrotal oedema
    Serum creatinine increased
    Testicular pain
    Testicular swelling
    Urethral bleeding
    Urethral burning
    Urethral pain
    Urethral stricture
    Urinary tract infections
    Vein disorder


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: May 2014

    Reference Sources

    Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press [Accessed on [May 1, 2014]].

    Summary of Product Characteristics: Muse 250 microgram urethral Stick. Meda Pharmaceuticals. Revised December 2013.
    Summary of Product Characteristics: Muse 500 microgram urethral Stick. Meda Pharmaceuticals. Revised December 2013.
    Summary of Product Characteristics: Muse 1000 microgram urethral Stick. Meda Pharmaceuticals. Revised December 2013.

    Summary of Product Characteristics: Vitaros 3 mg/g cream. Takeda UK Ltd. Revised October 2013.

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