Your Guide to Using Alprostadil

If you've been prescribed Alprostadil injections for erectile dysfunction, it's completely normal to feel a bit apprehensive when using it the first time. 

But you shouldn’t let apprehension stop you from enjoying a fulfilling sex life. With the right knowledge and preparation, Alprostadil can be an effective method to combat erectile dysfunction.

At Pharmacy Direct GB, we understand how important it is to take any medication correctly. This is why we have put together this guide to help you prepare, inject and manage your Alprostadil doses.

You should still go through the patient information leaflet, especially if you are using Alprostadil for the first time.

What is Alprostadil and how does it work?

Alprostadil is a vasodilator, meaning it widens blood vessels. 

Injected directly into the side of the penis (a technique called an intracavernosal injection), it increases blood flow to the area, producing an erection independently of sexual arousal. 

It's typically prescribed when tablets for erectile dysfunction haven't worked or aren't suitable.

Getting your starting dose right

When you are prescribed Alprostadil, your doctor will start you on the lowest dose likely to work and adjust it gradually. This helps find the correct dose for you and also reduces the risk of an erection that won't go down. 

Never adjust your own dose without medical advice, even if a previous dose didn't feel effective.

How to prepare the injection

Alprostadil is supplied as a powder that needs to be mixed with the diluent (solvent) provided immediately before use. In general terms:

• Clean the top of the powder vial with the antiseptic wipe provided.
• Use the larger needle supplied to draw up the diluent and inject it into the powder vial.
• Gently swirl (don't shake) the vial until the powder is fully dissolved.
• Check the mixture is clear. If it's cloudy or has particles in it, don't use it.
• Draw the correct dose into the syringe, then switch to the finer injection needle before injecting.
• Only ever mix the dose you're about to use. Once reconstituted, it must be used straight away and any unused solution discarded. The solution isn't suitable for storing or reusing later.

How to give the injection

Wash your hands first. Hold the penis firmly, with your fingers underneath and thumb on top, so the injection site is stretched slightly. Inject into the side of the shaft, avoiding any visible veins, then apply gentle pressure to the site for a few minutes afterwards to reduce bruising.

It's important to use a different spot each time. You should alternate sides and positions along the shaft to reduce the risk of scarring or lumps developing in the tissue with repeated use.

How long before sex should you inject it?

Alprostadil generally starts working within 5 to 15 minutes, so most people inject it a short time before they anticipate being intimate, rather than well in advance. There's no need to inject immediately. A few minutes' gap to let it take effect works well for most people.

How long does it last?

The erection typically lasts under an hour, though this varies by dose and individual response. This is also why frequency is tightly limited:

• No more than one injection in any 24-hour period
• Not on two consecutive days
• No more than three injections in any one week

Sticking to these limits isn't just about effectiveness. This is a key part of reducing the risk of the more serious side effects below.

Possible side effects

Very common: pain at the injection site is the most frequently reported effect.

Common: bruising, swelling or discolouration where you inject, mild bending or kinking of the penis, and muscle spasm.

Less common but important to know:

• Priapism - a prolonged, often painful erection lasting more than 4 hours. This is a medical emergency. Go to A&E or call NHS 111 immediately if this happens; treatment is needed quickly to avoid permanent damage.
• Penile fibrosis - small lumps, nodules or curvature that can develop with repeated injections over time. Tell your prescriber if you notice any changes to the shape or feel of the penis.
• Numbness, changes in blood pressure or heart rhythm, or faintness after injecting.

If an erection lasts between 1 and 4 hours and feels uncomfortable, contact your doctor or pharmacist for advice. It doesn’t need to be a 999 emergency at that stage, but it shouldn't be ignored either.

Who shouldn't use Alprostadil, and other safety warnings

Alprostadil isn't suitable for everyone. You should not use it if you:

• Have sickle cell disease, leukaemia, multiple myeloma, or any other condition that raises your risk of priapism
• Have a penile implant
• Have penile curvature, scarring or a tight foreskin
• Have been medically advised to avoid sexual activity because of a heart condition

Tell your prescriber if you take blood-thinning medicines such as warfarin or heparin, as you may bruise or bleed more at the injection site, or if you have a history of stroke, TIA, or cardiovascular risk factors such as high blood pressure or smoking, since sexual activity itself carries some cardiac exertion. 

It's also worth knowing that Alprostadil doesn't protect against sexually transmitted infections and a condom should be used. It does not protect against pregnancy and so a reliable form of contraception should be used if necessary.

Alprostadil can be used by couples trying for a baby and can also be used if your partner is pregnant or breast feeding. 

Storing and disposing of your Alprostadil kit

Store the unmixed powder below 25°C, away from direct heat. 

Never store a reconstituted (mixed) dose to use later. It must be used immediately or discarded. Dispose of needles, syringes and vials in a proper sharps bin, never in household waste. Your pharmacy can advise on collection or disposal if you don't already have a sharps bin.

When to speak to your pharmacist or doctor

Get in touch if: 

• Your dose doesn't seem to be working
• Side effects are troubling you
• You notice any change in the shape of your penis
• You’re unsure about the injection technique. 

And remember, an erection lasting more than 4 hours always needs emergency treatment, not a wait-and-see approach.

At Pharmacy Direct GB, we ensure Alprostadil is suitable for you with a comprehensive online consultation before it is prescribed.

This guide is for general information and doesn't replace the patient information leaflet supplied with your medicine or advice from your prescriber or pharmacist. Always follow the specific dose and instructions you've been given.