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Caverject (Alprostadil)
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Caverject

Caverject is a medication used to treat erectile dysfunction. Caverject (prostaglandin E1) is produced endogenously to relax vascular smooth muscle and cause vasodilation. In adult males, the vasodilatory effects of Caverject on the cavernosal arteries and the trabecular smooth muscle of the corpora cavernosa result in rapid arteriolar inflow and expansion of the lacunar spaces within the corpora.

Other names for this medication:
Alpostin, Caverject, Edex, Muse, Prostin, Vitaros

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Also known as: Alprostadil

Description

This medication is used to treat male sexual function problems (erectile dysfunction). It works by helping the blood flow into the penis to achieve and maintain an erection. This medication is not for use in women or children.

Dosage

Caverject is given as a shot into your penis. You will receive the first dose of Caverject in your doctor's office to find out the best dose for you. You will need to stay in the doctor's office until your erection is gone.

Special patient directions come with the suppositories and some of the injection medicines. Read the directions carefully before using the medicine.

For the injections—There are several Caverject products that can be injected. Although the injection method is the same, the mixing procedures are different. Be sure you know which of these products you will be using and the proper way to mix the injection.

One product called Caverject for Injection (brand names Caverject® and Edex®) is available as a powder in a vial. Caverject® must be mixed with a solution called Bacteriostatic Water for Injection USP. Edex® must be mixed with a solution called Sodium Chloride Injection USP. The solution for mixing comes with your product and may be already loaded into a syringe or contained in a vial.

It is important to follow several steps to prepare your Caverject injection correctly. Before drawing up the medicine into the syringe:

Wash your hands with soap and water. Set the bottles on a clean surface. Wipe the top of the injection bottles with an alcohol swab. Do not wipe the needle. Throw away the alcohol swab. You may need to attach the needle to the syringe. Do not take the cap off yet.

How to mix Caverject®:

If the syringe already contains the Bacteriostatic Water for Injection USP, then you need only add the plunger to the syringe. To do this: Pick up the rod-like plunger and place it within the barrel of the syringe until it touches the rubber piece. Gently screw the plunger into the rubber piece until it seems secure. Do not use a lot of force. Hold the syringe by the barrel (not the plunger) and take the cap off the needle. You are now ready to mix the water and the powder. Skip to the directions under the title, “To mix the water and powder." If the syringe does not already contain the Bacteriostatic Water for Injection USP, you must withdraw 1 milliliter (mL) of it from the bottle provided. To do this: Pick up the syringe and take the cap off the needle. Pull the plunger back to the 1-mL mark on the syringe. This pulls air into the syringe. Insert the needle into rubber top of the bottle while it is upright and inject the 1 mL of air into the bottle. Turn the bottle upside down using one hand. Be sure the tip of the needle is covered by solution. With your other hand, pull the plunger back slowly to withdraw 1 mL of solution into the syringe. Remove the needle and skip to the directions under the title, "To mix the water and powder." To mix the water and powder: Insert the needle into the bottle of Caverject and inject 1 milliliter of Bacteriostatic Water for Injection USP from your syringe into the bottle of Caverject. Remove the needle from the bottle, holding the barrel of the syringe. Gently swirl the bottle to mix the powder into the solution, turning it upside down to wet all the powder in the bottle. Follow the directions below, “How to draw your dose into the syringe."

How to mix Edex®:

The syringe already contains the Sodium Chloride Injection USP. You need only attach the needle to the syringe and add the plunger. To do this: Remove the needle from its package. Do not remove the needle cap. Gently screw the needle into place on the syringe tip. Pick up the rod-like plunger and place it within the barrel of the syringe until it touches the rubber piece. Gently screw the plunger into the rubber piece until it seems secure. Do not use a lot of force. Hold the syringe by the barrel (not the plunger) and take the cap off the needle. You are now ready to mix the Sodium Chloride Injection USP and the powder. Insert the needle into the bottle of Caverject and inject 1.2 milliliters of the Sodium Chloride Injection USP from your syringe into the bottle of Caverject. Remove the needle from the bottle, holding the barrel of the syringe. Gently swirl the bottle to mix the powder into the solution, turning it upside down to wet all the powder in the bottle. Use the mixture within 24 hours of mixing it. Follow the directions below, “How to draw your dose into the syringe."

How to draw your dose into the syringe (for all injection products):

Check the solution to make sure it is clear. Do not use the mixture if you can see anything solid in the solution or if the solution is cloudy or colored. After the Caverject solution is mixed and the needle is inserted into the Caverject bottle, turn the bottle with the syringe as a unit upside down in one hand. Be sure the tip of the needle is covered by the solution. With your other hand, pull the plunger back slowly to draw the correct dose of the medicine into the syringe. Hold the syringe with the measuring scale at eye level to see that the proper dose is withdrawn and to check for air bubbles. To remove air bubbles, tap gently on the measuring scale of the syringe to move any bubbles to the top of the syringe near the needle. If your dose measures too low in the syringe, withdraw more solution from the bottle. If there is too much medicine in the syringe, put some back into the bottle. Then check your dose again. Remove the needle from the bottle, holding the barrel of the syringe, not the plunger. Place the cover back on the needle. You are now ready to inject your dose. Follow the directions below, “How to give the Caverject injection."

How to give the Caverject injection:

Choose a spot on your penis as directed by your doctor where you will give the injection. Clean the injection site with alcohol. Sitting upright or slightly reclined, hold your penis against the side of your thigh so that it cannot move. Remove the cover from the needle and hold the needle at a 90-degree angle to the place of injection. Insert the needle until almost all of the metal part of the needle is inserted into the penis. Do not inject the medicine just under the surface of the skin, at the top or head of the penis, or at the base of the penis near the scrotum or testes. Avoid injecting the medicine into blood vessels that you can see. Press the plunger down slowly, taking 5 to 10 seconds to release the dose into the penis. The injection is usually not painful. If the injection is very painful or if you notice bruising or swelling at the place of injection, that means you are injecting the medicine under the skin. Stop, withdraw the needle, and reposition it properly before continuing with the injection. Remove the needle and recap it. After you have completed the injection, put pressure on the place of injection for about 5 minutes or until any bleeding stops. This will prevent bruising. Then massage your penis as instructed by your doctor. This helps the medicine spread to all parts of the penis, so that the medicine will work better.

Choose a different place of injection each time you use the medicine to prevent skin problems. This includes switching the place of injection from the right side of the penis for one injection to the left side for the next injection.

After a single-use injection is mixed, the medicine must be used immediately. Throw away any unused mixture in the syringe. It cannot be stored for a later injection.

Do not reuse or share your needles or cartridges.

Never use a bent needle and never try to straighten a bent needle prior to injecting.

How to throw away the syringes and bottles safely:

Dispose of your materials properly. Caverject® comes in a plastic case that can be permanently locked with the red locking device that is included with the packaging. When the case label is removed, you can see a hole in the center of the case. The red locking device can be inserted and, by firmly pressing it down with your thumb, you will permanently lock the case. The locked case is safe to be thrown away.

Caverject usually begins to work in about 5 to 10 minutes. You should attempt intercourse within 10 to 30 minutes after using the medicine. An erection may continue after ejaculation.

The dose of Caverject will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of Caverject. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For the treatment of erectile dysfunction: For injection dosage form: Adults—1.25 to 60 micrograms (mcg) as a single dose once a day. Your exact dose will be determined by your doctor. Inject Caverject very slowly into your penis as shown to you by your doctor 10 to 30 minutes before intercourse. Allow 5 to 10 seconds to completely inject the dose. Do not inject more than one dose within 24 hours. Also, do not use Caverject for more than 2 days in a row or more than 3 times a week.

Overdose

If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fainting, painful/prolonged erection.

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The most common side effects associated with Caverject are:

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Side effect occurrence does not only depend on medication you are taking, but also on your overall health and other factors.

Contraindications

No information is available on the relationship of age to the effects of Caverject urethral suppository in geriatric patients.

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The aims of this exploratory study were (1) to develop a standardized objective electrophysiological technique with laser-evoked potentials to assess dorsal root damage quantitatively and (2) to correlate these LEP measures with clinical parameters and sensory abnormalities (QST) in the affected dermatome. Any of these alterations results in the deregulated expression of the transcription factor E2F, one of the key mediators of cell cycle progression. Of the patients with medial compartment osteoarthritis and varus deformity treated with HTO between 2007 and 2012, 21 cases with kissing lesions and 22 cases without kissing lesions were selected. The minimal inhibitory concentrations (MICs) of antibiotics against multidrug-resistant H. Depressive and social anxiety symptoms were most severe but least well correlated among tertiary care outpatients with anxiety disorders, emphasising the need for comprehensive evaluation and treatment.

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