Alprostadil (prostaglandin E1, PGE1) is most famously known in two clinical forms: one is Pfizer's Caverject and Caverject Impulse, administered directly into the corpora cavernosa via injection or urethral suppository (muse), specifically for erectile dysfunction unresponsive to oral Viagra-like drugs; the other is the intravenous Prostin VR or commonly available emulsion injections (such as Keshen), which works by dilating blood vessels and inhibiting platelet aggregation, used for limb ulcers due to chronic arterial occlusive disease, antithrombotic therapy after organ transplantation, and maintenance of neonatal ductus arteriosus-dependent congenital heart disease.
For patients with erectile dysfunction (ED) caused by vascular or nerve problems, it is a game-changer. Whether administered via the urethra or directly into the corpora cavernosa, it works extremely quickly, rapidly filling previously lifeless tissue with blood within minutes to tens of minutes. For patients who do not respond to oral medications (such as Viagra) or suffer nerve damage due to prostate surgery, it often brings immediate confidence; the feeling of regaining control is truly exhilarating. Objective Disadvantages
First, it involves injecting the corpora cavernosa of the penis. Before attempting it yourself, you need a doctor to guide you two or three times. Shallow injections result in bruising, misaligned injections cause hematomas, and urethral bleeding can be dangerous. New users are understandably anxious during the first ten attempts.
Second, the incidence of injection pain is not low (reported in Caaverject literature as high as 30%), feeling like a bee sting followed by swelling.
Third, the biggest concern is priapism-if the erection doesn't soften after 4 hours, an emergency injection of phenylephrine is needed. If left untreated for more than 6 hours, the corpora cavernosa begin to fibrose, leading to hardening, curvature, and shortening. Among long-term users, about 10% develop localized fibrosis or mild curvature, which is not completely prevented by switching sides.
Fourth, it does not contain antibacterial preservatives (single-dose vials). It must be used within 24 hours of preparation; don't try to repackage it, refrigerate it, and use it again the following week.
Storage Conditions
Unprepared powder injections have two storage requirements: Cavern 20 mcg vials can be stored at room temperature (20–25℃); 40 mcg vials must be refrigerated at 2–8℃ from manufacturing to dispensing. After being shipped from the pharmacy, they can be stored at ≤25℃ for a maximum of 3 months (based on the expiry date in the instructions). Edex is similar. Do not refrigerate or freeze prepared solutions. Use within 24 hours at room temperature (≤25℃). Cavern Impulse dual-chamber pens, even after preparation, should also be stored at 2–25℃ for 24 hours. Muse suppositories in their original foil pouches should be stored at 2–8℃. When taken out of the pharmacy, do not keep them at room temperature for more than 14 days. Frozen vials are unusable. Discard any solutions that are cloudy or contain particles.
Precautions
The first injection must be given in the hospital. The doctor will determine the starting dose (usually 2.5–5 mcg, 1.25 mcg for neurogenic erections). Do not increase the dose at home. If an erection lasts longer than 1 hour, the dose is too high.
No more than 3 times per week, with an interval of ≥24 hours between injections. Daily injections into the corpora cavernosa are unbearable.
Change the left and right sides and the injection site each time. Repeated injections at the same spot will rapidly lead to fibrosis.
Sickle cell lung disease, leukemia, multiple myeloma, erythrocytosis/thrombocytosis, penile prosthesis, Peronis disease (curvature), urethral stricture, acute urethritis-these are either contraindications for ED or should only be used after a doctor's evaluation.
When using anticoagulants (warfarin, heparin), antihypertensive drugs, or PDE5 inhibitors, reduce the dosage and have someone accompany you to prevent fainting due to low blood pressure. Do not try to endure needle breakage, post-injection dizziness, or chest pain.
For priapism lasting >4 hours, go directly to the emergency room. Don't wait at home for it to "slowly subside," as this is the only point where this medication can cause permanent damage.
Dilution with benzyl alcohol should never be given to premature infants or newborns (Prostin VR is an exception, that line is not under the jurisdiction of ED); household sharps should be stored in a sharps box, not carelessly disposed of.
In short, Alprostadil brand injectable is the "most effective, most complicated to administer, and most risky" of the three lines of ED treatment. It's suitable for those who don't respond to oral medication, are willing to learn the technique, and can maintain discipline and avoid excessive erections. Treating it as an aphrodisiac by increasing the dosage, or buying research-grade PGE1 powder online and mixing it yourself, is gambling with penile tissue. If you really need to use it, get a referral from a urologist or andrologist, have the first injection in the clinic, and keep a log of your injections at home (dosage/onset time/subsidence time/pain level). This is more effective than any guide.
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