Alprostadil Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Erectile Dysfunction

Parenteral:

Erectile dysfunction of vasculogenic, psychogenic or mixed etiology:
Initial: 2.5 mcg injected intracavernously into the lateral penis. If there is a partial response, the dose may be increased, within one hour, by 2.5 mcg to a dose of 5 mcg, and then in increments of 5 to 10 mcg, depending on erectile response, until the dose that produces an erection suitable for intercourse and not exceeding a duration of 1 hour is reached. If there is no response to the initial dose of 2.5 mcg dose, the second dose may be increased to 7.5 mcg within one hour, followed by increments of 5 to 10 mcg. No more than 2 doses should be given within a 24-hour period during initial titration.

Erectile dysfunction of pure neurogenic etiology (spinal cord injury):
Initial: 1.25 mcg injected intracavernously into the lateral penis. If there is a partial response, the dose may be increased,within one hour, by 1.25 mcg to a dose of 2.5 mcg, followed by an increment of 2.5 mcg to a dose of 5 mcg, and then in 5 mcg increments until the dose that produces an erection suitable for intercourse and not exceeding a duration of 1 hour is reached. No more than 2 doses should be given within a 24-hour period during initial titration.

Maximum: doses of greater that 60 mcg are not recommended.

Transurethral suppository:
The dosage strengths of alprostadil suppositories include 125 mcg, 250 mcg, 500 mcg, and 1000 mcg per urethral suppository. The administration of these dose forms of alprostadil requires substantial assistance and patient education by qualified health care professionals. It is recommended that patients begin with either the 125 mcg or 250 mcg urethral suppositories and increase or decrease the dose based on clinical response. The lowest dose necessary to maintain an erection suitable for intercourse and achieve full detumescence within 1 hour is optimal.

Usual Pediatric Dose for Patent Ductus Arteriosus

Initial: alprostadil for injection to treat patent ductus arteriosus must be administered via continuous IV infusion. Begin infusion with 0.05 to 0.1 mcg/kg/min. If the response to this initial dose is inadequate, the dosage can be increased up to 0.4 mcg/kg/min, although in general, higher infusion rates do not produce greater effects.

Maintenance: after a therapeutic response is achieved, reduce the infusion rate to the lowest possible dosage that maintains the response. This may be accomplished by slowly reducing the dosage in a stepwise fashion from 0.1 to 0.05 to 0.025 to 0.01 mcg/kg/min.

Dose Adjustments

Each dose is individualized according to patient's needs. The lowest possible effective dose should be used in each patient.

Precautions

Each patient's dosage must be individualized by careful titration with the assistance of and under the supervision of a heath care professional. During initial dosage titration, the patient must be injected then trained in proper self-injection techniques by the health care practitioner and must remain in the office until complete detumescence occurs.

Patients receiving alprostadil should be advised to contact their doctor immediately or seek emergency medical attention in the event of a prolonged erection (4 to 6 hours) or priapism (erection lasting longer than 6 hours).

Penile fibrosis, including Peyronie's disease, has been reported in patients receiving alprostadil treatment. Treatment should be discontinued immediately in patients who develop angulation, cavernosal fibrosis, or Peyronie's disease.

Underlying treatable medical causes of erectile dysfunction should be diagnosed and treated prior to initiation of therapy.

Hypotension and/or dizziness may occur due to increased peripheral blood levels of prostaglandin E1, particularly in those patients with significant corpora cavernosa venous leakage.

Use of alprostadil in combination with other vasoactive agents have not been systemically studied. Use of such combinations is not recommended.

Patients receiving warfarin and heparin may be have an increased risk for bleeding after the intracavernosal injection.

The patient should be instructed not to reuse or share needles or syringes.

Other Comments

Administer the intracavernosum injection no more than 3 times per week. Allow at least 24 hours between each dose. For administration of the injectable preparation, the manufacturer recommends a one-half inch, 27 to 30-gauge needle.

The intracavernosum injection must be prepared under sterile conditions. The usual site of injection is along the dorso-lateral aspect of the proximal third of the penis. Avoid any visible veins. The side of the penis that is injected and the site of injection must be alternated.

Patients should be advised that there are different forms and concentrations of injectable alprostadil on the market, a dual-chamber syringe system and the lyophilized powder for reconstitution to be used for treating erectile dysfunction, and the other already in solution for injection which is intended for use to maintain patency of the ductus arteriosus in neonates awaiting surgical repair of this cardiovascular defect. The amounts of alprostadil available in unit packages of these different types of injectable drug vary greatly and inadvertent substitution of one for the other could result in serious damage.

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