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With injection therapy, a needle is used to inject medication directly into the penis. This medicine does not stop the spread of diseases like HIV or hepatitis that are passed through blood or having sex. Several different ingredients can be used to form the base of a suppository: A lack of spontaneity and the fact that using the device can be cumbersome and may cause some discomfort seem to be the biggest concerns of patients. Many couples have used this time to incorporate various types of foreplay. Dosage may be increased in a stepwise manner (to 1000 micrograms), or decreased (to 250 or 125 micrograms) under medical supervision until the patient achieves a satisfactory response.

How long will the effect of MUSE last?

Roll the penis between the hands for at least 10 seconds to ensure that the medication is adequately distributed along the wall of the urethra. Only a small percentage of men, mostly young men with trauma leading to the penis, may be candidates for this surgery. Symptomatic hypotension, persistent penile pain and in rare instances, priapism may occur with alprostadil overdosage. This medicine is for use in the urethra (the tube that urine passes through). Do not use this medicine more often than directed. Unlike the solid tablet version, it didn’t need to be taken with water. High concentrations of alprostadil (400 microgram/ml) had no effect on human sperm motility or viability in vitro.

A penile implant is a device that is placed in the penis surgically. Sildenafil potentiates the effect of the nitrates by inhibiting the breakdown of cGMP, causing hypotension due to severe vasodilation. Do not take other medicines unless they have been discussed with your doctor. No more than three injections per week are recommended, with a minimum period of 24 hours between injections. It is intended for general informational purposes only and does not address individual circumstances. Because of the presence of phosphodiesterase in the retina, patients with retinitis pigmentosa should not be given sildenafil.

If you do experience dizziness or feel faint, this may be due to the lowering of your blood pressure.

In Case Of Emergency/overdose

Be sure that you know which product you are using and that you fully understand the proper way to mix the injection. It is based on the discovery that the urethra (the normal pathway for urine) can absorb certain medications into the surrounding erectile tissues thereby creating an erection. If you have any questions about alprostadil urethral suppository, please talk with your doctor, nurse, pharmacist, or other health care provider.

For men who don’t mind needles, injections come in various formulations: The dose can be increased to 100 mg if needed. Next, the theory of the iontophoretic technique of drug delivery is discussed.

It is injected into the base of the penis, and as a localised treatment produces much quicker results than most tablets on average; in around 5 to 20 minutes. Erectile dysfunction, or ED, is quite common in male patients living in the Plano, Frisco and Dallas, Texas communities and around the country. Published by RelayHealth. The prescribed dosage should not be exceeded. Popular nutritional supplements to treat erectile dysfunction include bioflavonoids, zinc, vitamin C, vitamin E, and flaxseed meal. You may report side effects to Health Canada at 1-866-234-2345.

Be sure that you tell all healthcare providers who treat you about all the products you are taking.


Again, as an injection, it is not as discreet as taking a pill, but it may be just as potent. With these methods, you self-administer medicine into the penis to relax the blood vessels and allow increased blood flow into the penis, creating an erection. For non-prescription products, read the label or package ingredients carefully. Various positions that may favor blood flow into the penis. The male hormone testosterone is produced by the testicles and is responsible for the proper development of male sexual characteristics. Testosterone replacement therapy may improve energy and heighten sexual interest in older men who may have deficient levels of testosterone.

This medicine may be found in human semen and may have the potential for side effects to an unborn child. These drugs won’t produce an erection unless you’re sexually stimulated. Do not expose to direct sunlight. The increased blood flow into the corpora cavernosa in association with reduced venous outflow results in penile rigidity. These products are only available on prescription.

Who should not use urethral suppositories? Urethral suppositories, the size of a grain of rice, are inserted via the head of the penis; injections are self-administered near the base of the penis. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases.

Adverse Reactions

What if I miss a dose? Using a condom will prevent these symptoms. Before inserting the medication, the man should urinate. When a partner gets involved with therapy, men resolve stress-related erectile dysfunction 50 to 70 percent of the time. Some patients may experience some mild pain and aching in the penis or groin area. Rarely, your erection may last too long (see the section below ‘What if my erection lasts too long? )It’s a good idea to shop around because pharmacy prices may differ. Because MUSE has not been tested during human pregnancy, it is recommended that couples use adequate contraception if the female partner is of childbearing potential.

The most physiologically important mediator is nitric oxide. Contact your doctor immediately if the erection lasts longer than 4 hours or if it becomes painful. The medication works by softening the surrounding tissue and making your blood vessels expand, which increases the blood flow. Antibiotics should be provided pre-operatively, and the surgical site should be shaved immediately prior to surgery.

Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: How do I know if I have the correct dose of MUSE? However, we want you to know that ED can be an early warning sign of heart disease. Minor urethral bleeding or spotting due to improper administration. How should I store this medicine?

MUSE® has few side effects.

Laboratory Tests

4% at 125 mcg, 33. The cost of this ED treatment is $2 to $5 per injection. This anatomical change is inevitable, and does not affect a man’s physique or lifestyle. Read and follow the instructions carefully.

Clinical Pharmacology

Iontophoresis as a drug delivery alternative may gain popularity with ED patients who fail other types of therapy or in patients with other penile disorders. The vacuum increases blood flow to the area, which simulates an erection. If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

Further, men with breast cancer should not take testosterone replacement therapy. Patients with active coronary ischemia who do not take nitrates Patients with congestive heart failure and borderline low blood pressure, and borderline low volume status Patients on a complicated, multidrug antihypertensive regimen Patients taking drugs that are metabolized by or that inhibit cytochrome P450 enzyme 3A4 (CYP3A4) TABLE 5 Clinical Recommendations for Use of Sildenafil (Viagra) Sildenafil is clearly contraindicated in the following: Alprostadil belongs to a group of drugs called vasodilators --drugs that increase blood flow by relaxing and expanding blood vessels. • Patients who have conditions that might predispose them to priapism, such assickle cell anaemia or trait, thrombocythaemia, polycythaemia, multiple myeloma or leukemia; predisposition to venous thrombosis, or a history of recurrent priapism. If your sex partner is pregnant, always use a condom to protect the fetus from exposure to any of this medicine, although the chances of actually harming the fetus are rather low. View/Print Table TABLE 5 Clinical Recommendations for Use of Sildenafil (Viagra) Sildenafil is clearly contraindicated in the following: AFTER USING MUSE, YOU SHOULD AVOID ACTIVITIES, SUCH AS DRIVING OR HAZARDOUS TASKS WHERE INJURY COULD RESULT IF DIZZINESS OR FAINTING WERE TO OCCUR.

As of this writing, the drug cost to pharmacists is approximately $263 for 30 tablets of any size.

Though testosterone replacement therapy is generally safe, it is associated with several conditions including acne, oily skin, mild fluid retention, stimulation of prostate tissue and increased urination, breast enlargement, worsening of sleep apnea, and decreased testicular size. You may report side effects to the FDA at 1-800-332-1088. Adjunct to other tests in the diagnosis and management of erectile dysfunction. Vascular reconstructive surgery. Do not expose to temperatures above 30 degrees C (86 degrees F). Thus, specialized testing is now limited to PDE-I non-responders, young men with post-traumatic or primary ED, men with Peyronie’s Disease, and legal investigations. The manufacturer recommends that you use no more than 2 doses in a 24-hour period. The incidence of mild adverse effects was higher in the group taking sildenafil, but the incidence of cardiovascular events was similar in both groups.

Use this medicine exactly as directed by your doctor.

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This medicine is available only with your doctor's prescription. What are the possible side effects? 23 This translates to an average wholesale price of $8. Like MUSE, this item also contains alprostadil, which is a synthetic version of a type of chemical called a prostaglandin. The second phase of this study involved a diary of erectile activity in which 10 of 12 patients reported improved erectile activity while receiving sildenafil. Contact us today to make an appointment. The suppository must be thrown away after it is used.

On the other hand, while it is quicker to react in the body than most pills on average, it may be a little slower than its prostaglandin counterparts, taking up to half an hour to work. Leukemia, multiple myeloma, sickle cell anemia, or other health problems that may raise the chance of painful erection (hard penis) or an erection that lasts for longer than 4 hours. An even larger loss of testosterone in men, however, will cause undesirable side effects. New designs and surgical techniques have improved their safety and efficacy. Your doctor will discuss your options with you, along with the potential risks and benefits.

Although several patients have died after receiving prescriptions for sildenafil, it is unclear how many of these deaths resulted from appropriate use of the medication.

Intracavernosal Alprostadil

They contain the drug alprostadil (also known as prostaglandin E1) and are sold under the brand name Muse. 12 Patients usually start at 2. What are the side effects or potential complications of urethral suppositories? A very serious allergic reaction to this drug is rare. Treatment of priapism should be according to established medical practice. The vials version comes as a powder, which is then mixed with a liquid which is also supplied; whereas the dual chamber version is sold pre-mixed. This type of treatment can be given in the form of creams, gels, patches, injections, or pellets. Alprostadil pellets should not be used more than twice in a 24-hour period.

Comprehensive questionnaires have been developed (e. )You should attempt intercourse within 10 to 30 minutes after using the medicine. Each injection is intended to produce an erection that lasts no longer than an hour.

To help dissolve the suppository, roll your penis between your hands for 10 seconds. Conversely, the half-life of Viagra is 4 hours, for vardenafil 4 to 5 hours, and for Cialis 17 to 21 hours. Pressing on a deflation valve above the pump returns the fluid to the reservoir, deflating the penis. It may be kept at room temperature for up to 14 days. Side effects include pain, burning sensation and unsatisfactory erections. Very bad headache. Similarly, an erection that lasts longer than desired may require a dose decrease.

In this Article

But some men might choose alprostadil alone because the multi-drug cocktails can cost more and must be dispensed by a compounding pharmacy — one that is authorized to mix medications on site — which could mean the added hassle of a long drive to pick up the drug. If you experience dizziness or feel faint during sexual intercourse, this may be due to the lowering of your blood pressure. Do this even if there are no signs of discomfort or poisoning. Do not change the dose of your medicine.

In women, mild vaginal itching and burning have been observed. In addition to being easier to apply, it is also more discreet, and likely won’t take as long to prepare as the injection. If necessary, this may be followed by further aspiration of blood through the same butterfly needle. It should be used 5 to 30 minutes before intercourse and improvements in erection should last between 1 and 2 hours. It is important to sit, stand or walk about for 10 minutes after you insert the suppository. Maximum levels in the bloodstream are reached within 45 minutes with Levitra, an hour and 10 minutes with Sildenafil, and 2 hours with Tadalafil. There may be drug take-back programs in your area. MUSE can be used as an adjunct in evaluating penile vascular function using Doppler duplex ultrasonography.

When to Seek Treatment for Erectile Dysfunction: Jim Hotaling, MD, ESPN 700

Though inadequate testosterone production is not a common cause of erectile dysfunction, some men with low testosterone might see increased sexual functioning from testosterone replacement therapy. Not more than 2 doses are recommended to be used in any 24-hour period, and not more than 7 doses are recommended to be used in a 7-day period. Thus the initial trial dose of intra-cavernosal injection therapy should be administered under healthcare provider supervision. The most common side effects that have been observed using MUSE follow: You can also visit the NHS Choices website at www. 21 In 312 men receiving sildenafil, mean scores for the frequency of penetration and maintenance of erections after penetration increased significantly.

0 ml of the solution injected every 5-10 minutes.

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Wash your hands before and after use. Overdosage has not been reported with MUSE. In the past, patients have underreported this problem because of embarrassment and the belief that little could be done to alleviate it. Check with your pharmacist if you have questions about the best way to throw out drugs. Your doctor can discuss all of these options with you in more detail. Additionally, try looking for pharmaceutical manufacturer discount programs that offer a better price. These include prostaglandin E, acetylcholine, vasoactive intestinal peptide and nitric oxide. • Patients with anatomical deformation of the penis, such as stenosis of the distal urethra, severe hypospadias, severe curvature, balanitis, acute or chronic urethritis, angulation, cavernosal fibrosis or Peyronie's disease.

In the latter case, facilities should be available to manage a hypertensive crisis.

Aching in the penis, testicles, legs, or in the area between the penis and rectum. Alprostadil (prostaglandin E-1) is an FDA approved agent for the treatment of erectile dysfunction by intra-cavernosal injection. Therefore, if a man is having sexual intercourse with a pregnant woman and is using Alprostadil from either an injection or as a suppository, a condom is recommended. The biggest complaint about these treatments is a burning sensation in the penis as the drug takes effect. This medicine will not prevent pregnancy or protect you or your partner from diseases such as syphilis, herpes, or HIV. It all begins with the right questions. Common eye problems and infections, according to the authors of one study , about 30 percent of men with high blood pressure also have had ED. The entire length of the suppository should be inserted and within a few minutes, blood flow to the penis will begin so a full erection can be achieved.

Or you can use it as suppository, placing it into the opening at the tip of the penis. For erectile dysfunction: Pills can help you achieve an erection quickly and may have an effect on sexual intimacy. In the very unlikely event you have a painful or prolonged erection lasting 4 or more hours, stop using this drug and seek immediate medical attention, or permanent problems could occur. Risks and side effects of testosterone therapy may include:

Prices for Nipatra and Vitaros are for four individual doses.

These medications can be used safely in most men with diabetes.

Penile Prosthesis

However, tell your healthcare provider if you take any medicines for high blood pressure. Swelling of the leg veins. Though the directions advise men to take the drug one hour before sexual activity, research indicates that the drug can sometimes work when taken from 30 minutes to eight hours before intercourse. Gently and completely push down (Fig. )It contained exactly the same active ingredient as Viagra, a PDE5 inhibitor called sildenafil, and worked in a likewise manner. If you have a deformed penis, penile implant, or other penile problems. Life-threatening (Report these to your healthcare provider right away. )

If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

If you apply too much pressure you may scratch the lining of the urethra causing it to bleed. Call your doctor or health care professional to determine if your dose needs to be changed. The ultimate guide to whey protein powder supplements, but sex, whether through masturbation or with a partner, is a part of a healthy life. In patients experiencing hypotension and/or syncope, these events have usually occurred during initial titration and within one hour of drug administration. But a newer medicine, Stendra (avanafil), may pose fewer side effects. 11 When injected directly into the corpus cavernosum, alprostadil (prostaglandin E 1 ) acts on the arteriolar smooth muscle cells, causing them to relax and produce an erection, usually within several minutes.

Final Comment

Diabetes, on the other hand, occurs when you have too much glucose in your blood. The only FDA-approved urethral suppository is called MUSE® (Medicated Urethral System for Erection), which contains the drug alprostadil (also used in the injectable drugs, Caverject and Edex). There are a number of prescription medications available that may improve blood flow to the penis. It is very important that MUSE not be exposed to temperatures above 30°C/86°F since this will make MUSE ineffective. It may sound painful, but most people find that it causes little more than mild discomfort at first, before becoming more accustomed to use.

If you are interested in donating, please click here or contact us for more information (details at the bottom of this page). Remove the cap from the applicator stem. Tell your doctor immediately if any of these unlikely but serious side effects occur: For many, the thought of self-administering an injection into the penis can be a fairly daunting one, with the very careful administration required potentially putting some users off. 19 EFFICACY The first published efficacy trial of sildenafil involved only 12 patients, but it is the only study that included objective measurements of penile rigidity.

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If they are going to work, it takes about five to 10 minutes. Erections that last after ejaculation are not uncommon, but should be gone within an hour. In some cases, impotence can be one of these side effects. Symptom-based definitions are rapidly replacing the routine use of physiologic measures of erectile function such as penile tumescence. Before any of these drugs are prescribed, consideration should be given to existing medical illnesses and medications, partner satisfaction, comfort with the method of administration and the side effect profile.

  • Men are advised to use a condom when using Viridal® if their partner is, may be, or could become pregnant.
  • It is recommended that MUSE be stored in a refrigerator.
  • The dose of this medicine will be different for different patients.

Consumer Information Use

As with the injection, erections usually result within 15 minutes. It is best used just after passing urine, as the extra moisture helps the drug to be absorbed. The presence of other medical problems may affect the use of this medicine. How do urethral suppositories work? Be sure to straighten your penis to its full length when inserting the MUSE applicator. Patients should be individually titrated to the lowest dose that is sufficient for sexual intercourse.

MUSE provides an alternative delivery system for alprostadil.

Remember, each MUSE is good for a single administration only. For those who do not respond to non-surgical treatments or are not candidates for surgery, penile prosthesis is an excellent alternative. IN PATIENTS EXPERIENCING THESE SYMPTOMS, THE SYMPTOMS HAVE USUALLY OCCURRED DURING INITIATION OF THERAPY AND WITHIN ONE HOUR OF MUSE ADMINISTRATION. Make sure that the pellet is present before insertion (Fig. )If you are looking for an easy to use erectile dysfunction solution and are not sure where to begin, your doctor will be able to provide further guidance. Depending on its effectiveness and your tolerance to the medication, other approaches may be tried. When a man goes through counseling alone, the success rate is lower. Also, tell your healthcare provider if you are taking a medicine that reduces the chance of blood clots forming such as warfarin (Coumadin).

Men usually cannot get an erection without inflating the implant, and if the implant is removed, the man may never again have natural erections.

Why Is This Medication Prescribed?

When measured against ED pills, MUSE doesn’t do too badly. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. Treatment of priapism should not be delayed more than 6 hours (please refer to Section 4. New posts, it has also a gradual decrease in Leydig cells that synthesize testosterone in the testicles and also that of nerve cells located in the hypothalamus that produce GnRH (Gonadotropin Hormone releasin), the neurohormone that regulates the production of pituitary gonadotropin LH, which in turn regulates the production of testosterone by the testis. )This medicine is not approved for use in women. Suppositories are used to deliver medications that act both systemically and locally.

It does not work as a tablet but can also be used as a pellet (MUSE®) or a cream (Vitaros®). Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: The erection should last approximately 30 to 60 minutes. The first dose should be used in your healthcare provider's office.


Patients with active coronary ischemia who do not take nitrates Patients with congestive heart failure and borderline low blood pressure, and borderline low volume status Patients on a complicated, multidrug antihypertensive regimen Patients taking drugs that are metabolized by or that inhibit cytochrome P450 enzyme 3A4 (CYP3A4) The management of angina in patients who have taken sildenafil within 24 hours involves the use of non-nitrate antianginal drugs such as beta blockers. Use alprostadil exactly as directed. WHAT ARE THE POSSIBLE SIDE EFFECTS OF MUSE? Alprostadil is a medicine that men take for ED (erectile dysfunction). Sitting, standing, or walking for 10 minutes while an erection is developing helps increase the blood flow to your penis to gain a proper erection. Yohimbine, an alpha-2-adrenoceptor antagonist, has been available for some time as a treatment for erectile dysfunction, although its efficacy has remained questionable for many years.

Improve Erectile Function with Healthy Lifestyle Changes

Intercourse should be attempted within 10 to 30 minutes of using this medication. A suppository is a solid dosage form that is inserted into the rectum (rectal suppository), vagina (vaginal suppository), or urethra (urethral suppository), where it dissolves or melts and exerts local or systemic effects. This treatment is based on the discovery that the urethra (the tube through which urine is passed) can absorb certain medications. If ED is caused by low levels of the hormone testosterone, your doctor might recommend testosterone therapy.

MUSE is supplied as cartons of 1, 2, 3, 6 or 10 foil pouches, with each pouch containing one delivery system. The most frequently reported side effects of alprostadil suppositories include penile pain (32%), urethral burning (13%), and testicular pain (5%). When you take this medicine with other medicines, it can change the way this or any of the other medicines work. The MUSE system is see-through, and you will be able to see the medicated pellet at the end of the stem. To use this medication, you must be able to inject into the side of the penis on your own when you are ready to engage. It is important to sit, stand or walk about for 10 minutes after administration. This sheet is a summary. Though suppositories appear to be less effective than either injections or vacuum therapy, the drug can be used to treat erectile dysfunction due to a wide variety of causes.