Caverject (Alprostadil)

Caverject (Alprostadil) Medication Information

Uses

Caverject is a prostaglandin E1 agonist indicated for the treatment of erectile dysfunction and as an adjunct to other diagnostic tests in the diagnosis of erectile dysfunction (1.2)

Dosage

The injections are available in two strengths of lyophilized powder in single dose vials:

• 20 mcg
• 40 mcg

Side Effects

The most common side effects of Caverject include:

• Penile pain
• Prolonged erection
• Penile fibrosis

Speak with your doctor or pharmacist for a full list of side effects that applies to you.

Precautions

Prolonged erection and priapism have occurred in patients receiving Caverject. To minimize the chances of this occurring, titrate Caverject slowly to the lowest effective dose. Advise patients to seek immediate medical assistance for an erection that persists longer than 4 hours.

Penile fibrosis has occurred in patients receiving Caverject. Follow patients regularly to detect signs of penile fibrosis. Discontinue in patients who develop penile angulation or cavernosal fibrosis. 

Hypotension - injections of Caverject can lead to increased peripheral blood levels of alprostadil, especially in patients with significant corpora cavernosa venous leakage. Avoid use in patients with known cavernosal venous leakage.

Injection site bleeding may occur in patients taking anticoagulants, such as warfarin or heparin. Compress the site of injection with an alcohol swab or sterile gauze for 5 minutes.

Cardiovascular risk related to underlying medical conditions - Underlying treatable medical causes of erectile dysfunction should be diagnosed and treated prior to initiation of therapy. 

Risks of use in combination with other vasoactive medications injected intracavernosal - Safety and efficacy of combinations of Caverject and other vasoactive agents have not been systematically studied. Use of such combinations is not recommended 

Risk of needle breakage – Caverject uses a superfine needle and cases of needle breakage have been reported. Careful instruction in proper patient handling and injection techniques may minimize this risk.

Interactions

The potential for pharmacokinetic drug-drug interactions between alprostadil and other agents administered orally or intracavernosal has not been formally studied.

Speak with your doctor or pharmacist for more information. 

Storage

Store Caverject 20 mcg vials between 68°F to 77°F. The reconstituted solution should be used within 24 hours when stored at or below 77°F and not refrigerated or frozen.

Store Caverject 40 mcg vials between 36° to 46°F until dispensed. Once dispensed, vials should be stored at or below 77°F for up to 3 months or until the expiration date, whichever occurs first. The reconstituted solution should be used within 24 hours when stored at or below 77°F and not refrigerated or frozen.

Pharmacist Tips

• The use of other medical treatments for erectile dysfunction in combination with Caverject is not recommended. Discuss any concerns you may have about combination treatment with your doctor.

Caverject FAQs

What supplies are needed?

The following supplies are needed for injection and are not supplied with Caverject: 

• 1 mL of the diluent (bacteriostatic water for injection preserved with benzyl alcohol 0.945% w/v)
• 1 mL to 3 mL syringe, dependent on the titrated dose 
• 21 to 27 gauge needle for reconstitution 
• 29 or 30 gauge one-half inch needle for injection 
• alcohol swabs

Can I take this if I am pregnant?

Caverject Impulse is not indicated for use in females.

Can I take this while breastfeeding?

Caverject Impulse is not indicated for use in females.

Who should not use Caverject?

Do not use Caverject Impulse if you have: 

• Hypersensitivity to Caverject
• Certain medical problems that might cause you to have an erection that lasts for more than 4 hours, such as sickle cell anemia, sickle cell trait, multiple myeloma, leukemia. 
• A deformed penis shape 
• A penile implant

Is Caverject an injection?

Caverject is an intracavernosal injection.

The needle is inserted perpendicular to the long dorsolateral penile axis in the proximal third of penis.

What should I do if my erection will not go away?

If you have an erection that lasts more than 4 hours, get medical help right away. If it is not treated right away, this condition can permanently damage your penis.

Related Drugs

• Caverject Impulse
• Cialis
• Edex
• Levitra
• Priligy
• Staxyn
• Stendra
• Viagra

Reference:

Caverject {package insert}. New York, NY: Pfizer Inc.; 2017.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020379s032lbl.pdf

Author: Dr. Larisa Roybal, PharmD

Dr. Roybal is a board-certified pharmacotherapy specialist who has practiced in both ambulatory and acute care settings. Her pharmacy interests include oncology and general inpatient pharmacy.