alprostadil
Regulatory sources consulted
Approved indications
- Treatment and diagnostic support of erectile dysfunction.
Contraindications
Absolute
- Predisposition to priapism, anatomic penile deformity, penile implant, or a condition in which sexual activity is contraindicated; hypersensitivity.
Clinical warnings
- Major warning · An erection lasting more than 4 hours requires immediate medical care; priapism treatment must not be delayed beyond 6 hours. — CIMA/AEMPS, ficha técnica 60911
- Major warning · Perform penile examinations for fibrosis, nodules, or Peyronie disease; stop if they occur. Incorrect technique or anticoagulation increases local bleeding. — CIMA/AEMPS, ficha técnica 60911
Drug interactions
- HighOther erectile-dysfunction treatments or erection-inducing drugs
Mechanism: The combination has not been studied and may cause prolonged erection or priapism.
Recommendation: Do not combine with Caverject.
CIMA/AEMPS, ficha técnica 60911https://cima.aemps.es/cima/dochtml/ft/60911/FT_60911.html
- ModerateAnticoagulants or antiplatelets
Mechanism: They increase injection-site bleeding risk.
Recommendation: Compress the site and monitor bleeding.
CIMA/AEMPS, ficha técnica 60911https://cima.aemps.es/cima/dochtml/ft/60911/FT_60911.html
Adverse events
Common (≥1%)
Penile pain · Injection-site hematoma or bruising · Prolonged erection · Penile fibrosis
Rare but serious
Priapism · Hypotension or syncope · Severe fibrosis or Peyronie disease
Pregnancy and lactation
Not indicated in women.
Recent literature (PubMed)
Penile erection (PE) is a hemodynamic event that results from a neuroendocrine process, and it is influenced by the cardiovascular status of the patient. However, it may also modulate an individual's cardiovascular events. The present study provides the mechanisms involved in the association of PE and cardiovascular function. Erection upsurges the cardiac rate, blood pressure, and oxygen uptake. Sex-enhancing strategies, such as phosphodiesterase inhibitors, alprostadil, and testosterone also promote vasodilatation and cardiac performance, thus preventing myocardial infarction. More so, drugs that are used in the treatment of hypertensive heart diseases (such as angiotensin system inhibitors and β-blockers) facilitate vasodilatation and PE. These associations have been linked with nitric oxide- and testosterone-dependent enhancing effects on the vascular endothelium. In addition, impaired cardiovascular function may negatively impact PE; therefore, impaired PE may be a pointer to cardiovascular pathology. Hence, evaluation of the cardiovascular status of an individual with erectile dysfunction (ED) is essential. Also, employing strategies that are used in maintaining optimal cardiac function may be useful in the management of ED.
Herein, we seek to review the clinical applications of penile duplex Doppler ultrasound (PDDU) in sexual medicine practices and discuss the indications, protocols, advantages, and limitations of this diagnostic modality. Other more outdated diagnostic tests, such as cavernosometry, are briefly discussed to provide the reader a background of understanding on the evolution of diagnostic testing within the realm of sexual medicine. PDDU has become a key diagnostic tool in the clinical evaluation of both erectile dysfunction (ED) and Peyronie's disease (PD). With the assistance of intracavernosal injections such as alprostadil, clinicians can utilize ultrasound technology to produce a detailed description of the hemodynamics of the patient's erection cycle. This information plays a pivotal role in establishing an accurate diagnosis and creating a sensible management plan for the patient. This review aims to provide a better understanding regarding the technique and interpretation of PDDU as it pertains to male sexual function.
The utilization of contrast media (CM) in clinical diagnostic imaging and interventional procedures has escalated, leading to a gradual increase in the incidence of contrast-induced acute kidney injury (CI-AKI). Presently, the scarcity of effective pharmacological treatments for CI-AKI poses significant challenges to clinical management. Firstly, we explore the pathogenesis of CI-AKI in this review. Beyond renal medullary ischemia and hypoxia, oxidative stress, cellular apoptosis, and inflammation, emerging mechanisms such as ferroptosis, release of neutrophil extracellular traps (NETs), and nitrosative stress, which offer promising avenues for the management of CI-AKI, are identified. Secondly, a comprehensive strategy for the early prevention of CI-AKI is introduced. Investigating the risk factors associated with CI-AKI is essential for the timely identification of high-risk groups. Additionally, exploring early sensitive biomarkers is crucial for early diagnosis. A synergistic approach that combines these sensitive biomarkers, CI-AKI risk factors, and disease risk prediction models enhances both the accuracy and efficiency of early diagnostic processes. Finally, we explore recent pharmacological and non-pharmacological interventions for the management of Cl-AKI. Beyond the traditional focus on the antioxidant N-acetylcysteine (NAC), we look at active compounds from traditional Chinese medicine, including tetramethylpyrazine (TMP), salvianolic acid B (Sal B), as well as emerging preventive medications like N-acetylcysteine amide (NACA), alprostadil, and others, which all showed potential benefits in animal and clinical studies for CI-AKI prevention. Furthermore, innovative strategies such as calorie restriction (CR), enhanced external counterpulsation (EECP), and mesenchymal stem cell therapy are highlighted as providing fresh insights into Cl-AKI prevention and management.
Erectile dysfunction is increasingly prevalent due to lifestyle changes and increased life expectancy, significantly impacting the quality of life of patients and their partners. The 2018 American Urological Association guidelines emphasize shared decision-making, encouraging discussion of all treatment options. While many men initially choose less invasive therapies-such as oral medications, intraurethral alprostadil, or intracavernous injections-the guidelines support starting with any option, including penile prosthesis. Of note, over 25,000 penile implants are performed annually in the US. This review aims to bridge the knowledge gap by covering indications, types, imaging protocols, normal imaging appearances, and complications of penile prostheses.
Erectile dysfunction (ED) is defined as the inability to attain and/or maintain a penile erection. The first introduction of intracavernosal injection (ICI) for the treatment of erectile failure was in 1982 by Virag who reported the positive effects of papaverine on erectile tissue, followed by Brindley concurrently conducting research on ICI therapy with alpha-blockade. ICI remains a viable option for the treatment of ED, even after FDA approval of phosphodiesterase type 5 inhibitors in 1998. The American Urological Association (AUA) and the European Association of Urology (EAU) both recommend ICI as a second-line therapy for the treatment of ED. We herein provide an overview of the current state of ICI therapy for the treatment of ED. We performed a literature review from 1977-2022, using PubMed and the current AUA and EAU guidelines to discuss the current state of ICI for the treatment of ED. Although other oral agents are considered first line for the treatment of ED, the current guidelines and literature demonstrate that ICI is a safe and effective option for patients; however, careful patient selection and counseling should be performed to maximize the effectiveness and safety of this ED treatment.