Alprostadil is a synthetic prostaglandin E1 (PGE1) analog used therapeutically to manage erectile dysfunction and certain critical neonatal and adult cardiovascular conditions. As a potent vasodilator and antiplatelet agent, it mimics endogenous prostaglandin actions, offering targeted physiological benefits with well-established efficacy and safety profiles when administered under appropriate medical supervision. Its mechanisms involve direct relaxation of smooth muscle and modulation of vascular tone, making it a versatile agent across multiple clinical contexts.

Features

• Synthetic prostaglandin E1 analog with high receptor affinity
• Available in intracavernosal injection, intraurethral pellet, and intravenous formulations
• Rapid onset of action with localized or systemic effects depending on route
• Metabolized primarily within the target tissues, minimizing systemic exposure
• Compatible with specific delivery devices for precise dosing

Benefits

• Effectively induces penile erection by relaxing cavernosal smooth muscle and increasing blood flow
• Provides a non-hormonal, on-demand treatment option for erectile dysfunction
• Used in neonates to maintain patency of the ductus arteriosus until surgical correction
• Improves hemodynamics in critical limb ischemia by enhancing local blood perfusion
• May be suitable for patients who do not respond to oral phosphodiesterase inhibitors
• Offers flexibility through multiple administration routes tailored to clinical need and patient preference

Common use

Alprostadil is primarily indicated for the diagnosis and treatment of erectile dysfunction of vasculogenic, neurogenic, or mixed etiology. It is administered via intracavernosal injection or intraurethral application to facilitate erection. In neonatal intensive care, it is used to temporarily maintain patency of the ductus arteriosus in infants with congenital heart defects requiring surgery. Additionally, it is employed as a vasodilator in adults with severe peripheral arterial disease to improve microcirculation and avoid amputation in critical limb ischemia.

Dosage and direction

For erectile dysfunction, intracavernosal injection typically starts at 2.5 mcg, titrated upward in 2.5–5 mcg increments to a maximum of 60 mcg per dose, based on response and tolerability. Intraurethral pellets are administered in doses of 125–1000 mcg. In neonatal ductus arteriosus management, continuous intravenous infusion is initiated at 0.05–0.1 mcg/kg/min, adjusted to clinical response. For peripheral arterial disease, intra-arterial infusion rates are individualized. Always follow aseptic technique; rotate injection sites to avoid fibrosis. Administration should be guided by a healthcare professional until proper technique is confirmed.

Precautions

Use with caution in patients with anatomical penile deformities, bleeding disorders, or prone to priapism. Monitor for hypotension in cardiovascular applications. Avoid repeated injections at the same site to prevent fibrosis or nodules. Evaluate cardiovascular risk before use for erectile dysfunction. In neonates, monitor for apnea, bradycardia, fever, and seizures. Sterile technique is mandatory to prevent infection. Not recommended in patients with conditions that predispose to venous thrombosis.

Contraindications

Hypersensitivity to alprostadil or any component of the formulation; conditions where sexual activity is inadvisable (e.g., unstable cardiovascular disease); history of priapism; sickle cell anemia or trait; multiple myeloma; leukemia; penile implants; anatomical deformities of the penis. In neonatal use, contraindications include respiratory distress syndrome and where patency of the ductus arteriosus may be detrimental.

Possible side effect

• Penile pain, burning, or discomfort (common with intraurethral formulation)
• Prolonged erection (priapism) or hematoma at injection site
• Local urethral bleeding, dizziness, or syncope
• Hypotension, tachycardia, or flushing with systemic use
• Fever, seizures, or apnea in neonatal populations
• Fibrosis or plaques with chronic intracavernosal use

Drug interaction

Concomitant use with other vasodilators (e.g., antihypertensives, nitrates) may potentiate hypotensive effects. Anticoagulants may increase bleeding risk at injection sites. Avoid use with other agents for erectile dysfunction due to additive risk of priapism or cardiovascular effects. No clinically significant pharmacokinetic interactions are well-documented, though pharmacodynamic synergism should be anticipated.

Missed dose

Alprostadil is used on an as-needed basis for erectile dysfunction; no scheduled dosing applies. For continuous infusion in neonatal or vascular indications, interrupted therapy should be resumed promptly at the prescribed rate. Do not double the dose.

Overdose

Symptoms may include severe hypotension, syncope, persistent penile erection (priapism), or cardiovascular collapse. In case of priapism lasting more than 4 hours, seek immediate medical attention to avoid permanent tissue damage. For systemic overdose, supportive measures including fluid administration and supine positioning are indicated. Specific antidotes are not available.

Storage

Store at controlled room temperature (20–25°C). Protect from light. Do not freeze. Reconstituted or diluted solutions should be used immediately or as directed per product labeling. Keep out of reach of children and away from unauthorized use.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalized recommendations and supervision. Use only as prescribed.

Reviews

Clinical studies and post-marketing surveillance demonstrate that alprostadil is effective in approximately 70–80% of patients with erectile dysfunction when properly dosed. Neonatal use shows efficacy in maintaining ductal patency in most cases, though adverse events require careful monitoring. User reports often highlight efficacy but note local discomfort or anxiety around self-injection. Long-term adherence may be limited by injection-related concerns, though satisfaction remains high among responders.