Caverject
alprostadil (intracavernosal, intraurethral)
(al-pross-ta-dil) alprostadil,Caverject
(trade name),Edex
(trade name),MUSE
(trade name)Classification
Therapeutic: erectile dysfunction agentsPharmacologic: prostaglandins
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (erection)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| Intracavernosal | 5–10 min | within 20 min | 1 hr |
| Intraurethral | 5–10 min | within 20 min | 0.5–1 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- dizziness
- headache
Cardiovascular
- hypertension
- hypotension
Genitourinary
- penile pain (most frequent)
- penile edema
- penile fibrosis
- penile rashes
- priapism
Musculoskeletal
- back pain
Respiratory
- cough
Local
- bleeding
- ecchymosis (injection)
- hematomas (injection)
- irritation
Interactions
Drug-Drug interaction
Increased risk of bleeding at site of intracavernosal injection in patients receiving anticoagulants.Should not be used with other vasoactive agents.Increased risk of bleeding at injection site with anticoagulants.Route/Dosage
Availability
Nursing implications
Nursing assessment
- Monitor for hypotension during in-clinic dosing.
Potential Nursing Diagnoses
Acute pain (Side Effects)Implementation
- Intracavernosal Injection: Reconstitute Caverject with 1 mL of bacteriostatic water with benzyl alcohol. For Caverject Impulse and Edex, follow manufacuter's instructions for reconstitution. Do not shake. Use solution immediately; do not freeze or store. Do not administer solutions that are discolored or contain precipitates. A ½-in, 27- to 30-gauge needle is used for injection. Injection must take place under sterile conditions. Injection site is usually along the dorsolateral aspect of the proximal third of the penis. Avoid visible veins. Alternate sides of the penis with each injection. Swab site with alcohol before injection. AutoInjector (PenInject 2.25) is available for self-injection.
- Intraurethral: System comes with applicator, pellet, and instructions. Store unopened foil pouches in refrigerator.
Patient/Family Teaching
- Caution patient to report priapism (erection lasting 6 hr or longer) to health care professional immediately. Priapism is a medical emergency that can result in penile tissue damage and permanent loss of potency if not treated promptly.
- Caution patient that use of alprostadil offers no protection against sexually transmitted diseases (STDs). Injection of alprostadil may cause a small amount of bleeding at injection site, increasing risk of transmission of bloodborne diseases. Advise patient to use protective measures to prevent spread of STDs, including HIV.
- Intracavernosal Injection: Instruct patient on correct technique for preparation, injection, and disposal of equipment. Caution patient not to reuse or share needle with other persons. Desirable dose is determined with first injection in physician’s office. Advise patient not to increase dose without consulting physician. Injections should be administered no more than 3 times/wk, with 24 hr between injections. Advise patient to notify physician if nodules or hard tissue in the penis; redness, swelling, or tenderness; or curvature of the erect penis occurs.
- Emphasize the importance of follow-up exams every 3 mo to assess efficacy and safety of therapy and to adjust dose as needed.
- Intraurethral: Instruct patient on proper technique for administering before self-administration. Patient should urinate before insertion. Stretch penis lengthwise and press at top and bottom. Insert the delivery device into urethra, depress button to release suppository, and hold device upright and immobile for 5 sec to help dissolve suppository. Move penis and device as a unit from side to side to help dissolve suppository and remove device. If uncomfortable or pulling sensation occurs, remove device and repeat procedure if needed. After device is withdrawn, patient should roll penis between the hands for 10 sec to further distribute suppository within walls of urethra and decrease stinging sensation. Sitting, standing, or walking for 10 min while erection is developing promotes blood flow. Patient should not exceed 2 systems in 24 hr. An erection that lasts longer than desired may be relieved by the application of an icepack alternately to each inner thigh for a period no longer than 10 min.
- Advise patient to use contraception if engaging in sexual intercourse with female of reproductive age. Use a condom if female is pregnant; effects on the fetus are unknown.
Evaluation/Desired Outcomes
- After intracavernosal injection, an erection should occur within 5–20 min and last no longer than 1 hr.
- After intraurethral administration, erection should occur within 5–10 min and last 30–60 min.