Alprostadil (intracavernosal route)

Proper Use

This medicine is given as a shot into your penis. You will receive the first dose of this medicine in your doctor's office to find out the best dose for you. You will need to stay in the doctor's office until your erection is gone.

This medicine comes with a patient information leaflet and patient instructions. Read and follow these instructions carefully. Ask your doctor if you have any questions.

If you will be using alprostadil at home, your doctor will teach you how the injections will be given. Be sure you understand exactly how the medicine is to be injected.

For the injections—There are several alprostadil products that can be injected. Although the injection method is the same, the mixing procedures are different. Be sure you know which of these products you will be using and the proper way to mix the injection.

• One product called Alprostadil for Injection (brand names Caverject® and Edex®) is available as a powder in a vial. Caverject® must be mixed with a solution called Bacteriostatic Water for Injection USP. Edex® must be mixed with a solution called Sodium Chloride Injection USP. The solution for mixing comes with your product and may be already loaded into a syringe or contained in a vial.

It is important to follow several steps to prepare your alprostadil injection correctly. Before drawing up the medicine into the syringe:

• Wash your hands with soap and water.
• Set the bottles on a clean surface. Wipe the top of the injection bottles with an alcohol swab. Do not wipe the needle. Throw away the alcohol swab.
• You may need to attach the needle to the syringe. Do not take the cap off yet.

How to mix Caverject®:

• If the syringe already contains the Bacteriostatic Water for Injection USP, then you need only add the plunger to the syringe. To do this:
  • Pick up the rod-like plunger and place it within the barrel of the syringe until it touches the rubber piece. Gently screw the plunger into the rubber piece until it seems secure. Do not use a lot of force.
  • Hold the syringe by the barrel (not the plunger) and take the cap off the needle.
  • You are now ready to mix the water and the powder. Skip to the directions under the title, “To mix the water and powder."
• If the syringe does not already contain the Bacteriostatic Water for Injection USP, you must withdraw 1 milliliter (mL) of it from the bottle provided. To do this:
  • Pick up the syringe and take the cap off the needle. Pull the plunger back to the 1-mL mark on the syringe. This pulls air into the syringe. Insert the needle into rubber top of the bottle while it is upright and inject the 1 mL of air into the bottle.
  • Turn the bottle upside down using one hand. Be sure the tip of the needle is covered by solution.
  • With your other hand, pull the plunger back slowly to withdraw 1 mL of solution into the syringe. Remove the needle and skip to the directions under the title, "To mix the water and powder."
• To mix the water and powder:
  • Insert the needle into the bottle of alprostadil and inject 1 milliliter (mL) of Bacteriostatic Water for Injection USP from your syringe into the bottle of alprostadil.
  • Remove the needle from the bottle, holding the barrel of the syringe.
  • Gently swirl the bottle to mix the powder into the solution, turning it upside down to wet all the powder in the bottle.
  • Follow the directions below, “How to draw your dose into the syringe."

How to mix Edex®:

• The syringe already contains the Sodium Chloride Injection USP. You need only attach the needle to the syringe and add the plunger. To do this:
  • Remove the needle from its package. Do not remove the needle cap. Gently screw the needle into place on the syringe tip.
  • Pick up the rod-like plunger and place it within the barrel of the syringe until it touches the rubber piece. Gently screw the plunger into the rubber piece until it seems secure. Do not use a lot of force.
  • Hold the syringe by the barrel (not the plunger) and take the cap off the needle.
  • You are now ready to mix the Sodium Chloride Injection USP and the powder.
  • Insert the needle into the bottle of alprostadil and inject 1.2 milliliters of the Sodium Chloride Injection USP from your syringe into the bottle of alprostadil.
  • Remove the needle from the bottle, holding the barrel of the syringe.
  • Gently swirl the bottle to mix the powder into the solution, turning it upside down to wet all the powder in the bottle.
  • Use the mixture within 24 hours of mixing it.
  • Follow the directions below, “How to draw your dose into the syringe."

How to draw your dose into the syringe (for all injection products):

• Check the solution to make sure it is clear. Do not use the mixture if it is cloudy, colored, or has particles.
• After the alprostadil solution is mixed and the needle is inserted into the alprostadil bottle, turn the bottle with the syringe as a unit upside down in one hand. Be sure the tip of the needle is covered by the solution. With your other hand, pull the plunger back slowly to draw the correct dose of the medicine into the syringe.
• Hold the syringe upright, push the syringe to the correct mark and check for air bubbles. To remove air bubbles, tap gently on the measuring scale of the syringe to move any bubbles to the top of the syringe near the needle.
• If your dose measures too low in the syringe, withdraw more solution from the bottle. If there is too much medicine in the syringe, put some back into the bottle. Then check your dose again.
• Remove the needle from the bottle, holding the barrel of the syringe, not the plunger.
• Place the cover back on the needle. You are now ready to inject your dose. Follow the directions below, “How to give the alprostadil injection."

How to give the alprostadil injection:

• Choose a spot on your penis as directed by your doctor where you will give the injection.
• Clean the injection site with alcohol. Sitting upright or slightly reclined, hold your penis against the side of your thigh so that it cannot move. If your penis is not circumcised, pull the foreskin back. Take hold of the tip of your penis with your thumb and forefinger.
• Remove the cover from the needle and hold the needle at a 90-degree angle to the place of injection.
• Insert the needle until almost all of the metal part of the needle is inserted into the penis.
• Do not inject the medicine just under the surface of the skin, at the top or head of the penis, or at the base of the penis near the scrotum or testes. Avoid injecting the medicine into blood vessels that you can see.
• Press the plunger down slowly, taking 5 to 10 seconds to release the dose into the penis.
• The injection is usually not painful. If the injection is very painful or if you notice bruising or swelling at the place of injection, that means you are injecting the medicine under the skin. Stop, withdraw the needle, and reposition it properly before continuing with the injection.
• Remove the needle and recap it.
• After you have completed the injection, put pressure on the place of injection for about 5 minutes or until any bleeding stops. This will prevent bruising. Then massage your penis as instructed by your doctor. This helps the medicine spread to all parts of the penis, so that the medicine will work better.

Choose a different place of injection each time you use the medicine to prevent skin problems. This includes switching the place of injection from the right side of the penis for one injection to the left side for the next injection.

After a single-use injection is mixed, the medicine must be used immediately. Throw away any unused mixture in the syringe. It cannot be stored for a later injection.

Do not reuse or share your needles or cartridges.

Never use a bent needle and never try to straighten a bent needle prior to injecting.

How to throw away the syringes and bottles safely:

Dispose of your materials properly. Caverject® comes in a plastic case that can be permanently locked with the red locking device that is included with the packaging. When the case label is removed, you can see a hole in the center of the case. The red locking device can be inserted and, by firmly pressing it down with your thumb, you will permanently lock the case. The locked case is safe to be thrown away.

This medicine usually begins to work in about 5 to 10 minutes. You should attempt intercourse within 10 to 30 minutes after using the medicine. An erection may continue after ejaculation.