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Alprostadil

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Mar.01.2023

Alprostadil

Indications/Dosage

Labeled

  • ductus arteriosus maintenance
  • erectile dysfunction (ED)

Off-Label

    † Off-label indication

    For ductus arteriosus maintenance to maintain patency in neonates with patent ductus-dependent congenital heart defects until palliative or corrective surgery can be performed

    Intravenous or Intra-Arterial dosage

    Infants

    0.05 to 0.1 mcg/kg/minute continuous IV or intra-arterial (umbilical) infusion, initially. After a therapeutic response is achieved (i.e., increased pO2 in infants with restricted pulmonary blood flow or increased systemic blood pressure and blood pH in infants with restricted blood flow), reduce the dose to the lowest possible dose that maintains the response. Dose may be decreased from 0.1 to 0.05 to 0.025 to 0.01 mcg/kg/minute; if response to 0.05 mcg/kg/minute is inadequate, dosage may be increased. Usual dose: 0.01 to 0.1 mcg/kg/minute.[30848] 0.01 to 0.02 mcg/kg/minute may effectively maintain patency while minimizing the risk of apnea.[63412] [64934] Max: 0.4 mcg/kg/minute; however, high infusion rates do not usually produce greater effects and have a higher incidence of adverse effects.[30848]

    Neonates

    0.05 to 0.1 mcg/kg/minute continuous IV or intra-arterial (umbilical) infusion, initially. After a therapeutic response is achieved (i.e., increased pO2 in infants with restricted pulmonary blood flow or increased systemic blood pressure and blood pH in infants with restricted blood flow), reduce the dose to the lowest possible dose that maintains the response. Dose may be decreased from 0.1 to 0.05 to 0.025 to 0.01 mcg/kg/minute; if response to 0.05 mcg/kg/minute is inadequate, dosage may be increased. Usual dose: 0.01 to 0.1 mcg/kg/minute.[30848] 0.01 to 0.02 mcg/kg/minute may effectively maintain patency while minimizing the risk of apnea.[63412] [64934] Max: 0.4 mcg/kg/minute; however, high infusion rates do not usually produce greater effects and have a higher incidence of adverse effects.[30848]

    For the treatment of erectile dysfunction (ED)

    NOTE: Alprostadil intracavernous and intraurethral options are second-line treatments for ED per guidelines.[55926]

    for erectile dysfunction due to vasculogenic, psychogenic or mixed causes

    Intracavernous dosage (Caverject injection only)

    Adults

    2.5 mcg initially, injected into the corpus cavernosa, adjusting the dosage by 2.5 mcg increments, to 5 mcg, then by 5 mcg increments according to patient response. Maximum 60 mcg/dose. Do not administer more than 3 times per week, with a minimum of 24 hours between doses.[30849] [61405]

    Intracavernous dosage (Edex injection only)

    Adults

    2.5 mcg initially, injected into the corpus cavernosa. If there is a partial response, may be increase by 2.5 mcg to 5 mcg and then in 5 to 10 mcg increments according to patient response until the dose producing an erection suitable for intercourse and not more than 1 hour in duration achieved. If there is no response to the initial 2.5 mcg dose, the second dose may be increased to 7.5 mcg, followed by increments of 5 to 10 mcg. Patient must remain in physician's office until complete detumescence occurs. If there is no response, the next higher dose may be given within 1 hour. If there is a response, wait at least a 1-day interval before giving the next dose. Do not administer more than 3 times per week, with a minimum of 24 hours between doses.[55990]

    Intraurethral dosage (urethral suppository; i.e., Muse suppository)

    Adults

    125 or 250 mcg by intraurethral insertion, initially, as a single dose as needed. Adjust the dose on separate occasions in a stepwise manner until an erection that is sufficient for sexual intercourse is achieved. Dose range: 125 to 1,000 mcg/dose. Max: 2 doses/24 hours.[30847]

    for erectile dysfunction due to neurogenic origin

    Intracavernous dosage (Caverject injection only)

    Adults

    1.25 mcg initially, injected into the corpus cavernosa, adjusting the dosage by 2.5 mcg increments, to 5 mcg, then by 5 mcg increments according to patient response. Maximum 60 mcg/dose. Do not administer more than 3 times per week, with a minimum of 24 hours between doses.[30849] [61405]

    Intracavernous dosage (Edex injection only)

    Adults

    1.25 mcg initially, injected into the corpus cavernosa. May increase by 1.25 mcg to a dose of 2.5 mcg, followed by an increment of 2.5 mcg to a dose of 5 mcg, and then in 5-mcg increments until a dose producing an erection suitable for intercourse and not more than 1 hour in duration achieved. Patient must remain in physician's office until complete detumescence occurs. If there is no response, the next higher dose may be given within 1 hour. If there is a response, wait at least a 1-day interval before the next dose is given. Do not administer more than 3 times per week, with a minimum of 24 hours between doses.[55990]

    for the treatment of ED in combination with other vasoactive agents (i.e., papaverine, phentolamine)†

    Intracavernous dosage (Triple-drug regimen)

    Adults

    Triple drug regimen dose ranges reported in literature: 0.2 to 0.4 mg phentolamine plus 8 to 16 mg papaverine plus 10 to 20 mcg alprostadil per injection.[33055] Although alprostadil monotherapy has a high efficacy rate, reaching up to 70%, triple drug therapy with alprostadil, papaverine, and phentolamine has a response rate of up to 92%. Individual dosages are determined by series of trial injections under physician supervision. Limit use to 1 injection in a 24-hour period, given no more than 3 times per week.[55926] [55992]

    Therapeutic Drug Monitoring

    Maximum Dosage Limits

    • Adults

      Dependent on indication for therapy and product prescribed.

    • Geriatric

      Dependent on indication for therapy and product prescribed.

    • Adolescents

      Safety and efficacy have not been established.

    • Children

      Safety and efficacy have not been established.

    • Infants

      Safety and efficacy have not been established.

    • Neonates

      Doses greater than 0.4 mcg/kg/minute IV of Prostin VR Pediatric are not recommended.

    Patients with Hepatic Impairment Dosing

    Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

    Patients with Renal Impairment Dosing

    Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

    † Off-label indication
    Revision Date: 03/01/2023, 03:00:47 PM

    References

    30847 - MUSE (alprostadil) urethral suppository package insert. Somerset, NJ: Meda Pharmaceuticals; 2018 Apr.30848 - Prostin VR Pediatric (alprostadil injection) package insert. New York, NY: Pharmacia and Upjohn Company.; 2022 Oct.30849 - Caverject (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.33055 - Hatzimouratidis K, Hatzichristou DG. A comparative review of the options for treatment of erectile dysfunction: Which treatment for which patient? Drugs 2005;65(12):1621-50.55926 - Montague DK, Jarow JP, Broderick GA, et al. Chapter 1: The management of erectile dysfunction: an AUA update. J Urol 2005;174:230-9.55990 - Edex (alprostadil for injection) package insert. Lake Forest, Illinois: Actient Pharmaceuticals, LLC; 2015 Mar.55992 - Shamloul R, Ghanem H. Erectile dysfunction. Lancet 2013;381:153-65.61405 - Caverject Impulse (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.63412 - Marino BS, Tabutt S, MacLaren G, et al. Cardiopulmonary resuscitation in infants and children with cardiac disease: a scientific statement from the American Heart Association. Circulation 2018;137:e691-e782.64934 - Shenoi RP, Timm N, AAP Committee on Drugs, AAP Committee on Emergency Medicine. Drugs used to treat pediatric emergencies. Pediatrics 2020;145:e20193450.

    How Supplied

    Alprostadil Powder for solution for injection

    Caverject 5mcg Powder for Injection (00009-5131) (Pfizer Inc.) (off market)

    Alprostadil Powder for solution for injection

    Caverject 5mcg Powder for Injection (00009-7212) (Pfizer Inc.) (off market)

    Alprostadil Powder for solution for injection

    Caverject 10mcg Powder for Injection (00009-3778) (Pfizer Inc.) (off market)

    Alprostadil Powder for solution for injection

    Caverject Impulse 10mcg Dual Chamber Injection System (00009-5181) (Pfizer Inc.) nullCaverject Impulse 10mcg Dual Chamber Injection System package photo

    Alprostadil Powder for solution for injection

    Edex 10mcg Powder for Injection (00091-1010) (UCB Pharma Inc) (off market)

    Alprostadil Powder for solution for injection

    edex cartridge 10mcg Powder for Injection (00091-1110) (Endo Pharmaceuticals Inc.) (off market)

    Alprostadil Powder for solution for injection

    Edex Cartridge 10mcg Powder for Injection (52244-0010) (Endo Pharmaceuticals Inc.) nullEdex Cartridge 10mcg Powder for Injection package photo

    Alprostadil Powder for solution for injection

    Edex Cartridge Refill Pack 10mcg Powder for Injection (00091-1027) (UCB Pharma Inc) (off market)

    Alprostadil Powder for solution for injection

    edex Cartridge Starter Pack 10mcg Powder for Injection (00091-1110) (UCB Pharma Inc) (off market)edex Cartridge Starter Pack 10mcg Powder for Injection package photo

    Alprostadil Powder for solution for injection

    Edex Kits 10mcg Powder for Injection (00091-1410) (UCB Pharma Inc) (off market)

    Alprostadil Powder for solution for injection

    Caverject 20mcg Powder for Injection (00009-5133) (Pfizer Inc.) (off market)Caverject 20mcg Powder for Injection package photo

    Alprostadil Powder for solution for injection

    Caverject 20mcg Powder for Injection (00009-3701) (Pfizer Inc.) nullCaverject 20mcg Powder for Injection package photo

    Alprostadil Powder for solution for injection

    Caverject Impulse 20mcg Dual Chamber Injection System (00009-5182) (Pfizer Inc.) nullCaverject Impulse 20mcg Dual Chamber Injection System package photo

    Alprostadil Powder for solution for injection

    Edex 20mcg Powder for Injection (00091-1020) (UCB Pharma Inc) (off market)

    Alprostadil Powder for solution for injection

    edex cartridge 20mcg Powder for Injection (00091-1120) (Endo Pharmaceuticals Inc.) (off market)

    Alprostadil Powder for solution for injection

    Edex Cartridge 20mcg Powder for Injection (52244-0020) (Endo Pharmaceuticals Inc.) nullEdex Cartridge 20mcg Powder for Injection package photo

    Alprostadil Powder for solution for injection

    Edex Cartridge Refill Pack 20mcg Powder for Injection (00091-1029) (UCB Pharma Inc) (off market)

    Alprostadil Powder for solution for injection

    edex Cartridge Starter Pack 20mcg Powder for Injection (00091-1120) (UCB Pharma Inc) (off market)edex Cartridge Starter Pack 20mcg Powder for Injection package photo

    Alprostadil Powder for solution for injection

    Edex Kits 20mcg Powder for Injection (00091-1420) (UCB Pharma Inc) (off market)

    Alprostadil Powder for solution for injection

    Caverject 40mcg Powder for Injection (00009-7686) (Pfizer Inc.) nullCaverject 40mcg Powder for Injection package photo

    Alprostadil Powder for solution for injection

    Edex 40mcg Powder for Injection (00091-1040) (UCB Pharma Inc) (off market)Edex 40mcg Powder for Injection package photo

    Alprostadil Powder for solution for injection

    edex cartridge 40mcg Powder for Injection (00091-1140) (Endo Pharmaceuticals Inc.) (off market)

    Alprostadil Powder for solution for injection

    Edex Cartridge 40mcg Powder for Injection (52244-0040) (Endo Pharmaceuticals Inc.) nullEdex Cartridge 40mcg Powder for Injection package photo

    Alprostadil Powder for solution for injection

    Edex Cartridge Refill Pack 40mcg Powder for Injection (00091-1032) (UCB Pharma Inc) (off market)

    Alprostadil Powder for solution for injection

    edex Cartridge Starter Pack 40mcg Powder for Injection (00091-1140) (UCB Pharma Inc) (off market)edex Cartridge Starter Pack 40mcg Powder for Injection package photo

    Alprostadil Powder for solution for injection

    Edex Kits 40mcg Powder for Injection (00091-1440) (UCB Pharma Inc) (off market)Edex Kits 40mcg Powder for Injection package photo

    Alprostadil Solution for injection

    Caverject 10mcg/ml Solution for Injection (00009-7655) (Pfizer Inc.) (off market)

    Alprostadil Solution for injection

    Caverject 20mcg/ml Solution for Injection (00009-7654) (Pfizer Inc.) (off market)

    Alprostadil Solution for injection

    Caverject 40mcg/2ml Solution for Injection (00009-7650) (Pfizer Inc.) (off market)

    Alprostadil Solution for injection [Ductus Arteriosus Patency]

    Alprostadil 500mcg/ml Solution for Injection (55390-0506) (Bedford Laboratories, a Hikma Company) (off market)Alprostadil 500mcg/ml Solution for Injection package photo

    Alprostadil Solution for injection [Ductus Arteriosus Patency]

    Alprostadil 500mcg/mL Solution for Injection (00703-1501) (Teva Pharmaceuticals USA) (off market)Alprostadil 500mcg/mL Solution for Injection package photo

    Alprostadil Solution for injection [Ductus Arteriosus Patency]

    Alprostadil 500mcg/ml Solution for Injection (NOVAPLUS) (55390-0503) (Bedford Laboratories, a Hikma Company) (off market)

    Alprostadil Solution for injection [Ductus Arteriosus Patency]

    Prostin VR Pediatric 500mcg/ml Solution for Injection (00009-3169) (Pfizer Inc.) null

    Alprostadil Solution for injection [Ductus Arteriosus Patency]

    Prostin VR Pediatric 500mcg/mL Solution for Injection (NOVAPLUS) (00009-0215) (Pfizer Inc.) null

    Alprostadil Urethral suppository

    Muse 125mcg Urethral Suppository (62541-0110) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

    Alprostadil Urethral suppository

    Muse 125mcg Urethral Suppository (00037-8110) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

    Alprostadil Urethral suppository

    Muse 125mcg Urethral Suppository (62541-0110) (Vivus Inc) (off market)Muse 125mcg Urethral Suppository package photo

    Alprostadil Urethral suppository

    Muse 250mcg Urethral Suppository (62541-0120) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

    Alprostadil Urethral suppository

    Muse 250mcg Urethral Suppository (00037-8120) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) nullMuse 250mcg Urethral Suppository package photo

    Alprostadil Urethral suppository

    Muse 250mcg Urethral Suppository (62541-0120) (Vivus Inc) (off market)Muse 250mcg Urethral Suppository package photo

    Alprostadil Urethral suppository

    Muse 500mcg Urethral Suppository (62541-0130) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

    Alprostadil Urethral suppository

    Muse 500mcg Urethral Suppository (00037-8130) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) nullMuse 500mcg Urethral Suppository package photo

    Alprostadil Urethral suppository

    Muse 500mcg Urethral Suppository (62541-0130) (Vivus Inc) (off market)Muse 500mcg Urethral Suppository package photo

    Alprostadil Urethral suppository

    Muse 1000mcg Urethral Suppository (62541-0140) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

    Alprostadil Urethral suppository

    Muse 1000mcg Urethral Suppository (00037-8140) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) nullMuse 1000mcg Urethral Suppository package photo

    Alprostadil Urethral suppository

    Muse 1000mcg Urethral Suppository (62541-0140) (Vivus Inc) (off market)Muse 1000mcg Urethral Suppository package photo

    Description/Classification

    Description

    Alprostadil is used to treat erectile dysfunction (ED) in adult males. The efficacy of alprostadil in treating ED varies with the cause; response rate is generally lower in patients with ED due to mixed etiologies compared to those with ED due to neurogenic, psychogenic, or vasculogenic causes. Two dosage forms are marketed for treating ED in adult males: a transurethral product (MUSE) which uses a medicated pellet administered into the urethra, and an injection (Caverject or Edex) that is directly injected into the corpus cavernosa. According to ED treatment guidelines, oral phosphodiesterase type 5 inhibitors (PDE5 inhibitors) are considered first-line therapy. Second-line treatment options include intracavernous injection and intraurethral therapy. Intracavernous injection therapy is the most effective nonsurgical treatment for ED, with predictable and sustained response; however, it is invasive and caries notable side effects including priapism and penile fibrosis.[55926]

     

    Alprostadil is also used for other purposes. Alprostadil and other prostaglandins in the E series are naturally present in the placenta and ductus arteriosus of the fetus. The E-type prostaglandins vasodilate arterioles by direct relaxation of vascular smooth muscle. Other pharmacologic effects include increase in cardiac output, dilation of both systemic and pulmonary vessels, dilation of the ductus arteriosus, inhibition of platelet aggregation, relaxation of bronchial muscle, increase in renal blood flow, and delay of gastric emptying time. Intravenous alprostadil is used in neonates with obstruction of right or left ventricular outflow to maintain the patency of the ductus arteriosus up until the time of corrective or palliative surgery. Alprostadil is generally more effective in those neonates with low pretreatment blood PO2 and who are 4 days old or less. In neonates older than 4 days, there is a decrease in ductal smooth muscle reactivity due to postnatal involutional changes in the wall of the ductus arteriosus.[51788] Intravenous alprostadil requires respiratory monitoring during administration because apnea develops in 10% to 12% of neonates. Intravenous alprostadil (Prostin VR Pediatric) is FDA approved in pediatric patients as young as neonates.[30848]

    Classifications

    • Cardiovascular System
      • Cardiac Therapy
        • Ductus Arteriosus Agents
          • Agents used for Maintaining a Patent Ductus Arteriosus
    • Genito-urinary System and Sex Hormones
      • Urologicals
        • Sexual Dysfunction Agents
          • Erectile Dysfunction (ED) Agents
            • Other Agents for ED
    Revision Date: 01/04/2023, 11:17:23 AM

    References

    30848 - Prostin VR Pediatric (alprostadil injection) package insert. New York, NY: Pharmacia and Upjohn Company.; 2022 Oct.51788 - American Academy of Pediatrics. Prostaglandin E and the Ductus Arteriosus. Pediatrics in Review 1985; 7(3): 75 -76.55926 - Montague DK, Jarow JP, Broderick GA, et al. Chapter 1: The management of erectile dysfunction: an AUA update. J Urol 2005;174:230-9.

    Administration Information

    General Administration Information

    For storage information, see the specific product information within the How Supplied section.

    Route-Specific Administration

    Injectable Administration

    • Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.

     

    Dilution for Intravenous or Intra-arterial Infusion

    • Dilute 1 mL (500 mcg) of the concentrate in 0.9% Sodium Chloride Injection or 5% Dextrose Injection to an approximate concentration of 2 to 20 mcg/mL.
    • When using a device with a volumetric infusion chamber, add the proper amount of diluent to the chamber first and then add the concentrate. Avoid direct contact of the concentrate with the wall of the plastic volumetric infusion chamber, which may change the appearance of the chamber and create a hazy solution. If this occurs, replace the solution and volumetric infusion chamber.[30848]
    • ASHP Recommended Standard Concentrations for Pediatric Continuous Infusions: 5 mcg/mL or 10 mcg/mL.[66173]
    • Maximum concentration should not exceed 20 mcg/mL.
    • Storage: Store diluted solution at room temperature for up to 24 hours.[30848]

    Intravenous Administration

    Continuous Intravenous Infusion

    • Infusion into a large vein is the preferred route of administration.
    • The infusion rate depends on the concentration of the final solution and the desired dosage.
    • Periodically monitor IV site; ensure reliable IV access because the duration of effect is short and a significant interruption in therapy could have serious adverse consequences.
    • Closely monitor respiratory status, cardiovascular status, and temperature during alprostadil administration. Facilities and equipment for assisted ventilation should be readily available.[30848][51814]

    Other Injectable Administration

    Intra-arterial Infusion [i.e., umbilical artery catheter (UAC) positioned at the ductal opening]

    • The infusion rate depends on the concentration of the final solution and the desired dosage.
    • Ensure reliable UAC access because the duration of alprostadil's effect is short and a significant interruption in therapy could have serious adverse consequences.
    • Flushing may be the result of an incorrectly positioned intra-arterial catheter; assess catheter placement if flushing occurs.
    • Closely monitor respiratory status, cardiovascular status, and temperature during alprostadil administration. Facilities and equipment for assisted ventilation should be readily available.[30848][51814]

     

    Intracavernous Administration

    • Discussion with the patient about expectations of alprostadil therapy is important. Therapy should be initiated under the supervision of a health care provider to test a patient's responsiveness and to demonstrate proper administration technique. Patient education can minimize the likelihood of local adverse effects associated with faulty administration technique.
    • Patient self-injection should only begin after the patient has received and reviewed a copy of the patient instructions provided by the manufacturer and has been instructed carefully and trained well about proper administration techniques. Follow-up visits with the prescribing health care provider should occur every 3 months or as clinically appropriate to assist the patient in adjusting to alprostadil therapy and assess safety and efficacy of the treatment.
    • Remind patient not to exceed dose limits. The maximum frequency of use is no more than 1 injection per 24-hour period and no more than 3 injections per week.[30849][55990][61405]

     

    Reconstitution of CAVERJECT

    • Refer to the patient information and 'Instructions for Use' in the manufacturer label for complete detailed instructions on reconstitution and needle preparation steps.
    • Ensure proper vial strength is selected for the dose to be administered (20 or 40 mcg vial).
    • Reconstitute Caverject vials by adding 1 mL of bacteriostatic water for injection to vial. (NOTE: The syringe/needle should be in a straight line with the Caverject vial when injecting the diluent into the sterile powder vial and when removing the correct dose for injection from the Caverject vial).
    • After adding the diluent but before removing the syringe from the vial, the contents of the vial should be swirled gently until a clear solution is obtained. Do not use the solution if it is cloudy, colored, or contains particles.
    • The desired dose can then be withdrawn into the same syringe.
    • Replace the needle used for reconstitution with a 29 or 30-gauge 1/2 inch needle prior to injection.
    • Storage: Unused reconstituted solution may be stored for up to 24 hours if stored below 25 degrees C (77 degrees F) and not refrigerated or frozen.[30849]

     

    Reconstitution of CAVERJECT IMPULSE

    • Refer to the patient information and "Instructions for Use' in the manufacturer label for complete detailed instructions on preparing the syringe and injection preparation steps.
    • Ensure proper Caverject Impulse syringe is selected for the dose to be administered (10 or 20 mcg syringe).
    • Prepare the injection immediately before use.
    • Open the sealed plastic tray and remove the syringe, needle assembly, and alcohol swabs. Swab the rubber membrane at the tip of the syringe.
    • Pick up the needle assembly, grasp the paper tab, and peel off the paper cover. Hold the needle assembly by the cap and press the needle assembly onto the tip of the syringe. Turn it clockwise until the needle assembly is firmly locked into place.
    • Remove the outer protective cap from the needle by twisting it clockwise. Do not remove the inner protective cap (thin plastic tube covering the needle).
    • Hold the syringe system with the needle pointing upward. The plunger rod should still be fully extended with all threads visible. Slowly rotate the plunger rod clockwise until it goes all the way in and stops. Do not push on the plunger while trying to rotate it.
    • Turn the syringe upside down several times to make sure the solution is evenly mixed. The solution should be clear. Do not use if discoloration or particles are present.
    • Holding the syringe with needle upward, carefully remove the inner protective cap from the needle. Lightly tap the glass cartridge a few times with your finger until any large bubbles disappear up into the tip. With the syringe pointed upward, push in the plunger rod until it stops to push any air out.
    • Set the dose by locating the dose window on the syringe and slowly turning the plunger rod clockwise until the correct dose number appears in the center of the window. If the correct number is passed, keep turning the plunger in the same direction until the correct number comes around again. Do not try to turn the syringe backwards. The syringe is now ready for use.
    • Storage: Unused reconstituted solution may be stored for up to 24 hours if stored between 2 degrees C and 25 degrees C (36 F to 77 F). Do not freeze.
    • Caverject Impulse is for single-use only. Properly discard the entire injection delivery system and any remaining solution after use.[61405]

     

    Reconstitution of EDEX

    • Prepare the injection immediately before use.
    • The Edex injection device is used to reconstitute the single-dose dual-chamber cartridge. Use the plunger and force the sterile 0.9% Sodium Chloride injection (1.075 mL) in one chamber into the other chamber containing alprostadil.
    • After reconstitution, the Edex injection device is used to administer the dose of alprostadil; use only with the cartridges and needles supplied in the Edex cartridge packs.
    • Do not administer unless solution is clear. Do not add any drugs or solutions to the injection solution. Discard unused drug solution. The reconstituted injection solution should not be stored.[55990]

     

    Intracavernous Injection Administration

    • Alprostadil intracavernosal injection cartridge devices are designed for one-time use. After the single-use, the injection device and remaining solution should be discarded. Of note, the needle used for administration of alprostadil solution is a superfine (27 to 30-gauge) needle; with such a fine needle, breakage is possible. Patients should be carefully instructed on proper injection technique to minimize the risk of needle breakage. Needles or syringes should not be shared.
    • The head of the penis should be held between the thumb and forefinger and stretched lengthwise along the thigh while sitting upright or slightly reclined. The needle of the syringe is then positioned so that the drug will be injected into a corpus cavernosum underneath the tunica albuginea along the dorsolateral aspect of the proximal third of the penis. Visible veins should be avoided. Blood vessels, corpus spongiosum, subcutaneous tissue, urethra, and dorsal neural vascular structures should be avoided as injection sites.
    • Once positioned, the needle of the syringe provided by the manufacturer should be pushed straight into the site using a steady motion until the metal portion of the needle is almost entirely in the penis; the dose should then be injected slowly over 5 to 10 seconds into the chosen corpus cavernosum.
    • The syringe should be withdrawn and pressure applied to the injection site with an alcohol swab for 5 minutes (or until bleeding stops) to avoid hematologic complications, especially in patients receiving concomitant anticoagulant therapy. Injection site and side of the penis should be rotated to minimize adverse effects related to repeated local injection.
    • Patient should be cautioned against use of severely bent needles and should not attempt to straighten a bent needle as this can increase the risk of breakage. Patient should also avoid reuse of syringes and needles. Give patient instructions on proper disposal of syringes and needles in the puncture-resistant container provided by the manufacturer.[30849][55990][61405]

    Other Administration Route(s)

    Intraurethral Administration

    • Alprostadil (MUSE) is administered as an urethral suppository.
    • The initial dose titration should occur under the supervision of a physician in order to test a patient's responsiveness, to demonstrate proper administration technique, and to monitor for evidence of hypotension.
    • After the patient has been instructed on proper administration technique, the alprostadil urethral suppository (MUSE) may be self-administered. Each patient MUST receive the Patient Package Insert (i.e., step-by-step patient instructions) at the initiation of therapy.
    • Remind patients not to exceed recommended dose limits. The maximum frequency of use is no more than 2 urethral suppository systems per 24-hour period.[30847]

     

    Urethral Suppository (MUSE) Administration

    • The alprostadil urethral suppository (MUSE) is designed to be self-administered after proper education and dose titration. Each patient MUST receive the Patient Package Insert which specifies proper Instructions for Use when initiating therapy.
    • For urethral insertion only. Do not administer by any other route.
    • Key administration points:
      • Immediately prior to administration, patient should urinate and gently shake the penis several times to remove excess urine. The medicated pellet has been specially developed to dissolve in the small quantity of urine that remains in the urethra after urination.
      • Carefully open the foil pouch and allow the applicator to slide out.
      • Then remove the protective cover from the applicator stem without pushing the applicator button or touching the applicator stem or tip. Save the foil pouch and cover to later discard the MUSE applicator.
      • Visually inspect the MUSE system to make sure the pellet is present.
      • To straighten the urethra, patient should, while sitting or standing, take several seconds to gently and slowly stretch the penis upward to its full length, with gentle compression from top to bottom of the glans.
      • Slowly insert the MUSE stem into the urethra up to the collar. If any discomfort or a pulling sensation occurs, withdraw the applicator slightly and then gently reinsert.
      • To administer suppository, gently and completely push down the button at the top of the applicator until it stops to ensure that the medicated pellet is completely released. The patient should then hold the applicator in this position for 5 seconds, then, gently rock the applicator from side to side in order to separate the medicated pellet from the applicator tip. Instruct the patient not to apply too much pressure in order to avoid scratching the lining of the urethra and causing it to bleed.
      • Remove applicator while keeping the penis upright.
      • Without touching the stem of the applicator, visually inspect the applicator tip to make sure the pellet is no longer in the applicator. If residual medication is present, gently reinsert into the urethra and repeat.
      • After administration, instruct patient to hold the penis upright and stretched to its full length and roll the penis firmly between the hands for at least 10 seconds to ensure that the medication is adequately distributed along the walls of the urethra. If a burning sensation is felt, the patient may continue to roll the penis for an additional 30 to 60 seconds or until the burning subsides. Then, to increase blood flow to the penis and enhance erection, the patient should sit, stand, or walk about for 10 minutes while the erection is developing.
      • Instruct patient on proper disposal of unit.[30847]

    Clinical Pharmaceutics Information

    From Trissel's 2‚Ñ¢ Clinical Pharmaceutics Database

    Alprostadil

    pH Range
    pH 5.5 (0.5 mg/50 mL D5W)
    ReferencesTrissel LA. Drug information - pH values. Data on file.
    Stability
    Alprostadil injection in intact containers stored as directed by the manufacturer is stable until the labeled expiration date. The manufacturer indicates that the lyophilized alprostadil when reconstituted is stable for 24 hours at room temperature. The manufacturer of Prostin VR Pediatric injection has indicated that the liquid concentrate is stable at room temperature of 20 degree C for 34 days and for 26 days at 30 degree C. Alprostadil has been diluted for injection, usually in sodium chloride 0.9%. Although Wei reported that alprostadil was unusually unstable diluted in sodium chloride 0.9% and stored at room temperature, that study is likely flawed. The preponderance of studies have found alprostadil when diluted in sodium chloride 0.9% to be sufficiently stable for short-term storage, especially when refrigerated. See studies below. Study 1: Gatti et al. studied the stability of alprostadil (prostaglandin E1) prepared in a physiological solution. Prostin VR injection (Upjohn) is a solution of alprostadil 0.5 mg/mL in ethanol. Prostin VR injection was aseptically diluted in an unspecified physiological solution yielding a concentration of 10 mcg/mL. The dilution was stored at about 4degree C in the dark, at ambient temperature in the dark, and at ambient temperature exposed to sunlight. HPLC analysis found that the samples stored under refrigeration exhibited about 10% loss in 30 days. The samples at ambient temperature with or without exposure to light were less stable, exhibiting 15% to 18% loss in 15 days Study 2: Fraccaro et al. reported the stability of alprostadil (Prostin VR, Upjohn) diluted to a concentration of 10 mcg/mL in sodium chloride 0.9% or in sterile water for injection, packaged in glass vials, and stored under refrigeration. HPLC analysis found less than 10% alprostadil loss occurred over 90 days at 2 to 8 degree C. The drug loss reached 13% after 120 days. Study 3: Shulman and Fyfe evaluated the shelf life of alprostadil (Prostin VR, Upjohn) diluted to 20 mcg/mL in sodium chloride 0.9% and packaged in glass ampuls. Based on decomposition rates at elevated temperatures, shelf lives for 5% drug loss were calculated to be 4.8 days at 25 degree C and 52 days at 4 degree C. Shelf lives for 10% drug loss were calculated to be 9.8 days at 25 degree C and 106 days at 4 degree C. Study 4 (Knoxville Formula- Three Drugs): Trissel and Zhang evaluated the stability of a three-drug mixture of alprostadil (prostaglandin E1) 12.5 mcg/mL, papaverine hydrochloride 4.5 mg/mL, and phentolamine mesylate 0.125 mg/mL (commonly called the "Knoxville Formula") prepared from commercial injections diluted in bacteriostatic sodium chloride 0.9%. The injection mixture was packaged in commercial empty sterile vials and stored at room temperature near 23degree C, refrigerated at 4degree C, and frozen at -20 degree C and -70degree C. All of the samples remained clear and colorless throughout the study. Stability indicating HPLC analysis found that alprostadil was the least stable of the three drug components and was the limiting factor in the combination injection. At room temperature, alprostadil losses of 8% and 13% occurred in five and seven days, respectively. Under refrigeration, losses of about 6% in one month and 11% in two months occurred. Frozen at -20degree C and -70degree C, alprostadil losses did not exceed 5% in six months. Subjecting vials frozen at -20degree C to four freeze-thaw cycles warming the vials to room temperature each time resulted in no loss of any drug. The authors recommended a beyond use date of six months and one month stored frozen at -20degree C or under refrigeration, respectively, for batches that have passed a sterility test. They also recommended that room temperature exposure be limited, and vials should be returned to refrigeration as soon as possible after use. Packaged in Syringes: Study 5: Priano et al. reported the stability of alprostadil undiluted (500 mcg/mL) and diluted 1:2 (250 mcg/mL) and 1:4 (125 mcg/mL) with sodium chloride 0.9% and packaged in 1-mL Plastipak polypropylene syringes. HPLC analysis found 5% or less alprostadil loss occurred in 30 days at 4 degree C. Study 6: Uebel et al. evaluated the stability of alprostadil (prostaglandin E1) diluted in normal saline. Prostin VR injection (Pharmacia and Upjohn) was diluted to a concentration of 40 mcg/mL in sodium chloride 0.9% and packaged as 0.5 mL of the dilution in polypropylene plastic syringes. HPLC analysis found less than 10% drug loss occurred in 6 weeks stored at room temperature near 21 degree C and in 24 weeks refrigerated at 5 degree C.
    ReferencesAnon. Manufacturer's information and labeling. (Package insert).
    ReferencesCohen V, Jellinek SP, Teperikidis L, et al. Room-temperature storage of medications labeled for refrigeration. Am J Health-Syst Pharm. 2007; 64
    ReferencesFraccaro A, Grion AM, Gaion RM, et al. Prostaglandin E1 diluted solution: preparation technique and stability evaluation. Int J Impotence Res. 1993; 5
    ReferencesGatti R, Gotti R, Cavrini V, et al. Stability study of prostaglandin E1 (PGE1) in physiological solutions by liquid chromatography (HPLC). Int J Pharm. 1995; 115
    ReferencesPriano RM, Hocht C, Oyola E, et al. Estabilidad de prostaglandina E1 fraccionada en jeringas de polipropileno. Farm Hosp. 2003; 27
    ReferencesShulman NH, Fyfe RK. Shelf-life determination of prostaglandin E1 injections. J Clin Pharm Ther. 1995; 20
    ReferencesTrissel LA, Zhang Y. Long-term stability of trimix: a three-drug injection used to treat erectile dysfunction. Int J Pharmaceut Compound. 2004; 8
    ReferencesUebel RA, Wium CA, Schmidt AC. Stability evaluation of a prostaglandin E1 saline solution packed in insulin syringes. Int J Impotence Res. 2001; 13
    ReferencesWei M. Study on the stability and compatibility of alprostadil for injection. Zhongguo Yaoshi. 2008; 11
    pH Effects
    Younger and Szabo reported that Upjohn alprostadil exhibited much greater stability in normal saline at pH values near 4.5 than at a buffered pH of 7.4. In test solutions at pH 4.5 and 7.4, losses of 25% and 95%, respectively, occurred at in 32 days stored at 37 degree C. Paul et al. also reported that the stability of alprostadil was greater at lower pH values. In their study the pH of maximum stability was found to be pH 3 and was much less at neutral pH.
    ReferencesPaul M, Razouq N, Tixier G, et al. Stability of prostaglandin E1 (PGE1) in aqueous solutions. Eur J Hosp Pharm Sci. 2005; 11
    ReferencesYounger EW, Szabo RM. The stability of prostaglandin E1 in dilute physiological solutions at 37 degrees C. Prostaglandins. 1986; 31
    Light Exposure
    Paul et al. reported that alprostadil 20 mcg/mL in sodium chloride 0.9% stored at room temperature of 20 degree C for 196 days exhibited no increase in drug degradation when exposed to ambient light compared to identical solutions protected from light.
    ReferencesPaul M, Razouq N, Tixier G, et al. Stability of prostaglandin E1 (PGE1) in aqueous solutions. Eur J Hosp Pharm Sci. 2005; 11
    Sorption Leaching
    Sorption: Priano et al. and Uebel et al. reported little loss of alprostadil by HPLC analysis both as the undiluted injection and diluted in sodium chloride 0.9% when packaged in Plastipak polypropylene syringes. Leaching: Shulman and Fyfe reported that alprostadil (Prostin VR, Upjohn) 20 mcg/mL in sodium chloride 0.9% stored in plastic syringes leached materials, probably from the plastic and the plunger head, that did not appear when the solution was stored in glass containers. Kawano et al. demonstrated that an emulsion formulation of alprostadil available outside the United States containing soybean oil and lecithin as a surfactant leached substantial amounts of diethylhexyl phthalate (DEHP) plasticizer from polyvinyl chloride (PVC) plastic containers and administration sets. An alprostadil 0.5-mcg/mL solution stored in PVC bags for 24 hours leached DEHP 20.5 mcg/mL.
    ReferencesAnon. Manufacturer's information and labeling. (Package insert).
    ReferencesKawano K, Matsunaga A, Nakajima S. The leaching of plasticizer from a polyvinyl chloride container or a parenteral infusion set into the intravenous alprostadil solution. Jpn J Hosp Pharm. 1993; 19
    ReferencesPriano RM, Hocht C, Oyola E, et al. Estabilidad de prostaglandina E1 fraccionada en jeringas de polipropileno. Farm Hosp. 2003; 27
    ReferencesShulman NH, Fyfe RK. Shelf-life determination of prostaglandin E1 injections. J Clin Pharm Ther. 1995; 20
    ReferencesUebel RA, Wium CA, Schmidt AC. Stability evaluation of a prostaglandin E1 saline solution packed in insulin syringes. Int J Impotence Res. 2001; 13
    Other Information
    Interaction with Plastic: The undiluted alprostadil concentrate in dehydrated alcohol will interact with plastic volumetric infusion chambers changing their appearance and making the alprostadil solution hazy. The manufacturer recommends adding the infusion fluid to the volumetric chamber first with the alprostadil concentrate added into the solution avoiding the chamber walls to dilute the concentrate.
    ReferencesAnon. Manufacturer's information and labeling. (Package insert).
    Stability Max
    Maximum reported stability periods: In D5W- 24 hours at room temperature In NS- 9 days at room temperature and 106 days refrigerated
    ReferencesAnon. Manufacturer's information and labeling. (Package insert).
    ReferencesShulman NH, Fyfe RK. Shelf-life determination of prostaglandin E1 injections. J Clin Pharm Ther. 1995; 20
    Revision Date: 12/29/2022, 10:44:59 AMCopyright 2004-2024 by Lawrence A. Trissel. All Rights Reserved.

    References

    30847 - MUSE (alprostadil) urethral suppository package insert. Somerset, NJ: Meda Pharmaceuticals; 2018 Apr.30848 - Prostin VR Pediatric (alprostadil injection) package insert. New York, NY: Pharmacia and Upjohn Company.; 2022 Oct.30849 - Caverject (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.51814 - Heymann MA, Clyman RI. Evaluation of alprostadil in the management of congenital heart disease in infancy. Pharmacotherapy 1982; 2: 148-155.55990 - Edex (alprostadil for injection) package insert. Lake Forest, Illinois: Actient Pharmaceuticals, LLC; 2015 Mar.61405 - Caverject Impulse (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.66173 - American Society of Health-System Pharmacists. Standardize 4 Safety Initiative, Pediatric Continuous Infusion Standards. Retrieved December 15th, 2020. Available at: https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/Pediatric-Infusion-Standards.ashx

    Adverse Reactions

    Severe

    • anuria
    • apnea
    • bradycardia
    • cardiac arrest
    • disseminated intravascular coagulation (DIC)
    • heart failure
    • hyperkalemia
    • myocardial infarction
    • penile edema
    • phimosis
    • seizures
    • ventricular fibrillation
    • visual impairment

    Mild

    • back pain
    • diaphoresis
    • diarrhea
    • dizziness
    • ecchymosis
    • fever
    • flushing
    • gastroesophageal reflux
    • headache
    • hypoesthesia
    • hypothermia
    • increased urinary frequency
    • injection site reaction
    • irritability
    • lethargy
    • muscle cramps
    • mydriasis
    • nausea
    • perineal pain
    • pruritus
    • rash
    • rhinitis
    • syncope
    • testicular pain
    • urinary urgency
    • vaginal irritation
    • weakness
    • xerostomia

    Moderate

    • anemia
    • bleeding
    • edema
    • erythema
    • hematoma
    • hematuria
    • hyperbilirubinemia
    • hypercholesterolemia
    • hyperemia
    • hyperglycemia
    • hypertension
    • hypertriglyceridemia
    • hypoglycemia
    • hypotension
    • penile fibrosis
    • penile pain
    • peripheral edema
    • peripheral vasodilation
    • priapism
    • respiratory depression
    • sinus tachycardia
    • supraventricular tachycardia (SVT)
    • tachypnea
    • thrombocytopenia
    • urethral pain
    • urinary retention
    • wheezing

    Central nervous system adverse reactions of alprostadil are reported more frequently after intravenous administration (i.e., when used for ductus arteriosus maintenance). Apnea has been reported in approximately 10% to 12% of neonates and infants with congenital heart defects treated with alprostadil and was most seen in neonates weighing less than 2 kg at birth. Apnea usually occurred during the first hour of drug infusion. Other respiratory adverse reactions occurring in less than 1% of patients include bradypnea, bronchial wheezing, hypercapnia, respiratory depression, respiratory distress, and tachypnea. Other common adverse reactions include fever (14%) and seizures (4%). The following adverse reactions have been reported in less than 1% of patients receiving IV alprostadil: cerebral bleeding, hyperextension of the neck, irritability (reported as hyperirritability), hypothermia, jitteriness, lethargy, and stiffness.[30848]

    Cardiovascular adverse effects have been reported with alprostadil. Alprostadil associated hypotension has been reported following use for treatment of erectile dysfunction, as well as with intravenous use in neonates.[30847] [30848] [30849] [55990] Specifically, transurethral administration causes approximately 3% of male adult patients to develop symptomatic hypotension; clinically insignificant hypotension may also occur; intracavernosal injection causes hypotension in less than 1% of male adult patients and is considered clinically insignificant.[30847] [30849] [55990] Intracavernosal alprostadil can also result in hypertension (reported in 2% of patients).[30849] [55990] In male adult patients receiving alprostadil transurethral suppositories, approximately 2% to 4% reported dizziness, and less than 2% reported sinus tachycardia, and 0.4% had syncope.[30847] Dizziness (1%), peripheral vasodilation (less than 1%), and supraventricular extrasystoles (less than 1%) have also been reported with alprostadil intracavernous injection.[30849] [55990] During postmarketing surveillance, syncope occurring within 1 hour of administration has been reported.[30847] Additionally, myocardial infarction and abnormal ECG have been reported in 1% of adult male patients treated with intracavernous alprostadil.[55990] In neonates receiving intravenous infusions of alprostadil (i.e., for ductus arteriosus maintenance), flushing (10%), sinus bradycardia (7%), hypotension (4%), sinus tachycardia (3%), cardiac arrest (1%), and edema (1%) were the most common cardiovascular adverse reactions. Other cardiovascular adverse reactions reported in less than 1% neonates receiving intravenous infusions of alprostadil include congestive heart failure, hyperemia, second degree heart block, shock, spasm of the right ventricle infundibulum, supraventricular tachycardia (SVT), and ventricular fibrillation.[30848]

    Local adverse reactions associated with alprostadil used for treating erectile dysfunction were usually mild and transient; however, approximately 7% of patients withdrew from therapy because of adverse reactions. The most frequent local adverse reactions reported with the use of alprostadil urethral suppository include penile pain (32% to 36%), urethral pain (12% to 13%), and testicular pain (5%). Urethral bleeding or spotting and other minor abrasions to the urethra were reported in approximately 3% to 5% of patients. In clinical trials of alprostadil urethral suppository, priapism (rigid erection lasting 6 hours or longer) and prolonged erection (rigid erection lasting between 4 hours to under 6 hours) were reported in less than 0.1% and 0.3% of patients, respectively.[30847] The most common local adverse reactions reported with alprostadil administered by intracavernosal injection include penile pain (29% to 37%), penile fibrosis (3% to 5%), injection site reaction (local bleeding (15%), hematoma (3% to 5%), ecchymosis (2% to 4%), erythema (2%)), penis disorder (numbness, yeast infection, phimosis, irritation, sensitivity, pruritus, erythema, discoloration of penile head, penile skin tear, abnormal feeling of penis) (3%), penile rash (1%), penile edema (1%), penile angulation (1%), and testicular pain (1%). Most cases of hematoma and ecchymosis were due to faulty injection technique. Prolonged erection and priapism were reported in 4% and less than 1% of patients, respectively, following intracavernosal injection. This incidence of priapism is reportedly less than that of combined phentolamine and papaverine or papaverine alone. The patient should be instructed to seek immediate medical assistance for any erection that persists for longer than 4 hours. If not treated immediately, penile tissue damage and permanent loss of potency may result. Systemic adverse reactions of alprostadil associated with intracavernosal or transurethral administration (i.e., when used for erectile dysfunction) include headache (2% to 3%), mydriasis (less than 1%), visual impairment (1%), back pain (1% to 2%), leg or muscle cramps (less than 1%), flu-like symptoms (2% to 4%), inguinal hernia (1%), pelvic pain (2%), peripheral edema, perineal pain (less than 2%), swelling of leg veins (less than 2%), leg pain (less than 2%), prostatic disorder (prostatitis, pain, hypertrophy, enlargement; 1% to 2%), respiratory disorder such as rhinitis (2%), sinusitis (1% to 2%), nasal congestion (1%), upper respiratory infection (3% to 5%), or cough (1%), and accidental injury (3%).[30847] [30849] [55990] Alprostadil injection uses a superfine needle for administration. As with all superfine needles, the possibility of needle breakage exists. Careful instruction in proper patient handling and injection techniques may minimize the potential for needle breakage. If needle breakage occurs upon injection into the tissue, the patient should seek medical assistance to help avoid local trauma or injury. Cases of needle breakage, with a portion of the needle remaining in the penis, have been reported with postmarketing use. In some cases, hospitalization and surgical removal were required.[30849] [55990] [61405]

    Disseminated intravascular coagulation (DIC) has been reported in approximately 1% of neonatal patients receiving intravenous administration of alprostadil (i.e., for ductus arteriosus maintenance). In addition, anemia, bleeding, and thrombocytopenia have been reported in less than 1%, and sepsis reported in about 2%, of neonatal patients receiving intravenous administration of alprostadil.[30848]

    Female partners of men using alprostadil urethral suppository (i.e., when used for erectile dysfunction) have reported adverse reactions. Vaginal irritation (i.e., vaginal burning or itching) was reported by 5.8% of female partners of patients on active vs 0.8% of partners of patients on placebo. It is unknown if these adverse reactions in female partners were a result of the medication or a result of resuming sexual intercourse.[30847]

    Gastrointestinal adverse reactions have been reported following intravenous administration of alprostadil (i.e., when used for ductus arteriosus maintenance). Diarrhea occurred in about 2% of treated neonates and gastric regurgitation (gastroesophageal reflux), hyperbilirubinemia, and peritonitis were reported in less than 1% of neonatal patients.[30848] Nausea and dry mouth (xerostomia) were reported in less than 1% of patients treated with alprostadil intracavernous injection (i.e., used for the treatment of erectile dysfunction) in clinical trials.[30849]

    Hypoesthesia, generalized weakness, diaphoresis, rash, and non-application site pruritus were reported in less than 1% of male patients treated with alprostadil intracavernous injection (for the treatment of erectile dysfunction) in clinical trials.[30849]

    Urinary adverse reactions reported in less than 1% of male adult patients treated with alprostadil intracavernous injection for erectile dysfunction (ED) in clinical trials include impaired urination or urinary retention, increased urinary frequency, urinary urgency, and increased serum creatinine. The use of the alprostadil transurethral system requires proper patient instructions for use; some adults with ED have reported confusion about how to properly use the system and this sometimes leading to urethral hemorrhage (urinary bleeding and hematuria).[30847] [30849] [55990] [61405] Hematuria and anuria were reported in less than 1% of neonatal patients following intravenous administration of alprostadil when used for ductus arteriosus maintenance.[30848]

    Hypertriglyceridemia (2%), hypercholesterolemia (1%), and hyperglycemia (1%) have been reported with alprostadil intracavernous injection (for erectile dysfunction) in adult males treated during clinical trials.[55990] Hypoglycemia and hyperkalemia were reported in less than 1% of neonatal patients following intravenous administration of alprostadil (i.e., when used for ductus arteriosus maintenance).[30848]

    Revision Date: 01/03/2023, 04:34:31 PM

    References

    30847 - MUSE (alprostadil) urethral suppository package insert. Somerset, NJ: Meda Pharmaceuticals; 2018 Apr.30848 - Prostin VR Pediatric (alprostadil injection) package insert. New York, NY: Pharmacia and Upjohn Company.; 2022 Oct.30849 - Caverject (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.55990 - Edex (alprostadil for injection) package insert. Lake Forest, Illinois: Actient Pharmaceuticals, LLC; 2015 Mar.61405 - Caverject Impulse (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.

    Contraindications/Precautions

    Absolute contraindications are italicized.

    • balanitis
    • children
    • females
    • hypospadia
    • infants
    • leukemia
    • multiple myeloma
    • neonates
    • penile implants
    • penile structural abnormality
    • Peyronie's disease
    • polycythemia
    • pregnancy
    • sickle cell disease
    • thrombocytosis
    • urethral stricture
    • urethritis
    • anticoagulant therapy
    • apnea
    • benzyl alcohol hypersensitivity
    • bleeding
    • breast-feeding
    • cardiac disease
    • coagulopathy
    • contraception requirements
    • driving or operating machinery
    • geriatric
    • GI obstruction
    • hypotension
    • labor
    • premature neonates
    • priapism
    • renal impairment
    • requires a specialized care setting
    • respiratory depression
    • respiratory distress syndrome
    • sexually transmitted disease
    • syncope

    Post-mortem tissue sections of the ductus and pulmonary arteries from infants treated with alprostadil infusions at the usual doses for 10 hours to 12 days and who died of causes unrelated to ductus structural weakness have shown intimal lacerations, a decrease in medial muscularity and disruption of the medial and internal elastic lamina. Localized and aneurysmal dilatations and vessel wall edema also were noted. The incidence and clinical implications of these structural alterations has not been defined.[30848]

    Always select the proper product (e.g., Prostin VR injection) for administration of alprostadil to pediatric patients.[30848] Given the indications for use for adult male erectile dysfunction, alprostadil intracavernosal injection (e.g., Caverject, Edex) and urethral suppository (e.g., MUSE) are contraindicated for use in children under the age of 18 years, infants, and neonates. Intracavernosal injections of alprostadil are not indicated for infants or neonates and should not be substituted for intravenous alprostadil injection in these populations.[30847] [30849] [55990] [61405] Some alprostadil intracavernosal injection products (e.g., Caverject and Caverject Impulse) contain the preservative benzyl alcohol, which can cause adverse effects in neonates or in patients with a benzyl alcohol hypersensitivity. The preservative has been associated with reports of fatal 'gasping syndrome' in neonates; symptoms include a striking onset of gasping respiration, CNS depression, and metabolic acidosis. The minimum amount of benzyl alcohol at which toxicity may occur is not known. The risk of benzyl alcohol toxicity depends on the quantity administered and the hepatic and renal capacity to detoxify the chemical. Premature and low-birth weight infants may be more likely to develop toxicity.[30849] [61405]

    Apnea is experienced by approximately 10% to 12% of neonates and infants with congenital heart disease defects treated with intravenous alprostadil. Apnea is most often seen in premature neonates weighing less than 2 kg at birth and usually occurs during the first hour of drug infusion. Respiratory status should be monitored throughout treatment and neonatal use of alprostadil requires a specialized care setting and should only be undertaken where ventilatory assistance is immediately available. Alprostadil should be used cautiously in neonates and infants with respiratory depression.[30848]

    The intravenous administration of alprostadil to neonates may result in GI obstruction secondary to antral hyperplasia. Duration of therapy and the accumulation of the drug appears to be related to this adverse effect. Careful monitoring is recommended in neonates receiving alprostadil for greater than 120 hours. Alprostadil should be administered at the lowest effective dose and for the shortest length of time. The risks of prolonged infusion should be weighed against the potential benefits to the infant.[30848]

    Alprostadil intravenous infusions should not be used in neonates with neonatal respiratory distress syndrome. In these neonates, the ductus arteriosus must close in order to prevent overload of the pulmonary circulation. A differential diagnosis between neonatal respiratory distress syndrome and cyanotic heart disease (restricted pulmonary blood flow) should be made prior to initiating alprostadil therapy. If full diagnostic facilities are not immediately available, cyanosis (pO2 less than 40 torr) and restricted pulmonary blood flow apparent on an X-ray are appropriate indicators of congenital heart defects.[30848]

    Alprostadil injection for the maintenance of patency of the ductus arteriosus may cause hypotension; neonates and infants receiving an alprostadil infusion should be carefully monitored for a drop in blood pressure. Arterial pressure should be monitored periodically via umbilical artery catheter, auscultation, or Doppler transducer. If arterial pressure falls significantly, decrease the rate of the infusion immediately.[30848] Alprostadil for the management of erectile dysfunction (ED) should be used cautiously in adults with cardiac disease. There is a potential for cardiac risk during sexual activity in those with preexisting cardiovascular disease. Medications for ED generally should not be used in men for whom sexual activity is inadvisable because of their underlying cardiovascular status. Increased peripheral blood levels of alprostadil and its metabolites, especially in those patients with significant corpora cavernosa venous leakage, may lead to hypotension and/or dizziness, and very rarely syncope. Monitor treated adults for symptoms of hypotension; prescribe the lowest effective dose for ED. The use of other vasoactive substances with alprostadil for ED may increase hypotensive risk and is not advised. Treated adults should use caution with driving or operating machinery, or other hazardous tasks, where injury could result if hypotension or syncope were to occur directly after alprostadil administration.[30847] [30849] [55990] [61405]

    Alprostadil inhibits platelet aggregation and therefore can increase the risk of bleeding. Use intravenous alprostadil cautiously in patients with bleeding tendencies or receiving anticoagulant therapy. Additionally, caution should be used in patients at risk of coagulopathy.[30848] Alprostadil products for erectile dysfunction (ED) should be used cautiously in men with a coagulopathy, known bleeding disorder, or in those men receiving anticoagulant therapy. Patients on anticoagulants may have increased propensity for bleeding after intracavernous injection, so proper adherence to administration technique is important to avoid hematoma or other bleeding. A small amount of bleeding may occur in any male at the site of intracavernous administration and may increase the transmission of blood-borne diseases to a sexual partner.[30849] [55990] Improper administration of the alprostadil urethral suppository may cause urethral abrasion resulting in minor bleeding or spotting. Although patients on anticoagulant therapy have been treated safely with the urethral suppository, the manufacturer recommends that the risk/benefit ratio in these patients be considered prior to prescribing.[30847]

    Any underlying and treatable medical cause for erectile dysfunction should be diagnosed and treated before therapy with alprostadil intracavernosal injection or urethral suppository is initiated.[30847] [30849] [55990] [61405] The use of alprostadil intracavernosal injection or urethral suppository is contraindicated in men with penile structural abnormality. The intracavernosal injection is specifically contraindicated in patients with penile angulation, cavernosal fibrosis, or Peyronie's disease. The urethral suppository is contraindicated in men with urethral stricture, balanitis, Peyronie's disease, severe hypospadia and curvature, or acute or chronic urethritis. The use of alprostadil in patients with penile implants is also contraindicated and has not been studied. Both of these products are contraindicated in patients for whom sexual intercourse is inadvisable or contraindicated. In addition, there is no experience of using alprostadil in homosexual men and no experience with non-vaginal intercourse.[30847] [30849] [55990] [61405]

    The use of alprostadil intracavernosal injection or urethral suppository is contraindicated in patients who are prone to venous thrombosis or who have a hyperviscosity syndrome and are therefore at increased risk of priapism. This includes patients with sickle cell disease or trait, thrombocytosis, polycythemia, leukemia, or multiple myeloma. Prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours in duration) have been associated with administration of drugs for the treatment of erectile dysfunction, including alprostadil. Priapism, if not treated promptly, can result in irreversible damage to the erectile tissue. Men who have an erection lasting 4 hours or greater, whether painful or not, should seek emergency medical attention. Lower dosages or discontinuation of treatment should be considered in patients who develop priapism or prolonged erection.[30847] [30849] [55990] [61405]

    Safety concerns in geriatric adults versus use in younger adults were not evident based on age alone during clinical trials of alprostadil for erectile dysfunction. Geriatric adults should be dosed and titrated according to the usual recommendations, using the lowest effective dosage. Alprostadil is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in those with renal impairment. Because older adults are more likely to have decreased renal function or underlying cardiac disease, care should be taken in dose selection and titration, and it may be useful to monitor renal function.[30847] [30849] [61405] [55990]

    Given the indications for use, alprostadil dosage forms for erectile dysfunction (ED) are not to be used in females or during pregnancy. There is no information on the effects on early pregnancy of prostaglandin E1 (PGE1) at the levels received by female partners via the semen of an alprostadil-treated partner. Prostaglandins generally promote uterine contractions, and exposure to prostaglandins during pregnancy may induce uterine contractions and labor. Animal data report embryotoxic effects when alprostadil was given as a subcutaneous bolus, however, no developmental harm was reported when the drug was given intravaginally.[30847] [30849] [55990] Recommended contraception requirements for adults using alprostadil urethral suppositories for ED are available. Alprostadil urethral suppository should not be used by males for sexual intercourse with a pregnant partner unless the couple uses a condom barrier.[30847] All couples using alprostadil urethral suppositories for ED are recommended to employ adequate contraception if a partner is of childbearing potential.[30847] Use of alprostadil for the treatment of erectile dysfunction (ED) offers no protection against the transmission of blood-borne or sexually transmitted disease.[30847] [30849] [61405] [55990]

    Given the indications for use, alprostadil would not be expected to be used during lactation. Use in the lactating female during breast-feeding is not indicated.[30847] [30848] [30849] [55990] [61405]

    Revision Date: 01/04/2023, 12:21:39 PM

    References

    30847 - MUSE (alprostadil) urethral suppository package insert. Somerset, NJ: Meda Pharmaceuticals; 2018 Apr.30848 - Prostin VR Pediatric (alprostadil injection) package insert. New York, NY: Pharmacia and Upjohn Company.; 2022 Oct.30849 - Caverject (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.55990 - Edex (alprostadil for injection) package insert. Lake Forest, Illinois: Actient Pharmaceuticals, LLC; 2015 Mar.61405 - Caverject Impulse (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.

    Mechanism of Action

    Alprostadil is a smooth muscle relaxant. For the treatment of erectile dysfunction (ED), alprostadil binds to specific receptors in human penile tissue, which causes an increase in intracellular cAMP. Human cavernosus smooth muscle cells respond to alprostadil by releasing intracellular calcium into the surrounding medium. Smooth muscle relaxation accompanies the reduction in cytoplasmic free calcium concentration. Alprostadil also attenuates presynaptic noradrenaline release in the corpus cavernosum which is essential for the maintenance of a flaccid and non-erect penis. An erection is induced by relaxing trabecular smooth muscle and dilating cavernosal arteries. Dilation of the cavernosal arteries is accompanied by increased arterial inflow velocity and increased venous outflow resistance. As a result, the lacunar spaces expand and blood becomes entrapped secondary to compression of venules against the tunica albuginea. This process is also referred to as the corporal veno-occlusive mechanism.[30847][30849][55990]

     

    Alprostadil (prostaglandin E1) is one of a family of naturally occurring acidic lipids with various pharmacologic effects. Vasodilation, inhibition of platelet aggregation, and stimulation of intestinal and uterine smooth muscle are among the most notable of these effects. In the treatment of ductus arteriosus-dependent congenital heart defects, alprostadil maintains ductal patency by relaxing the smooth muscles of the ductus arteriosus. Alprostadil is only effective if given prior to complete anatomic closure of the ductus arteriosus. Administration of alprostadil to neonates with cyanotic congenital heart defects (restricted pulmonary blood flow) results in an increase in pulmonary blood flow and/or increase in mixing between the systemic and pulmonary circulation which leads to a temporary increase in arterial oxygen partial pressure (PO2) and oxygen saturation. The response of the cyanotic neonate to alprostadil therapy is also inversely related to pretreatment PO2. The greatest response appears to be in those neonates with low pretreatment PO2 (less than 20 torr), narrowing ductus arteriosus, and who are 4 days old or younger. Neonates with PO2 values of 40 torr or more usually have little response to alprostadil.[30848] In neonates with restricted systemic blood flow, administration of alprostadil can result in prevention or correction of acidemia, increased cardiac output with increased systemic blood pressure, increased femoral pulse volume, increased renal blood flow and function, decreased gradient of descending to ascending aortic blood pressures (in neonates with coarctation of the aorta), and/or decreased ratio of pulmonary artery pressure to descending aortic pressure (in neonates with interruption of the aortic arch). Unlike in cyanotic neonates, the efficacy of alprostadil in acyanotic neonates does not depend on age or pretreatment PO2.[30848][51806]

    Revision Date: 08/09/2021, 07:50:13 PM

    References

    30847 - MUSE (alprostadil) urethral suppository package insert. Somerset, NJ: Meda Pharmaceuticals; 2018 Apr.30848 - Prostin VR Pediatric (alprostadil injection) package insert. New York, NY: Pharmacia and Upjohn Company.; 2022 Oct.30849 - Caverject (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.51806 - Heymann MA and Clyman RI. Evaluation of Alprostadil (Prostaglandin E1) in the Management of Congenital Heart Disease in Infancy. Pharmacotherapy 1982; 2: 148-155.55990 - Edex (alprostadil for injection) package insert. Lake Forest, Illinois: Actient Pharmaceuticals, LLC; 2015 Mar.

    Pharmacokinetics

    Alprostadil is administered by intravenous infusion, intracavernosal injection, or via an urethral suppository.[30847][30848][30849][55990] Once in the systemic circulation, alprostadil is bound primarily to albumin (81%). No significant binding to erythrocytes or white blood cells occurs.[30849] Alprostadil is completely metabolized in the lung to several metabolites with a first-pass pulmonary elimination of 60% to 90% of PGE1. The main metabolites (15-keto-PGE1, 15-keto-PGE0, and PGE0) are primarily excreted in the urine (88%) and feces (12%) over 72 hours; total excretion is essentially complete within 24 hours after administration. The terminal half-life of PGE1 is approximately 9 to 11 minutes.[55990]

    Route-Specific Pharmacokinetics

    Intravenous Route

    Intravenous administration of alprostadil requires a continuous infusion of the drug because approximately 80% of the dose is metabolized in one pass through the lungs, mostly by beta- and omega-oxidation. There is no evidence of tissue retention of alprostadil or its metabolites following IV administration.

    Other Route(s)

    Intracavernosal Route

    After intracavernosal administration, minimal systemic absorption occurs. After intracavernous injection of 20 mcg of alprostadil, peak concentrations of 16.8 +/- 18.9 pg/mL were reached within 2 to 5 minutes and decreased to endogenous plasma levels within 2 hours. The absolute bioavailability estimated from systemic exposure was 98% as compared to the same dose given by short-term IV infusion. Any alprostadil absorbed by the intracavernous route is rapidly metabolized in the lungs. After intracavernous injection of 20 mcg of alprostadil, terminal half-lives of 15-keto-PGE0 and PGE0 were 40.9 +/- 16.5 minutes and 63.2 +/- 31.1 minutes, respectively.[55990] Following intracavernosal administration, erection usually occurs within 5 to 20 minutes and may last for about 1 to several hours. Tolerance to the beneficial vascular effects does not appear to occur.[30849][55990]

     

    Intraurethral Route

    After intraurethral administration, minimal systemic absorption occurs. Any alprostadil absorbed by this route is rapidly metabolized. Alprostadil given via the urethra is delivered directly to the urethral lining for transfer via the corpus spongiosum to the corpora cavernosa. The onset of effect is within 5 to 10 minutes after urethral administration and the duration of effect is approximately 30 to 60 minutes and will vary from patient to patient.[30847]

    Special Populations

    Hepatic Impairment

    In a study in symptomatic patients with hepatic impairment who were administered 120 mcg of alprostadil by IV infusion over 2 hours, the mean Cmax value of PGE1 was 96% higher compared to that in healthy volunteers. Mean Cmax values of both 15-keto-PGE0 and PGE0 increased 65% compared to those in healthy volunteers. The terminal half-lives of PGE1, PGE0, and 15-keto-PGE0 were similar in both groups of patients. PGE1 is primarily metabolized in the lung; the mechanism responsible for the observed differences in patients with hepatic impairment is unknown.[55990]

    Renal Impairment

    In a study in symptomatic patients with end-stage-renal disease undergoing dialysis who were administered 120 mcg of alprostadil by IV infusion over 2 hours, the mean Cmax value of PGE1 was 37% lower compared to that in healthy volunteers. However, mean Cmax values of 15-keto-PGE0 and PGE0 increased 104% and 145%, respectively, compared to healthy volunteers. The terminal half-lives of PGE1, PGE0, and 15-keto-PGE0 were similar in both groups of patients. The mechanism responsible for the observed differences in patients with renal impairment is unknown.[55990]

    Other

    Pulmonary Disease

    Due to the near-complete pulmonary first pass metabolism of PGE1, patients with pulmonary disease may have impaired elimination of alprostadil. In patients with adult respiratory distress syndrome (ARDS), pulmonary extraction of intravascularly administered alprostadil was decreased by approximately 15% compared to control patients with normal respiratory function (66 +/- 3.2% vs. 78 +/- 2.4%).[30847][30849][55990]

    Revision Date: 05/18/2016, 02:15:17 PM

    References

    30847 - MUSE (alprostadil) urethral suppository package insert. Somerset, NJ: Meda Pharmaceuticals; 2018 Apr.30848 - Prostin VR Pediatric (alprostadil injection) package insert. New York, NY: Pharmacia and Upjohn Company.; 2022 Oct.30849 - Caverject (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.55990 - Edex (alprostadil for injection) package insert. Lake Forest, Illinois: Actient Pharmaceuticals, LLC; 2015 Mar.

    Pregnancy/Breast-feeding

    contraception requirements, females, labor, pregnancy, sexually transmitted disease

    Given the indications for use, alprostadil dosage forms for erectile dysfunction (ED) are not to be used in females or during pregnancy. There is no information on the effects on early pregnancy of prostaglandin E1 (PGE1) at the levels received by female partners via the semen of an alprostadil-treated partner. Prostaglandins generally promote uterine contractions, and exposure to prostaglandins during pregnancy may induce uterine contractions and labor. Animal data report embryotoxic effects when alprostadil was given as a subcutaneous bolus, however, no developmental harm was reported when the drug was given intravaginally.[30847] [30849] [55990] Recommended contraception requirements for adults using alprostadil urethral suppositories for ED are available. Alprostadil urethral suppository should not be used by males for sexual intercourse with a pregnant partner unless the couple uses a condom barrier.[30847] All couples using alprostadil urethral suppositories for ED are recommended to employ adequate contraception if a partner is of childbearing potential.[30847] Use of alprostadil for the treatment of erectile dysfunction (ED) offers no protection against the transmission of blood-borne or sexually transmitted disease.[30847] [30849] [61405] [55990]

    breast-feeding

    Given the indications for use, alprostadil would not be expected to be used during lactation. Use in the lactating female during breast-feeding is not indicated.[30847] [30848] [30849] [55990] [61405]

    Revision Date: 01/04/2023, 12:21:39 PM

    References

    30847 - MUSE (alprostadil) urethral suppository package insert. Somerset, NJ: Meda Pharmaceuticals; 2018 Apr.30848 - Prostin VR Pediatric (alprostadil injection) package insert. New York, NY: Pharmacia and Upjohn Company.; 2022 Oct.30849 - Caverject (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.55990 - Edex (alprostadil for injection) package insert. Lake Forest, Illinois: Actient Pharmaceuticals, LLC; 2015 Mar.61405 - Caverject Impulse (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.

    Interactions

    Level 1 (Severe)

    • Ibuprofen lysine

    Level 3 (Moderate)

    • Heparin

    Level 4 (Minor)

    • Acebutolol
    • Aliskiren; Hydrochlorothiazide, HCTZ
    • Amiloride
    • Amiloride; Hydrochlorothiazide, HCTZ
    • Amlodipine
    • Amlodipine; Atorvastatin
    • Amlodipine; Benazepril
    • Amlodipine; Celecoxib
    • Amlodipine; Olmesartan
    • Amlodipine; Valsartan
    • Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ
    • Angiotensin II receptor antagonists
    • Angiotensin-converting enzyme inhibitors
    • Atenolol
    • Atenolol; Chlorthalidone
    • Azilsartan
    • Azilsartan; Chlorthalidone
    • Benazepril
    • Benazepril; Hydrochlorothiazide, HCTZ
    • Beta-blockers
    • Betaxolol
    • Bisoprolol
    • Bisoprolol; Hydrochlorothiazide, HCTZ
    • Brimonidine; Timolol
    • Bumetanide
    • Calcium-channel blockers
    • Candesartan
    • Candesartan; Hydrochlorothiazide, HCTZ
    • Captopril
    • Captopril; Hydrochlorothiazide, HCTZ
    • Carteolol
    • Carvedilol
    • Central-acting adrenergic agents
    • Chlorothiazide
    • Chlorthalidone
    • Clevidipine
    • Clonidine
    • Diazoxide
    • Diltiazem
    • Dorzolamide; Timolol
    • Doxazosin
    • Enalapril, Enalaprilat
    • Enalapril; Hydrochlorothiazide, HCTZ
    • Eplerenone
    • Epoprostenol
    • Eprosartan
    • Eprosartan; Hydrochlorothiazide, HCTZ
    • Esmolol
    • Ethacrynic Acid
    • Felodipine
    • Fenoldopam
    • Fosinopril
    • Fosinopril; Hydrochlorothiazide, HCTZ
    • Furosemide
    • Guanfacine
    • Hydralazine
    • Hydralazine; Isosorbide Dinitrate, ISDN
    • Hydrochlorothiazide, HCTZ
    • Hydrochlorothiazide, HCTZ; Moexipril
    • Iloprost
    • Irbesartan
    • Irbesartan; Hydrochlorothiazide, HCTZ
    • Isradipine
    • Labetalol
    • Levamlodipine
    • Levobunolol
    • Lisinopril
    • Lisinopril; Hydrochlorothiazide, HCTZ
    • Loop diuretics
    • Losartan
    • Losartan; Hydrochlorothiazide, HCTZ
    • Mecamylamine
    • Methyldopa
    • Metolazone
    • Metoprolol
    • Metoprolol; Hydrochlorothiazide, HCTZ
    • Minoxidil
    • Moexipril
    • Nadolol
    • Nebivolol
    • Nebivolol; Valsartan
    • Nicardipine
    • NIFEdipine
    • Nimodipine
    • Nisoldipine
    • Nitroprusside
    • Olmesartan
    • Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ
    • Olmesartan; Hydrochlorothiazide, HCTZ
    • Perindopril
    • Perindopril; Amlodipine
    • Phenoxybenzamine
    • Pindolol
    • Potassium-sparing diuretics
    • Prazosin
    • Propranolol
    • Quinapril
    • Quinapril; Hydrochlorothiazide, HCTZ
    • Ramipril
    • Sacubitril; Valsartan
    • Sotalol
    • Spironolactone
    • Spironolactone; Hydrochlorothiazide, HCTZ
    • Telmisartan
    • Telmisartan; Amlodipine
    • Telmisartan; Hydrochlorothiazide, HCTZ
    • Terazosin
    • Thiazide diuretics
    • Timolol
    • Torsemide
    • Trandolapril
    • Trandolapril; Verapamil
    • Treprostinil
    • Triamterene
    • Triamterene; Hydrochlorothiazide, HCTZ
    • Valsartan
    • Valsartan; Hydrochlorothiazide, HCTZ
    • Vasodilators
    • Verapamil
    Acebutolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Aliskiren; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Amiloride: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as spironolactone or other potassium-sparing diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Amiloride; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as spironolactone or other potassium-sparing diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Amlodipine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Amlodipine; Atorvastatin: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Amlodipine; Benazepril: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Amlodipine; Celecoxib: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Amlodipine; Olmesartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Amlodipine; Valsartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Angiotensin II receptor antagonists: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Angiotensin-converting enzyme inhibitors: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Atenolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Atenolol; Chlorthalidone: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Azilsartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Azilsartan; Chlorthalidone: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Benazepril: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Benazepril; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Beta-blockers: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Betaxolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Bisoprolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Bisoprolol; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Brimonidine; Timolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Bumetanide: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as loop diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Calcium-channel blockers: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Candesartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Candesartan; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Captopril: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Captopril; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Carteolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Carvedilol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Central-acting adrenergic agents: (Minor) The concomitant use of systemic alprostadil injection and central-acting antihypertensive agents may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Chlorothiazide: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Chlorthalidone: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Clevidipine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Clonidine: (Minor) The concomitant use of systemic alprostadil injection and central-acting antihypertensive agents may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Diazoxide: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as the vasodilators, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Diltiazem: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Dorzolamide; Timolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Doxazosin: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as doxazosin, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Enalapril, Enalaprilat: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Enalapril; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Eplerenone: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as eplerenone, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Epoprostenol: (Minor) Systemic alprostadil and epoprostenol are both prostaglandins that reduce blood pressure, and would not be commonly prescribed together at the same time. The concomitant use of systemic alprostadil injection and epoprostenol would be expected to cause additive hypotension. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Eprosartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Eprosartan; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Esmolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Ethacrynic Acid: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as loop diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Felodipine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Fenoldopam: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as the vasodilators, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Fosinopril: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Fosinopril; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Furosemide: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as loop diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Guanfacine: (Minor) The concomitant use of systemic alprostadil injection and central-acting antihypertensive agents may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Heparin: (Moderate) Caution is advised with the concomitant administration of alprostadil injection for dilation of the ductus arteriosis and heparin infusions. Coadministration resulted in a 140% increase in partial thromboplastin time and a 120% increase in thrombin time in a study of 12 healthy volunteers receiving alprostadil 90 mcg infusion over 3 hours and heparin 5000 units. Monitor patients for increased bleeding if these agents are used together. [30848] Hydralazine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as the vasodilators, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Hydralazine; Isosorbide Dinitrate, ISDN: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as the vasodilators, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Hydrochlorothiazide, HCTZ; Moexipril: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Ibuprofen lysine: (Contraindicated) As ibuprofen lysine is used for the pharmacologic closure of patent ductus arteriosus (PDA), do not administer to patients who require alprostadil injection for dilation of the ductus arteriosus for oxygenation and perfusion. Alprostadil injection for pediatric use (Prostin VR) has been used with the standard therapy for neonates with restricted pulmonary or systemic blood flow which includes antibiotics (e.g., penicillin and gentamicin), vasopressors (e.g., dopamine, isoproterenol), cardiac glycosides, and diuretics (e.g., furosemide). [30848] [32402] Iloprost: (Minor) Systemic alprostadil and epoprostenol are both prostaglandins that reduce blood pressure, and would not be commonly prescribed together at the same time. The concomitant use of systemic alprostadil injection and epoprostenol would be expected to cause additive hypotension. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Irbesartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Irbesartan; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Isradipine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Labetalol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Levamlodipine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Levobunolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Lisinopril: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Lisinopril; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Loop diuretics: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as loop diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Losartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Losartan; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Mecamylamine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as mecamylamine, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Methyldopa: (Minor) The concomitant use of systemic alprostadil injection and central-acting antihypertensive agents may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Metolazone: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Metoprolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Metoprolol; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Minoxidil: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as the vasodilators, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Moexipril: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Nadolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Nebivolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Nebivolol; Valsartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Nicardipine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] NIFEdipine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Nimodipine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Nisoldipine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Nitroprusside: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as the vasodilators, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Olmesartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Olmesartan; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Perindopril: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Perindopril; Amlodipine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Phenoxybenzamine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as phenoxybenzamine, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Pindolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Potassium-sparing diuretics: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as spironolactone or other potassium-sparing diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Prazosin: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as prazosin, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Propranolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Quinapril: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Quinapril; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Ramipril: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Sacubitril; Valsartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Sotalol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Spironolactone: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as spironolactone or other potassium-sparing diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Spironolactone; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as spironolactone or other potassium-sparing diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Telmisartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Telmisartan; Amlodipine: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Telmisartan; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Terazosin: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as terazosin, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Thiazide diuretics: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Timolol: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as beta-clockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Torsemide: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as loop diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Trandolapril: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Trandolapril; Verapamil: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Treprostinil: (Minor) Systemic alprostadil and treprostinil are both prostaglandins that reduce blood pressure, and would not be commonly prescribed together at the same time. The concomitant use of systemic alprostadil injection and treprostinil would be expected to cause additive hypotension. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Triamterene: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as spironolactone or other potassium-sparing diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Triamterene; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as spironolactone or other potassium-sparing diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Valsartan: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Valsartan; Hydrochlorothiazide, HCTZ: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as angiotensin II receptor antagonists (angiotensin receptor blockers, or ARBs), may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as thiazide diuretics, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Vasodilators: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as the vasodilators, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990] Verapamil: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. [30847] [30849] [55990]
    Revision Date: 01/11/2024, 04:54:00 PM

    References

    30847 - MUSE (alprostadil) urethral suppository package insert. Somerset, NJ: Meda Pharmaceuticals; 2018 Apr.30848 - Prostin VR Pediatric (alprostadil injection) package insert. New York, NY: Pharmacia and Upjohn Company.; 2022 Oct.30849 - Caverject (alprostadil for injection) package insert. New York, NY: Pharmacia and Upjohn Company; 2022 Dec.32402 - NeoProfen (ibuprofen lysine) package insert. Charleston, SC: Alcami Carolinas Corporation; 2023 Oct.55990 - Edex (alprostadil for injection) package insert. Lake Forest, Illinois: Actient Pharmaceuticals, LLC; 2015 Mar.

    Monitoring Parameters

    • laboratory monitoring not necessary

    US Drug Names

    • Caverject
    • Caverject Impulse
    • Edex
    • Muse
    • Prostin VR
    ;