Alprostadil cream in the treatment of erectile dysfunction: clinical evidence and experience

Abstract

Erectile dysfunction (ED) is a very common disorder with a deep impact on quality of life on both patients and partners. Several options are available for treating ED: oral pharmacotherapy with phosphodiesterase 5 (PDE5) inhibitors currently represents the firstline option for many patients with ED. Alprostadil, a prostaglandin, has been marketed for many years as a urethral stick and an intracavernous injection for the treatment of ED. It is now available in the form of a cream (Vitaros/Virirec), a noninvasive treatment which combines an active drug (alprostadil, a synthetic prostaglandin E1) with a skin enhancer improving its local absorption directly at the site of action. Alprostadil has a favourable pharmacodynamic profile and is poorly absorbed in systemic circulation, which makes it suitable in a lot of circumstances and results in a reduced risk of adverse effects (AEs). Systemic AEs are reported in only 3% of the treated population. Clinical efficacy has been demonstrated in both phase II and III trials, showing a global efficacy up to 83% with the 300 μg dose in patients with severe ED, significantly better than placebo. Its fast onset of action and lack of interactions with other drugs makes alprostadil cream a possible first-line therapeutic option for some patients with ED: individuals who are reluctant to take systemic treatments or have AEs, patients who do not respond, cannot tolerate, or do not accept PDE5 inhibitor therapy, and patients treated with nitrates. Therefore, this new treatment for ED can be offered to patients and could help address the needs unmet by other treatments.

Examining Endothelial Dysfunction and The Effect of Topical Treatment with Prostaglandin E1 In Diabetics Suffering from Erectile Dysfunction

“…In contrast to PDE5i, alprostadil cream circumvents the barrier of non-functional nerves of diabetic patients with neuropathy and acts directly in erectile tissue . Alprostadil acts independently of the psychological factors and neurological components of the entire process that lead to erection [17]. For a long time, alprostadil is available as an intracavernous injection.…”

Is topical alprostadil an usable and reliable alternative to intracavernous injection for penile dynamic duplex ultrasonography?

“…The alprostadil cream is minimally absorbed in the systemic circulation (98% is retained in the navicular fossa; Cuzin, ; Moncada, ); therefore, there is a low risk of systemic adverse events (3%), and there are no interactions with food, drugs, and alcohol. Local adverse effects (65%) are mild to moderate, and they have a short duration (Becher, ; Yeager & Beihn, ).…”

“…The onset of action of topical alprostadil is rapid, the full stiffness is reached after 10–20 min from the application, and this persists for more than 1 hr, also in the majority of patients there is an interval of only 5–30 min between application and successful penetration (Cuzin, ; Moncada, ).…”

“…Topical alprostadil combines the efficacy of alprostadil (synthetic PGE1) with an easy to use cream formulation, which allows a topical application. The possible role of alprostadil cream in the therapy of ED is emerging (Cuzin, ; Moncada, ); however, currently, no study has yet been done to evaluate its usability as alternative vasoactive agent for PDDU.…”

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. II. Urological Self-Inflicted Harms: 1. Unintentional Patient’s Side-Inflictor Urological Injuries

“…Pharmacological topical penile medications are used for many purposes including erectile dysfunctions with few side effects [26]. However, dramatic harms could evolve by the misuse of pharmacological [27] or traditional preparations [28].…”