Caverject

Caverject is an injection of a chemical called alprostadil, produced by Upjohn, used to treat Erectile dysfunction (impotence in men).

Caverject Sterile Powder contains alprostadil as the naturally occurring form of prostaglandin E1 (PGE1) and designated chemically as (11alpha, 13E, 15S)-11,15-dihydroxy-9-oxoprost-13-en-1-oic acid. The molecular weight is 354.49. Alprostadil is a white to off-white crystalline powder with a melting point between 115° and 116°C. Its solubility at 35°C is 8000 micrograms (mcg) per 100 milliliter double distilled water.

Usage

Caverject is administered via small-needle injection into an area of the penis known as the corpus cavernosum. It works by relaxing smooth muscle tissue which, in turn, enhances blood flow to the penis, creating an erection. The drug is indicated for the treatment of erectile dysfunction whether the cause is neurological, vascular, psychological or of mixed origin. Patients selected for treatment with Caverject receive initial injections from medically-trained personnel to determine optimum dosing. Usual dosing is from 5 mcg to 20 mcg with standard kit doses available in the 10 mcg and 20 mcg strengths. Up to 60 mcg can be injected at one time. Caverject can be administered by the patient once he has been trained to self-inject.

In certain markets, a self-contained, self measuring syringe kit is available known as Caverject Impulse. The self measuring syringe has a dial in which the patient selects the correct dose for injection. The amount is metered automatically when the plunger is depressed. Other markets contain conventional injection materials which must be mixed and measured manually. Both kits become self-locking, self-contained sharps containers after the injection process.

Administration

Using either the Caverject Impulse or conventional Caverject kit, the mixing of the alprostadil dry powder with sterile, bacteriostatic water is done first.

The amount to be injected is then selected using the Caverject Impulse kit dial, or in the case of the conventional kit the correct amount is measured in to the syringe for injection.

The injection site is selected on the side of the penis, and cleaned using the supplied isopropyl alcohol pads. The site is roughly perpendicular to the top and bottom of the penis, and represents the best possible entry of the needle in to the corpus cavernosum. The patient is advised to alter the injection site from one side to the other, and along the lower length of the penile shaft with each injection. Obvious surface veins should be avoided as injection in these sites may cause formation of hematoma.

The fine (30)-gauge needle attached to the syringe is then inserted in to the injection site. Often there is some resistance felt as the needle attempts to penetrate the corpus cavernosum. Once fully inserted, the plunger is slowly pressed and the needle removed, and the isopropyl alcohol pad is held at the injection site for several minutes to inhibit bruising and hematoma.

Efficacy

Depending on dosing, age and general health most men experience an erection in a few minutes. With proper dosing the erection will last approximately 1 hour. While some deviation in the length of time the erection is sustained is not cause for alarm, care must be taken to avoid prolonged erection or priapism. Since the erection is entirely uncommanded, patients should ensure that detumesence of the penis occurs within the prescribed time frame.

ide Effects

Caverject may cause mild pain, irritation or slight bleeding at the injection site. There is also a possibility to develop: tenderness or swelling of the penis, redness/lumps/unusual curving of the penis. Caverject can cause priapism and long-term use carries a 3% risk of developing fibrosis of the penis. Controlled-dose titration within the context of a medical professional's office is essential to the safety of using the product.

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