How it works
Alprostadil is a synthetic copy of prostaglandin E1 (PGE1). It binds to EP2 and EP4 receptors on the smooth muscle cells of the corpus cavernosum and, to a lesser extent, to IP receptors on penile resistance arteries. These receptors are coupled to Gs proteins that activate adenylyl cyclase, raising intracellular cyclic adenosine monophosphate (cAMP). Elevated cAMP reduces cytosolic calcium, producing trabecular smooth muscle relaxation and dilation of the cavernosal arteries. The resulting expansion of lacunar spaces compresses the venules against the tunica albuginea (the corporal veno-occlusive mechanism), trapping blood and sustaining the erection. Unlike PDE5 inhibitors, alprostadil does not depend on nitric oxide release or sexual stimulation to initiate this cascade. (StatPearls alprostadil; BPS British Journal of Pharmacology 2003)Clinical evidence
Two pivotal phase 3 studies in 1,732 men with erectile dysfunction compared Vitaros (100, 200 or 300 μg) with placebo over 12 weeks. All three doses produced statistically significant improvements versus placebo on the IIEF erectile function domain score and on SEP2 (vaginal penetration success) and SEP3 (maintenance of erection sufficient for intercourse). Improvements were also observed in predefined subgroups, including men with diabetes, men with cardiovascular disease, men who had undergone radical prostatectomy, and men who had not responded to sildenafil. Local adverse effects were the most common reason for discontinuation. (Vitaros UK SmPC; Cuzin, Ther Adv Urol 2016, PMC5131739)Contraindications
Alprostadil cream is contraindicated in men with a predisposition to priapism (sickle-cell disease, thrombocythaemia, polycythaemia, multiple myeloma, leukaemia), with abnormal penile anatomy (severe hypospadias, penile curvature, urethritis, balanitis), or with venous thrombosis or hyperviscosity syndromes — conditions in which the local vasodilatory effect of PGE1 carries disproportionate risk. It is also contraindicated when sexual activity is medically inadvisable due to unstable cardiovascular or cerebrovascular conditions. (Vitaros UK SmPC 4.3)Interactions
No formal pharmacokinetic interaction studies have been conducted, and drug-drug interactions are considered unlikely because alprostadil is metabolised predominantly at the site of application. However, Vitaros must not be combined with PDE5 inhibitors because the additive vasodilatory effect on the corpora cavernosa can raise the risk of prolonged erection. Caution is advised with antihypertensives and other vasoactive medicines, particularly in older patients. (Vitaros UK SmPC 4.5)Population considerations
Alprostadil has not been studied in patients with hepatic or renal impairment, and dose adjustment may be required. Vitaros is not indicated in individuals under 18 years. No formal pharmacokinetic study has been conducted in patients over 65, although phase 3 data included both age groups. (Vitaros UK SmPC 4.2)How to use it
Each container is used once, in a fixed order. Read this through before the first application rather than during it.1
Apply one prescribed single-use container
Urinate first, wash hands, then place the cream at the opening on the tip of the penis exactly as shown in the leaflet. Hold the penis upright for about 30 seconds so the cream can enter. Do not insert the applicator into the urethra.
2
Use once and discard
Each AccuDose container is for one application. Do not use a second container to replace cream that remains at the opening. Wash hands after use, and do not urinate immediately afterwards.
Dose schedule
Five to thirty minutes before sex
The effect may begin within 5–30 minutes and can last about 1–2 hours, with individual variation.
Maximum frequency
Do not use more than once in 24 hours, or more than 2–3 times per week. Do not combine with another erectile-dysfunction treatment unless the prescriber has explicitly planned it.
What has been reported
Contact your doctor if
- An erection lasts 4 hours or longer, is very painful, or does not settle — seek emergency care
- Fainting, chest symptoms, heavy urethral bleeding, marked swelling, or a severe allergic reaction
- Local pain or partner irritation is persistent, or the dose needs adjustment
Storage
Keep unopened sachets refrigerated at 2–8°C and do not freeze. A sachet may be kept below 25°C for up to 3 days before use — discard it if not used within that time. Protect from light and use immediately after opening.What to expect
A licensed EU doctor will review your case in under 24 hours. Because alprostadil does not permanently correct the underlying cause of erectile dysfunction, the doctor may also discuss oral options.Common questions
How does alprostadil cream work?
How does alprostadil cream work?
Alprostadil is a copy of prostaglandin E1, a substance the body makes naturally that widens blood vessels. Applied to the tip of the penis, it relaxes the smooth muscle of the corpora cavernosa and widens the arteries feeding them, increasing blood flow. Because it acts directly on the blood vessels, it does not depend on sexual arousal in the way PDE5 tablets do.
How long before sex should I apply it?
How long before sex should I apply it?
The effect may begin within 5 to 30 minutes and can last about 1 to 2 hours, with individual variation. Use the prescribed dose as needed, up to once in 24 hours and no more than 2 to 3 times per week.
Can I combine Vitaros with other erectile dysfunction treatments?
Can I combine Vitaros with other erectile dysfunction treatments?
Do not combine Vitaros with another erectile-dysfunction treatment unless the prescriber has explicitly planned it. The doctor may discuss oral PDE5 inhibitors such as vardenafil or avanafil as alternatives.
What side effects should I watch for?
What side effects should I watch for?
Penile burning, pain, redness, tingling, swelling or genital discomfort can occur. A partner may also experience burning or irritation after contact. Dizziness or faintness can occur. An erection lasting 4 hours or longer needs emergency care.
How should Vitaros be stored?
How should Vitaros be stored?
Keep unopened sachets refrigerated at 2 to 8°C and do not freeze. A sachet may be kept below 25°C for up to 3 days before use. Discard it if not used within that time. Protect from light and use immediately after opening.
How Hi-Doctor handles it
Related reading: vardenafil (Levitra) and avanafil (Spedra), the oral PDE5-inhibitor alternatives a doctor may consider instead. See also safety and eligibility checks and how a Hi-Doctor consultation works.Start a consultation
Sexual health consultation
Answer the sexual health questionnaire and a registered doctor reviews it.
They decide whether treatment is appropriate, which one, and at what dose —
and declining is a normal outcome. See what it costs
and how the review works.