> ## Documentation Index
> Fetch the complete documentation index at: https://docs.hi-doctor.ai/llms.txt
> Use this file to discover all available pages before exploring further.
# MUSE (alprostadil urethral pellet)
> What MUSE is, its Spanish national authorisation, current availability, and the side effects reported in its pivotal trial.
MUSE is a small pellet of alprostadil, a man-made copy of the natural body chemical prostaglandin E1, inserted into the urethra rather than taken as a tablet or injection. Because it works locally, the main side effects are also local — burning, pain or redness where it is applied, and rarely an erection that lasts too long, which needs urgent medical attention.
## What it is
**Active ingredient:** Alprostadil · **Dosage form on catalogue:** Cream 3 mg/g, on demand
MUSE contains the active ingredient alprostadil — the same substance used in the Caverject injection and Virirec/Vitaros cream. It is indicated for erectile dysfunction of mainly physical (organic) cause in men aged 18 and over, and can also be used alongside other tests in the diagnosis and treatment of erectile dysfunction.
## How it works
Alprostadil is chemically identical to prostaglandin E1, a signalling substance the body already makes. It is not swallowed — it is placed into or onto the penis itself, so it acts on the erectile tissue at the site rather than circulating through the whole body first.
It relaxes the smooth muscle of the corpora cavernosa — the two spongy cylinders that run the length of the penis — and widens the cavernosal arteries feeding them. Blood flow into the erectile tissue rises, and that increase in flow is what produces rigidity.
## EU authorisation
MUSE holds **national authorisations rather than a centralised EU one**. The details here come from the Spanish authorisation (AEMPS registrations 62696, 62697 and 62698, holder Viatris Healthcare Limited). All three Spanish strengths are recorded as authorised but not currently marketed, and MUSE no longer appears in the United Kingdom medicines compendium, so European availability is very limited.
Alprostadil itself has been authorised for use in EU countries for erectile dysfunction since 1994 as an injection and since 2014 as a cream. The medicine behind MUSE is a small pellet inserted into the urethra rather than a tablet or an injection.
## What the studies reported
The evidence base for alprostadil spans its three delivery routes. The IIEF changes reported for the cream form are small in absolute terms, and the authors describe the SEP2 and SEP3 improvements as slight though statistically significant; those studies ran for 12 weeks and cover the topical cream only.
| Source | What it studied |
| ---------------------------------- | ------------------------------------------------------------------ |
| *N Engl J Med* 1997 (PMID 8970933) | Transurethral alprostadil, MUSE Study Group |
| *N Engl J Med* 1996 (PMID 8596569) | Efficacy and safety of intracavernosal alprostadil |
| *Urology* 2006 (PMID 16904458) | Integrated analysis of alprostadil topical cream in 1,732 patients |
## What has been reported
| Effect | Route | Reported frequency |
| ------------------------------------------------------- | ---------------------------------- | ---------------------------------------------------------------------------------------------------------- |
| Penile pain | Urethral pellet | Most common effect in the transurethral pivotal trial, occurring after **10.8%** of treatments |
| Low blood pressure (in-clinic) | Urethral pellet | **3.3%** of men in the transurethral pivotal trial |
| Priapism or penile fibrosis | Urethral pellet | None reported in the transurethral pivotal trial |
| Penile burning, pain, erythema; genital pain/discomfort | Cream (same active ingredient) | Common (EU product information for the cream form). Trial withdrawal rate 30% at 300 mcg vs 20% at 200 mcg |
| Prolonged erection / priapism | Injection (same active ingredient) | 4% / 0.4% respectively (EU product information for the injection form) |
An erection lasting **4 hours or more is priapism**, and it is a medical emergency. Untreated priapism can permanently damage erectile tissue.
## Who it is not suitable for
MUSE is indicated for erectile dysfunction of mainly physical (organic) cause in men aged 18 and over. Because the Spanish strengths are recorded as authorised but not currently marketed, and MUSE is not listed in the UK medicines compendium, its European availability is very limited — the reviewing doctor considers whether it can be sourced and whether it is the appropriate route for you compared with the alprostadil cream or injection.
## How Hi-Doctor handles it
A doctor reviews every sexual health option and recommends what fits your history and goals. If alprostadil is appropriate, they explain the chosen route and administration technique.
If a doctor decides alprostadil is right for you, they explain how to use the pellet or the alternative route.
The consultation fee is listed on [pricing](/essentials/pricing); the medicine itself is paid separately at a pharmacy.
## Related reading
* [Alprostadil](/library/medicines/alprostadil) — the same active ingredient as a cream or injection
* [Tadalafil (Cialis)](/library/medicines/cialis) — an oral alternative when tablets are suitable
* [How a consultation works](/essentials/how-it-works)
* [Safety and eligibility](/essentials/safety)
## Start a 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](/essentials/pricing)
and [how the review works](/essentials/how-it-works).
This page is reference information, not medical advice and not a prescription.
Whether a medicine is appropriate for you is decided by a registered doctor
after reviewing your consultation.