What it is
Active ingredient
Alprostadil, chemically identical to prostaglandin E1.
Route
Cream, 3 mg/g, applied at the tip of the penis on demand.
How it works
A copy of prostaglandin E1
Alprostadil is chemically identical to prostaglandin E1 (PGE1). It binds
to EP (prostaglandin E) receptors on the smooth muscle cell membrane,
which raises intracellular cAMP through activation of adenylyl cyclase.
Elevated cAMP relaxes the smooth muscle directly — a pathway entirely
independent of the nitric-oxide–cGMP system used by PDE5 inhibitors.
Alprostadil is applied to the penis itself, so it acts on the erectile
tissue at the site rather than circulating through the whole body first.
Cavernosal muscle relaxes
The raised cAMP triggers relaxation of 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, so blood flow into the
erectile tissue rises.
It does not need arousal
Because it acts directly on the blood vessels, it does not depend on the
signalling pathway used by PDE5 tablets such as sildenafil or tadalafil.
A non-PDE5 route
A different pathway from oral erectile dysfunction tablets.
Local application
Acts on the blood vessels at the site, not system-wide.
Guided by your doctor
Considered when oral PDE5 tablets aren’t the right fit or aren’t allowed.
What the studies reported
An integrated analysis of two multicentre, double-blind, parallel-group randomised trials of alprostadil topical cream in 1,732 patients was published in Urology 2006 (PMID 16904458). Patients with an IIEF erectile-function domain score of 25 or less were randomly assigned to placebo or alprostadil cream (100, 200, or 300 µg) for 12 weeks of at-home use. Unlike many ED trials, patients receiving organic nitrates and patients with diabetes were included — broadening the relevance of the safety data. The primary end points were the change in the IIEF erectile-function domain score and the change from baseline in Sexual Encounter Profile (SEP) questions 2 (vaginal penetration) and 3 (maintenance to ejaculation). The IIEF changes reported are described by the authors as small in absolute terms, with SEP2 and SEP3 improvements described as slight though statistically significant. Most adverse events were localised to the application site and resolved within 2 hours. A related intraurethral pellet form of alprostadil was studied in the transurethral pivotal trial reported in N Engl J Med 1997 (PMID 8970933, MUSE Study Group) — mild penile pain was its most common side effect, occurring after 10.8% of treatments, with in-clinic low blood pressure in 3.3% of men and no priapism or penile fibrosis reported. Every NCT identifier in Hi-Doctor’s evidence base links to its ClinicalTrials.gov record; a readout is not the same as peer-reviewed publication.What has been reported
Who it is not suitable for
A doctor assesses history and current medication before prescribing, and decides whether Vitaros or another sexual health option is appropriate. For men for whom an injection is more suitable, Caverject is the alprostadil intracavernosal injection form, reviewed separately.Common questions
What is Vitaros and how does it work?
What is Vitaros and how does it work?
Vitaros is alprostadil 3 mg/g cream applied to the tip of the penis. Alprostadil is chemically identical to prostaglandin E1, a substance the body makes naturally. It relaxes the smooth muscle of the corpora cavernosa and widens the arteries feeding them, increasing blood flow into the erectile tissue. Because it acts locally, it does not depend on sexual arousal in the same way PDE5 tablets do.
How is Vitaros different from oral ED tablets?
How is Vitaros different from oral ED tablets?
Vitaros is a cream rather than a tablet, so it is used mainly when tablets are unsuitable. It works through a different pathway from PDE5 inhibitors such as sildenafil or tadalafil. Because it acts on the blood vessels at the site, the main side effects are also local.
What side effects are common with Vitaros?
What side effects are common with Vitaros?
Penile burning, penile pain, penile erythema, genital pain and discomfort are all listed as common in the EU product information. Vulvovaginal burning and vaginitis in a female partner are also listed as common. Dizziness and fainting occurred in 0.4% to 0.5% of patients across the three dose groups in the phase 3 studies.
What is the risk of priapism?
What is the risk of priapism?
Priapism (an erection lasting more than 6 hours) was seen in 1 patient (0.06%) across two 3-month studies, and in 5 patients (0.4%) in a study lasting more than 6 months. An erection lasting 4 hours or more is a medical emergency — untreated priapism can permanently damage erectile tissue.
How Hi-Doctor handles it
The questionnaire covers symptoms, cardiovascular history, current medication and allergies — see how eligibility works. Certain answers, such as nitrate medication, rule treatment out entirely because of a dangerous interaction; see safety for how these checks run. Vitaros is one of several sexual health options a doctor may consider. The consultation cost is set out on pricing; the medicine itself is paid separately at a pharmacy.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.