What is the difference between caverject and caverject impulse

If you would like more information, talk with your healthcare provider. There are several causes of ED. These include medications that you may be taking for other conditions, poor blood circulation in the penis, nerve damage, emotional problems, too much smoking or alcohol use, use of street drugs, and hormonal problems.

Often, ED is due to more than one cause. Treatments for ED include switching medications if you are taking a medication that causes erectile dysfunction, prescription medications, medical devices that produce an erection, surgical procedures to correct blood flow in the penis, penile implants, and psychological counseling.

Discuss any concerns you may have about combination treatment with your doctor. Your dose has been selected for your individual needs. Do not change your dose without consulting your doctor. If you are not sure of the volume or dose to be used, talk to your doctor or pharmacist. Each tray contains: a a syringe , b a separate needle assembly and c two alcohol swabs. The syringe and the needle assembly are shown in Figure A below.

Please note that the needle assembly is packaged as a single piece and is sealed with a paper cover on the bottom. First-read through ALL of the instructions Step 1 through Step 12 before trying to assemble the syringe. Then go back to Step 1 and begin to prepare the syringe for use. Each syringe is designed to be used only one time , but you can select the dose that will be delivered:.

If you deliver a partial dose there will be left-over solution in the syringe — this is normal. Do not keep any solution in the cartridge to use for a second injection. When you have finished with the syringe, discard it carefully as recommended by your doctor, so no one will use it or stick themselves with it. S Food and Drug Administration. DailyMed will deliver notification of updates and additions to Drug Label information currently shown on this site through its RSS feed.

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Approval: Advise patients to seek immediate medical assistance for an erection that persists longer than 4 hours 5. Follow patients regularly to detect signs of penile fibrosis. Discontinue in patients who develop penile angulation or cavernosal fibrosis 5. Avoid use in patients with known cavernosal venous leakage 5.

Compress the site of injection with an alcohol swab or sterile gauze for 5 minutes 5. Use of such combinations is not recommended 5. Careful instruction in proper patient handling and injection techniques may minimize this risk 5. Counseling of patients about the protective measures necessary to guard against sexually transmitted disease including the Human Immunodeficiency Virus HIV is advised.

The site of injection is usually along the dorso-lateral aspect of the proximal third of the penis. Wipe the intended injection site with an alcohol swab prior to injection. Avoid visible veins during injection. Alternate the side of the penis that is injected and the site of injection.

The following are discussed in more detail in other sections of the labeling: Prolonged Erection and Priapism [see Warnings and Precautions 5. Table 1. No systemic adverse reactions were reported in the patients who received placebo. Pharmacokinetics in Specific Populations Geriatric: The potential effect of age on the pharmacokinetics of alprostadil has not been formally evaluated.

When self-administering the patient should be instructed to: Discard any reconstituted solution with precipitates or discoloration Administer the injection along the dorso-lateral aspect of the proximal third of the penis Wipe the intended injection site with an alcohol swab prior to injection Avoid visible veins during injection Alternate the side of the penis that is injected and the site of injection Compress the site of injection with an alcohol swab or sterile gauze for 5 minutes Use each CAVERJECT IMPULSE system only once and discard after use Do not use a bent needle.

If the needle is bent, it must not be used; they should also not attempt to straighten a bent needle. They should remove the needle from the syringe, discard it, and attach a new, unused sterile needle to the syringe. Not re-use or share needles and to properly discard after use. Penile Pain Advise patients that the most frequently occurring side-effect is penile pain after injection, and is usually mild to moderate in severity [see Adverse Reactions 6.

Before you use CAVERJECT IMPULSE, tell your healthcare provider if you: have had an erection that lasted more than 4 hours have sickle cell trait or sickle cell anemia have or have had a blood cell cancer called multiple myeloma or leukemia have a deformed penis shape have a penile implant have low blood pressure hypotension have bleeding problems have or have had heart problems such as a heart attack, irregular heartbeat, angina, chest pain, narrowing of the aortic valve or heart failure have any other medical conditions Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Ask your healthcare provider or pharmacist for a list of these medicines, if you are not sure. Your healthcare provider may change your dose if needed. Change the exact place and side of the penis that you inject Caverject Impulse each time you use it. If you have an erection that lasts more than 4 hours, get medical help right away. If it is not treated right away, this condition can permanently damage your penis. Your healthcare provider should check your penis regularly for signs of penile fibrosis.

People who take certain medicines called anticoagulants such as heparin or warfarin may have a risk for increased bleeding at the injection site. Sexual activity can put an extra strain on your heart, especially if your heart is weak from a heart attack or heart disease. Ask your healthcare provider if your heart is healthy enough to handle the extra strain of having sex.

Stop sexual activity and get medical help right away if you get symptoms of a heart problem such as chest pain, dizziness or nausea. To best avoid breaking the needle, you should pay careful attention to your healthcare provider's instructions and try to handle the syringe and needle properly.

If the needle is bent at any time, do not attempt to straighten it and do not use it. A bent and re-straightened needle is predisposed to breakage. Remove the needle from the syringe, discard, and attach a new, unused sterile needle to the syringe. If the needle breaks during injection and you are able to see and grasp the broken end, you should remove it and contact your healthcare provider. If you cannot see or cannot grasp the broken end, you should promptly contact your healthcare provider benzyl alcohol toxicity.

Benzyl alcohol has caused serious side effects, including death, in children, especially premature and low-birth weight infants, who have received the preservative benzyl alcohol. The most common side effects of CAVERJECT IMPULSE include: penile pain erection lasting 4 to 6 hours prolonged erection penile fibrosis deformed penis shape bruising at the injection site penile numbness, irritation, sensitivity, itching, swelling and discoloration skin tears of the penis penile rash Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

For more information, go to www. What are the causes of and treatments for ED? You should not stop taking any prescription medications, unless told to do so by your doctor. Wash your hands thoroughly and dry them with a clean towel. STEP 1. Open the sealed plastic tray.

Remove the syringe, the needle assembly, and the alcohol swabs from the tray. All items should be present. Look at the needle assembly.

The needle assembly is a sealed unit that contains the outer protective cap, the inner protective cap, and the superfine needle, as shown in Figure A. It is sealed with a small round paper cover not shown in Figure A. Do not open the needle assembly at this point — leave it sealed inside the outer protective cap. Next, examine the syringe. Find the location of the dose window. Right now you will not see anything in this window, but at a later Step, a number will appear in this window the dose to be delivered.

Finally, look at the Plunger, but do not move it at this time. It is important to only rotate the plunger — or only push — as directed in each Step, but DO NOT do both at the same time. Never PUSH on the plunger — even slightly — while trying to rotate it. This can cause the plastic threads on the plunger rod to stick. STEP 2. Open the packet containing the alcohol swab, and then pick up the syringe. Caverject is an injection directly into the penis so it is really only suitable for men who do not respond to other medications to treat erectile dysfunction.

There is an alternative to Caverject called Invicorp that is not yet licensed in the UK. The product is licensed in Denmark and we have managed to secure a reliable supply. This product is now available through The Online Clinic for next day delivery. Invicorp has a success rate comparable to Caverject and most men who have used the treatment say that there is no pain on injection. There are very few contraindications. You can read more about Invicorp here.

Customer Services: Login Register. Medications from UK licensed pharmacies. Start Now. If there is no response to the initial 2. Patient must remain in physician's office until complete detumescence occurs. If there is no response, the next higher dose may be given within 1 hour.

If there is a response, wait at least a 1-day interval before giving the next dose. Therapy should be initiated with mcg or mcg into the urethra as directed. If necessary, the dose should be increased or decreased on separate occasions in a stepwise manner until the patient achieves an erection that is sufficient for sexual intercourse.

Once dose titration is complete, MUSE should be used as needed. The maximum frequency of use is 2 administrations per hour period. May increase by 1. If there is a response, wait at least a 1-day interval before the next dose is given. Individual dosages are determined by series of trial injections under physician supervision. Limit use to 1 injection in a hour period, given no more than 3 times per week. Triple drug regimen dose ranges: 0. Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. When using a device with a volumetric infusion chamber, add the proper amount of diluent to the chamber first and then add the concentrate. Avoid direct contact of the concentrate with the wall of the plastic volumetric infusion chamber, which may change the appearance of the chamber and create a hazy solution.

If this occurs, replace the solution and volumetric infusion chamber. Storage: Store diluted solution at room temperature for up to 24 hours. Continuous Intravenous Infusion Infusion into a large vein is the preferred route of administration. The infusion rate depends on the concentration of the final solution and the desired dosage. Periodically monitor IV site; ensure reliable IV access because the duration of effect is short and a significant interruption in therapy could have serious adverse consequences.

Closely monitor respiratory status, cardiovascular status, and temperature during alprostadil administration. Facilities and equipment for assisted ventilation should be readily available. Intra-arterial Infusion i. Ensure reliable UAC access because the duration of alprostadil's effect is short and a significant interruption in therapy could have serious adverse consequences.

Flushing may be the result of an incorrectly positioned intra-arterial catheter; assess catheter placement if flushing occurs. Therapy should be initiated under the supervision of a physician to test a patient's responsiveness and to demonstrate proper administration technique. Patient education can minimize the likelihood of local adverse effects associated with faulty administration technique. Patient self-injection should only begin after the patient has received and reviewed a copy of the patient instructions provided by the manufacturer and has been instructed carefully and trained well about proper administration techniques.

Long-term follow-up to the patient and his partner should also be provided to assist in adjusting to alprostadil therapy. Remind patient not to exceed dose limits. The maximum frequency of use is no more than 1 injection per hour period and no more than 3 injections per week.

After adding the diluent but before removing the syringe from the vial, the contents of the vial should be swirled gently until a clear solution is obtained. The desired dose can then be withdrawn into the same syringe. Storage: Unused reconstituted solution may be stored for up to 24 hours if stored below 25 degrees C 77 degrees F and not refrigerated or frozen. The Edex injection device is used to reconstitute the single-dose dual-chamber cartridge.

Use the plunger and force the sterile 0. After reconstitution, the Edex injection device is used to administer the dose of alprostadil; use only with the cartridges and needles supplied in the Edex cartridge packs.

Do not administer unless solution is clear. Do not add any drugs or solutions to the injection solution. Discard unused drug solution.

The reconstituted injection solution should not be stored. After the single-use, the injection device and remaining solution should be discarded. Of note, the needle used for administration of alprostadil solution is a superfine to gauge needle; with such a fine needle, breakage is possible. Patients should be carefully instructed on proper injection technique to minimize the risk of needle breakage. Needles or syringes should not be shared. The needle of the syringe is then positioned so that the drug will be injected into a corpus cavernosum underneath the tunica albuginea along the dorsolateral aspect of the proximal third of the penis.

Visible veins should be avoided. Blood vessels, corpus spongiosum, subcutaneous tissue, urethra, and dorsal neural vascular structures should be avoided as injection sites. Once positioned, the needle of the syringe provided by the manufacturer should be pushed straight into the site using a steady motion until the metal portion of the needle is almost entirely in the penis; the dose should then be injected slowly over 5 to 10 seconds into the chosen corpus cavernosum.

The syringe should be withdrawn and pressure applied to the injection site with an alcohol swab for 5 minutes or until bleeding stops to avoid hematologic complications, especially in patients receiving concomitant anticoagulant therapy.

Injection site and side of the penis should be rotated to minimize adverse effects related to repeated local injection. Patient should be cautioned against use of severely bent needles, reuse of syringes and needles. Give patient instructions on proper disposal of syringes and needles in the puncture-resistant container provided by the manufacturer.

The initial dose titration should occur under the supervision of a physician in order to test a patient's responsiveness, to demonstrate proper administration technique, and to monitor for evidence of hypotension.

After the patient has been instructed on proper administration technique, the alprostadil urethral suppository MUSE may be self-administered.

Remind patients not to exceed recommended dose limits. The maximum frequency of use is no more than 2 urethral suppository systems per hour period. For urethral insertion only. Do not administer by any other route. Key administration points: Immediately prior to administration, patient should urinate and gently shake the penis several times to remove excess urine.

The medicated pellet has been specially developed to dissolve in the small quantity of urine that remains in the urethra after urination. Carefully open the foil pouch and allow the applicator to slide out. Then remove the protective cover from the applicator stem without pushing the applicator button or touching the applicator stem or tip. Save the foil pouch and cover to later discard the MUSE applicator.

Visually inspect the MUSE system to make sure the pellet is present. To straighten the urethra, patient should, while sitting or standing, take several seconds to gently and slowly stretch the penis upward to its full length, with gentle compression from top to bottom of the glans. Slowly insert the MUSE stem into the urethra up to the collar. If any discomfort or a pulling sensation occurs, withdraw the applicator slightly and then gently reinsert.

To administer suppository, gently and completely push down the button at the top of the applicator until it stops to ensure that the medicated pellet is completely released. The patient should then hold the applicator in this position for 5 seconds, then, gently rock the applicator from side to side in order to separate the medicated pellet from the applicator tip.

Instruct the patient not to apply too much pressure in order to avoid scratching the lining of the urethra and causing it to bleed. Remove applicator while keeping the penis upright. Without touching the stem of the applicator, visually inspect the applicator tip to make sure the pellet is no longer in the applicator. If residual medication is present, gently reinsert into the urethra and repeat. After administration, instruct patient to hold the penis upright and stretched to its full length and roll the penis firmly between the hands for at least 10 seconds to ensure that the medication is adequately distributed along the walls of the urethra.

If a burning sensation is felt, the patient may continue to roll the penis for an additional 30 to 60 seconds or until the burning subsides.

Then, to increase blood flow to the penis and enhance erection, the patient should sit, stand, or walk about for 10 minutes while the erection is developing. Instruct patient on proper disposal of unit.

Caverject: - Protect from freezing - Store below 77 degrees F Caverject Impulse: - Do not freeze - Store unreconstituted product at 68 to 77 degrees F; excursions permitted to 59 to 86 degrees F Edex: - Discard product if it contains particulate matter, is cloudy, or discolored - Reconstituted product should be used immediately.

Discard unused portion - Store at 77 degrees F; excursions permitted to degrees F Muse: - Product may be used for up to 14 days if kept below 86 degrees F after container is opened - Store unopened containers in refrigerator 36 to 46 degrees F Prostin VR: - Refrigerate between 36 and 46 degrees F. Post-mortem tissue sections of the ductus and pulmonary arteries from infants treated with alprostadil infusions at the usual doses for 10 hours to 12 days and who died of causes unrelated to ductus structural weakness have shown intimal lacerations, a decrease in medial muscularity and disruption of the medial and internal elastic lamina.

Localized and aneurysmal dilatations and vessel wall edema also were noted. The incidence and clinical implications of these structural alterations has not been defined. Always select the proper product e. Given the indications for use for adult male erectile dysfunction, alprostadil intracavernosal injection e. Alprostadil intracavernosal injections e. The preservative has been associated with reports of fatal 'gasping syndrome' in neonates; symptoms include a striking onset of gasping respiration, CNS depression, and metabolic acidosis.

The minimum amount of benzyl alcohol at which toxicity may occur is not known. The risk of benzyl alcohol toxicity depends on the quantity administered and the hepatic and renal capacity to detoxify the chemical.