Caverject®
Intracavernous injection.
It is recommended to use a needle size 27-30 G, length 13 mm. The injection site is the dorsolateral part of the proximal third of the penis.
Selecting the starting dose in the doctor's office
The dose is selected individually for each patient by careful titration under the supervision of a physician. The following regimen should be followed, taking into account the erectile response, until a dose is reached that causes an erection of sufficient duration for sexual intercourse, but not more than 60 minutes. If there is no response to a certain dose, then the next higher dose can be administered after 1 hour.
If there is a response, the interval between doses should be at least 1 day. The patient should remain in the doctor's office until complete detumescence occurs.
| Neurogenic etiology (Spinal cord injury) | Vascular, psychogenic and mixed etiology | |
| Initial injection | 1.25 mcg | 2.5 mcg |
| Second injection | 2.5 mcg | For partial response to first injection: 5 mcg If no response: 7.5 mcg |
| Third injection | 5 mcg | With a subsequent increase in dose by 5-10 mcg |
| The amount of stepwise dose increase until the optimal dose is achieved | 5 mcg | 5-10 mcg |
Maintenance therapy
The dose chosen for self-injection should cause the patient to have an erection sufficient for sexual intercourse, lasting no more than 1 hour.
If the duration of erection exceeds 1 hour, the dose should be reduced. Self-treatment at home should begin with the dose prescribed in the doctor's office.
If necessary, dosage changes should be made only after consultation with a doctor and in accordance with the dosage instructions. The lowest effective dose should be administered. The recommended frequency of injections is no more than three times a week, but not more than once a day. An erection usually occurs 5-20 minutes after the injection.
The average dose of alprostadil at the end of 6 months of therapy was 20.7 mcg. In most patients, the maintenance dose was 5-20 mcg. Doses above 60 mcg are not recommended.
Additional diagnostic tool for erectile dysfunction
In the simplest test for erectile dysfunction (pharmacological test), after intracavernosal administration of the drug Caverject®, the patient is observed to develop an erection. Caverject® is also used in addition to laboratory tests, such as duplex or Doppler ultrasound, xenon-133 washout test, radioisotope phallography and penile arteriography, which allows visualization and assessment of the condition of the penile vessels. In any case, a single dose of Caverject® should be used, which causes a normal erection.
Dilution and self-administration procedure
For dilution, use only the supplied solvent or water for injection with benzyl alcohol 0.9%. After dilution in 1 ml of solvent, the volume of the resulting solution is 1.13 ml. 1 ml of this solution, bottles with a dosage of 10 mcg and 20 mcg, will contain 10.5 mcg or 20.5 mcg of alprostadil, respectively, but after injection, 10 mcg or 20 mcg of alprostadil will enter the body, respectively, since 0.5 mcg is lost due to adsorption on the walls of the syringe and vial. After diluting the drug, do not add any substances to the bottle.
Before administration, the solution must be checked visually for the presence of particles or color changes.
1.Wash your hands with soap and water.
2.Remove the plastic protective cap from the bottle.
3.Use one of the provided alcohol wipes to wipe the rubber stopper of the bottle (you will need a second wipe later). The used tissue should be thrown away.
4.Unpack the large needle marked 22G11/2 without removing the plastic protective cap. Connect the needle to the syringe by carefully screwing it into the thread.
5.Carefully remove the protective cap from the needle. ( Fig. 1
)
6.Holding the syringe with the needle tip up, move the syringe plunger towards the o (to remove excess water from the syringe.)
7.Poke the needle into the rubber stopper of the bottle in its central part and press the plunger down to introduce water into the bottle.
8.Carefully holding the syringe and bottle as one unit, use light circular movements until the powder is completely dissolved. Do not use the drug if the resulting solution is cloudy, or has become colored, or contains any particles.
9.Turn the bottle upside down without removing the syringe. After making sure that the tip of the needle is below the liquid level, slowly pull the syringe plunger towards you until the solution level reaches the mark corresponding to the selected dose.
10.To remove air bubbles, lightly tap the syringe, or inject the solution back into the vial, and then slowly draw it into the syringe again.
11.Remove the needle from the bottle and carefully put the protective cap on it.
12.Open the package with a smaller needle (30G1/2), but do not take out the needle, but put the package aside.
13.Remove the larger needle and protective cap from the syringe and set it aside for later discarding.
14. Holding the syringe in one hand, take a smaller needle from the opened package, without removing the plastic protective cap from it, and connect it to the syringe as you did with a larger needle.
Rice. 2.
A cross-section of the penis shows the injection sites.
Rice. 3.
Penis, top view: injection sites are shaded.
The drug should be injected into one of two areas of the penis called the corpora cavernosa.
15. The procedure for self-administration of the drug should be carried out in a sitting, standing or reclining position.
16.Inject only into the places indicated in Fig. 2 and 3. Avoid contact with visible veins. Repeated injections should be performed alternately on one and the other side of the penis. Each time you should select a new injection point on the appropriate side.
17.Grip the head of the penis with your thumb and forefinger. Pull back the penis and hold it firmly with your fingers so that it does not slip out during the procedure. Men who have not been circumcised (excision of the foreskin) should retract the foreskin to accurately locate the injection site.
18.Carefully clean the skin at the injection site with an unused cloth soaked in alcohol. Set this napkin aside.
19.Grip the syringe with your thumb and forefinger without placing your thumb on the plunger. Using a firm motion, insert the needle at a 90-degree angle into the injection site indicated by your doctor.
Rice. 4
. Inserting a needle into the injection site.
20.Use your thumb or index finger to press down on the plunger. Inject the entire contents of the syringe with a slow, steady motion.
21.Remove the needle from the penis. Holding the penis on both sides, press a cloth soaked in alcohol to the injection site and hold it there for about 3 minutes. If blood appears, you should press the napkin until the bleeding stops.
22. After using the contents of this package, all materials should be discarded according to appropriate safety regulations.
Pharmacodynamics and pharmacokinetics
Pharmacodynamics
The drug is an analogue of PgE1, has a vasodilator effect mainly at the level of arterioles, muscular arteries and precapillary sphincters, and also has angioprotective and antiplatelet effects. When the drug is administered into the cavernous bodies of the penis, alpha1-adrenergic receptors are blocked, microcirculation and blood flow in the smooth muscles of the cavernous bodies and dilatation of the lacunar spaces are enhanced. At the same time, venous outflow is limited, which stimulates an erection. The effect appears 10-15 minutes after administration and lasts up to three hours.
Pharmacokinetics
The drug, when administered intravenously, is rapidly metabolized by oxidation. As a result of oxidation processes, various metabolites are formed that have a relatively low biological effect relative to alprostadil. Excreted by the kidneys (about 90% of the dose) and in feces. When administered into the corpora cavernosa, the level of the main metabolite of the drug in the peripheral blood increased within 30 minutes and returned to the initial level one hour after injection. Alprostadil binds predominantly to albumin (81%). No significant binding to leukocytes or erythrocytes is observed.
Price
You can buy a certified medicinal product only in specialized clinics and pharmacies with a prescription. There are websites selling the stimulant, where you can purchase it without a prescription. However, in this case, the quality guarantee remains in doubt.
The cost of a single dose of the drug in a pharmacy depends on the company and country of manufacture, volume, pharmacological network and ranges from 850-1500 rubles. The drug is also sold in sets of several ampoules, therefore, the price of Caverject will be higher in this case.
Buying online will be cheaper, but you need to add up the delivery of the goods, plus take into account the likelihood of receiving a counterfeit.
Side effects
The most common local reactions are manifested by burning and pain in the penis, hematoma at the injection site, prolonged erection, fibrosis of the penis, and the formation of fibrous nodules.
Less commonly - balanitis , inflammation, swelling and itching of the injection site, allergic reactions, bleeding from the urethra, numbness of the penis, painful erection, phimosis
, skin hyperemia, ejaculation disorders.
Systemic manifestations include: increased urination, spermatocele , abdominal pain, urge to urinate, tachycardia , decreased blood pressure, hypoesthesia , hyperhidrosis , myasthenia gravis , rash, generalized itching, dry mouth, nausea, calf muscle cramps.
Analogues of the drug "Caverject"
When selecting similar products, emphasis should be placed on the composition of the medications; they must have the same active ingredient and the principle of prescription and procedure.
It is better to give preference to large, proven companies from Western Europe, Japan, and the USA.
The most popular analogues:
- “Alprostan” (Czech Republic “Zentiva”), 10 mcg ampoule, price for 10 pcs. 5500 rubles;
- “Vasaprostan” (Germany “Bayer Pharma”), ampoules of 20 mcg, cost of a package of 10 pieces - 10,000 rubles;
- "Arteris-vero" (Germany "Biologika GmbH"), 60 mcg (1 ampoule) for 12,000 rubles;
- “VAP 20” (Germany “BEG”), 5 ampoules of 20 mcg each, price 3,500 rubles;
- "Alprostadil" (USA PHARMACIA CORPORATION); 1 ampoule (10 mcg), price 1500 rubles.
How to insert caverject into the penis?
We do not recommend introducing caverject yourself.
It is better to have a doctor do this. Treatment of sexual disorders in men . Treatment of impotence . Treatment of erectile dysfunction . Why isn't the dick worth it ? Reviews of treatment at the sarclinic . Sign up for a consultation. There are contraindications. Specialist consultation is required.
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Comments ()
Reviews about Caverject
Reviews about the drug are different, sometimes diametrically opposed:
- “...After psychological trauma, problems with erection arose. After the examination, the doctor prescribed Caverject. I injected half an ampoule a day, 3 times a week. Great effect."
Other patients write that the use of Caverject is ineffective. After its administration, the erection is very short and completely unsuitable for sexual intercourse. Apparently, the patient was given the wrong dose or the dose was not selected at all.
