Alprostadil

How it works

It activates prostaglandin receptors to relax vascular and corporal smooth muscle, increasing penile blood inflow to produce an erection, and dilating ductal smooth muscle in neonates.

Prescribing in practice

• Prolonged erection or priapism can occur; patients must seek urgent medical attention if an erection lasts beyond a few hours to avoid permanent damage.
• In neonates given by infusion, apnoea is a recognised effect requiring respiratory monitoring and resuscitation facilities.
• For erectile dysfunction it is administered as an intracavernosal injection or intraurethral preparation by an appropriately trained user.

Monitoring

For neonatal use, monitor respiration, temperature and blood pressure continuously; for erectile dysfunction, review response and any prolonged erection.

Counselling the patient

• Seek urgent help if an erection lasts longer than a few hours.
• Follow the taught injection or applicator technique carefully and report penile pain or fibrosis.

Evidence & guidelines

Alprostadil is an established second-line therapy for erectile dysfunction and standard for maintaining ductal patency in duct-dependent neonatal cardiac lesions.