Alprostadil

Alprostadil (prostaglandin E1 [PGEJ; Edex, Topiglan) exerts a number of effects, including systemic vasodila-tion, inhibition of platelet aggregation, and stimulation of intestinal motility. PGE1 relaxes isolated smooth muscle cells contracted by norepinephrine. It has become widely used in the treatment of ED. Alprostadil binds with PGE receptors and results in a cyclic adeno-sine monophosphate (cAMP) mediated smooth muscle relaxation. Little is known about the pharmacokinetics of PGE1, but it is believed that as much as 80% is metabolized in one pass through the lungs. Such rapid degradation probably accounts for its lack of significant cardiovascular side effects when administered intracav-ernosally. PGE1 can also be metabolized in the penis.

PGE1 is not orally effective. Its therapeutic success depends on its being injected intracavernosally or administered transurethrally or intraurethrally. PGE1 has also been used in combination with other agents, such as papaverine. The injection does not appear to produce any long-term side effects on penile smooth muscle. Transurethral therapy with alprostadil, such as MUSE (alprostadil urethral suppository or medicated urethral system for erection) is also an effective therapeutic technique, and there may be a role for this form of administration in selected patients with ED. The intracav-ernosal injection of alprostadil (e.g., alprostadil alfadex; Edex, Viridal) is safe and effective in patients with ED when sildenafil is ineffective. Both of these delivery systems have been used in the treatment of ED. MUSE can also be used in conjunction with a penile constrictor device (e.g., ACTIS).

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