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Alprostadil: Pediatric drug information

Alprostadil: Pediatric drug information
2024© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Alprostadil: Drug information" and "Alprostadil: Patient drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Apnea (Prostin VR Pediatric):

Apnea is experienced by about 10% to 12% of neonates with congenital heart defects treated with alprostadil pediatric sterile solution. Apnea is most often seen in neonates weighing less than 2 kg at birth and usually appears during the first hour of drug infusion. Therefore, monitor respiratory status throughout treatment, and use alprostadil pediatric injection where ventilatory assistance is immediately available.

Brand Names: US
  • Caverject;
  • Caverject Impulse;
  • Edex;
  • Muse;
  • Prostin VR
Brand Names: Canada
  • Caverject;
  • Muse;
  • Prostin VR
Therapeutic Category
  • Prostaglandin
Dosing: Neonatal
Congenital diaphragmatic hernia-related pulmonary hypertension

Congenital diaphragmatic hernia-related pulmonary hypertension: Note: May consider in patients with supersystemic levels of pulmonary hypertension or right ventricle failure (Ref). Very limited data in preterm neonates; limited data available in term neonates; optimal dose not established:

Neonates: Continuous IV infusion: Usual dose: 0.01 to 0.05 mcg/kg/minute; reported range: 0.003 to 0.2 mcg/kg/minute (Ref).

Ductus arteriosus patency, maintenance

Ductus arteriosus patency, maintenance: Preterm and term neonates: Continuous IV infusion: Initial: 0.01 to 0.05 mcg/kg/minute; range: 0.01 to 0.1 mcg/kg/minute; titrate gradually based on clinical response; maximum dose: 0.4 mcg/kg/minute; once therapeutic response is achieved, reduce rate to lowest effective dose (Ref). Note: Higher doses may be required in patients receiving extracorporeal membrane oxygenation support (Ref).

Dosing: Pediatric
Ductus arteriosus patency, maintenance

Ductus arteriosus patency, maintenance: Infants: Continuous IV infusion: Initial: 0.05 to 0.1 mcg/kg/minute; once therapeutic response is achieved, reduce rate to lowest effective dosage; with unsatisfactory response, increase rate gradually; usual maintenance: 0.01 to 0.4 mcg/kg/minute. Note: Therapeutic response is indicated by an increase in systemic blood pressure and pH in those with restricted systemic blood flow and acidosis, or by an increase in oxygenation (pO2) in those with restricted pulmonary blood flow.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Adult

(For additional information see "Alprostadil: Drug information")

Erectile dysfunction

Erectile dysfunction, treatment:

Intracavernous (Caverject, Caverject Impulse, Edex): Individualize dose by careful titration; doses >40 mcg (Edex) or >60 mcg (Caverject) are not recommended: Initial dose must be titrated in health care provider setting. Patient must stay in the health care setting until complete detumescence occurs; if there is no response, then the next higher dose may be given within 1 hour; if there is still no response, a 1-day interval before giving the next dose is recommended; doses should be titrated to the lowest effective dose; increasing the dose or concentration in the treatment of impotence results in increasing pain and discomfort.

Initial dose titration: According to the prescribing information for Caverject and Caverject Impulse, no more than 2 doses should be given within a 24-hour period during the initial titration.

Vasculogenic, psychogenic, or mixed etiology: Initiate dosage titration at 2.5 mcg.

If there is a partial response, administer another dose of 2.5 mcg within 1 hour; if additional titration is needed, administer doses in increments of 5 to 10 mcg at least 24 hours apart (depending on erectile response) until the dose that produces an erection suitable for intercourse and not exceeding a duration of 1 hour is reached.

If there is no response to the initial 2.5 mcg dose, the second dose may be increased to 7.5 mcg and administered within 1 hour, followed by increments of 5 to 10 mcg (Edex).

If there is a response, then there should be at least a 24-hour interval before the next dose is given.

Neurogenic etiology (eg, spinal cord injury): Note: Caverject powder must be used to prepare a 1.25 mcg dose: Initiate dosage titration at 1.25 mcg; if there is a partial response, administer another dose of 1.25 mcg within 1 hour; if additional titration is needed, administer a dose of 5 mcg at least 24 hours later. Repeat the titration as needed until an optimal dose is reached that produces an erection suitable for intercourse and not exceeding a duration of 1 hour.

Maintenance: Once an appropriate dose has been determined, patient may self-administer injections at a frequency of no more than 3 times/week with at least 24 hours between doses; reevaluate every 3 months (or as clinically appropriate) to determine if dosage adjustments are needed.

Intraurethral (Muse Pellet):

Initial: 125 to 250 mcg; dose may be increased or decreased on separate occasions in a stepwise manner until the patient achieves an erection that is sufficient for sexual intercourse.

Maintenance: Administer as needed to achieve an erection; duration of action is about 30 to 60 minutes; use only two systems per 24-hour period.

Erectile dysfunction, adjunct to the diagnosis of (Caverject, Caverject Impulse): Intracavernous: As an adjunct to laboratory tests (eg, duplex or Doppler ultrasound), administer a single dose that induces a rigid erection; see vasculogenic, psychogenic, or mixed etiology dosage regimen.

Raynaud phenomenon

Raynaud phenomenon, refractory or digital ischemia (off-label use):

Note: Consider for use in patients who have suboptimal response to first-line oral therapies (Ref).

IV: 60 mcg over 3 hours once daily for 5 or 6 consecutive days; may repeat this same regimen at 6-week intervals or may administer a maintenance dose of 60 mcg over 3 hours once every 30 days (Ref).

Dosage adjust ment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Intraurethral:

>10%: Genitourinary: Penile pain, urethral burning

2% to 10%:

Central nervous system: Dizziness, headache, pain

Genitourinary: Testicular pain, urethral bleeding (minor), vulvovaginal pruritus (female partner)

<2%: Leg pain, perineal pain, tachycardia

Intracavernosal injection:

>10%: Genitourinary: Penile pain

1% to 10%:

Cardiovascular: Hypertension

Central nervous system: Dizziness, headache

Genitourinary: Prolonged erection (>4 hours, 4%), penile disease, penile rash, penile swelling, Peyronie's disease

Local: Bruising at injection site, hematoma at injection site

<1%: Balanitis, injection site hemorrhage, priapism (0.4%)

Intravenous:

>10%:

Cardiovascular: Flushing

Respiratory: Apnea

Miscellaneous: Fever

1% to 10%:

Cardiovascular: Bradycardia, cardiac arrest, edema, hypertension, hypotension, tachycardia

Central nervous system: Dizziness, headache, seizure

Endocrine & metabolic: Hypokalemia

Gastrointestinal: Diarrhea

Hematologic & oncologic: Disseminated intravascular coagulation

Infection: Sepsis

Local: Local pain (in structures other than the injection site)

Neuromuscular & skeletal: Back pain

Respiratory: Cough, flu-like symptoms, nasal congestion, sinusitis, upper respiratory tract infection

<1%: Anemia, anuria, bradypnea, cardiac failure, cerebral hemorrhage, gastroesophageal reflux disease, hematuria, hemorrhage, hyperbilirubinemia, hyperemia, hyperirritability, hyperkalemia, hypoglycemia, hypothermia, jitteriness, lethargy, neck hyperextension, peritonitis, second degree atrioventricular block, shock, stiffness, supraventricular tachycardia, thrombocytopenia, ventricular fibrillation, wheezing (bronchial)

Contraindications

Intracavernous: Hypersensitivity to alprostadil or any component of the formulation; conditions predisposing men to priapism (eg, sickle cell anemia or trait, multiple myeloma, leukemia); men with anatomical deformation or fibrotic conditions of the penis (eg, angulation, cavernosal fibrosis, or Peyronie disease); penile implants

IV: There are no contraindications listed in the US labeling.

Canadian labeling: Cyanotic neonates with persistent circulation; neonates with total anomalous pulmonary venous return below the diaphragm; neonates with polysplenia or asplenia in whom pulmonary atresia is combined with anomalous pulmonary venous return, which may be obstructed

Transurethral: Hypersensitivity to alprostadil or any component of the formulation; urethral stricture, balanitis, severe hypospadias and curvature, and in men with acute or chronic urethritis; men who are prone to venous thrombosis or who have a hyperviscosity syndrome (eg, sickle cell anemia or trait, thrombocythemia, polycythemia, multiple myeloma) predisposing them to priapism; use in men for whom sexual activity is inadvisable; sexual intercourse with a pregnant woman unless a condom barrier is being used

Warnings/Precautions

Concerns related to adverse effects:

• Apnea: [US Boxed Warning]: Prostin VR Pediatric: Apnea may occur in 10% to 12% of neonates with congenital heart defects, especially in those weighing <2 kg at birth. Apnea usually appears during the first hour of drug infusion.

• Hypotension/syncope: Intracavernous injections can increase peripheral blood levels of alprostadil, resulting in hypotension. Syncope has also been reported. Avoid use in men with known cavernosal venous leakage. Patients must be cautioned to avoid tasks such as operating machinery or driving following administration where injury could result if hypotension or syncope were to occur.

• Penile fibrosis: May occur when used for erectile dysfunction; discontinue use in men who develop penile angulation or cavernosal fibrosis.

• Priapism/prolonged erection: May occur when used for erectile dysfunction; instruct patient to seek immediate medical assistance if an erection persists ≥4 hours; discontinue therapy if priapism or prolonged erection occurs or if signs of penile fibrosis develop (penile angulation, cavernosal fibrosis, or Peyronie disease). To minimize the chances of prolonged erection or priapism, titrate slowly to the lowest effective dose. Use is contraindicated in men who have conditions that predispose them to priapism (eg, sickle cell anemia or trait, multiple myeloma, leukemia). Underlying causes of erectile dysfunction should be evaluated and treated prior to therapy.

Disease related concerns:

• Cardiovascular disease: Treatment for erectile dysfunction should not be used in men whom sexual activity is inadvisable because of underlying cardiovascular status.

Special populations:

• Neonates: Prostin VR Pediatric: Use with caution in neonates with bleeding tendencies.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.

Other warnings/precautions:

• Administration: Muse: Urethral abrasion resulting in minor bleeding or spotting may occur from improper administration.

• Needle breakage: Caverject and Caverject Impulse: A superfine needle is used for administration. Needle breakage (a portion of the needle remaining in the penis) has been reported; hospitalization and surgical removal may be necessary.

• Patency of ductus arteriosus: Appropriate use: Prostin VR Pediatric: Infuse for the shortest time at the lowest dose consistent with good patient care. Use for >120 hours has been associated with antral hyperplasia and gastric outlet obstruction.

Warnings: Additional Pediatric Considerations

Alprostadil should not be used in neonates with respiratory distress syndrome; full diagnostic workup should be done to differentiate between respiratory distress syndrome and cyanotic heart disease. Cortical proliferation of long bones has been associated with long-term infusions of alprostadil; most cases of bone changes occurred 4 to 6 weeks after starting alprostadil, but has occurred as early as 9 days. In a study of 86 infants awaiting cardiac transplant, the incidence of hyperostosis was 42% at <30 days of alprostadil infusion, 87% at 30 to 60 days and 100% at >60 days. Cortical hyperostosis usually resolves over 6 to 12 months after stopping alprostadil (Kaufman 1996; Woo 1994).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Kit, Intracavernosal:

Caverject Impulse: 10 mcg, 20 mcg [contains benzyl alcohol, lactose]

Edex: 10 mcg, 20 mcg, 40 mcg [pyrogen free; contains lactose]

Pellet, Urethral:

Muse: 125 mcg (1 ea [DSC], 6 ea [DSC]); 250 mcg (1 ea, 6 ea); 500 mcg (1 ea, 6 ea); 1000 mcg (1 ea, 6 ea)

Solution, Injection:

Prostin VR: 500 mcg/mL (1 mL) [contains alcohol, usp]

Generic: 500 mcg/mL (1 mL [DSC])

Solution Reconstituted, Intracavernosal:

Caverject: 40 mcg (1 ea) [contains benzyl alcohol, lactose]

Solution Reconstituted, Intracavernosal [preservative free]:

Caverject: 20 mcg (1 ea) [contains lactose]

Generic Equivalent Available: US

May be product dependent

Pricing: US

Kit (Caverject Impulse Intracavernosal)

10 mcg (per each): $98.62

20 mcg (per each): $126.98

Kit (Edex Intracavernosal)

10 mcg (per each): $204.62

20 mcg (per each): $264.35

40 mcg (per each): $360.98

Pellet (Muse Urethral)

250 mcg (per each): $81.78

500 mcg (per each): $87.53

1000 mcg (per each): $94.51

Solution (Prostin VR Injection)

500 mcg/mL (per mL): $175.54

Solution (reconstituted) (Caverject Intracavernosal)

20 mcg (per each): $126.01

40 mcg (per each): $166.22

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Kit, Intracavernosal:

Caverject: 20 mcg [contains benzyl alcohol, lactose]

Pellet, Urethral:

Muse: 250 mcg (1 ea); 500 mcg (1 ea); 1000 mcg (1 ea)

Solution, Injection:

Prostin VR: 500 mcg/mL (1 mL) [contains alcohol, usp]

Solution Reconstituted, Intracavernosal:

Caverject: 20 mcg (1 ea) [contains lactose]

Administration: Pediatric

Continuous IV infusion: Administer into a large vein or alternatively through an umbilical artery catheter placed at the ductal opening.

Rate of infusion (mL/hour) = dose (mcg/kg/minute) x weight (kg) x 60 minutes/hour divided by concentration (mcg/mL)

Administration: Adult

Intracavernous: Erectile dysfunction:

Caverject: Wipe the intended injection site with an alcohol swab prior to injection. Use a 1/2 inch, 29- or 30-gauge needle. Inject into the dorsolateral aspect of the proximal third of the penis, avoiding visible veins; alternate side of the penis for injections. Compress the site of injection with an alcohol swab or sterile gauze for 5 minutes after administration.

Caverject Impulse: Supplied as a disposable, single-dose, dual chamber syringe system. Wipe the intended injection site with an alcohol swab prior to injection. After attaching the provided needle assembly, select dose and inject into the dorsolateral aspect of the proximal third of the penis, avoiding visible veins; alternate side of the penis for injections. Compress the site of injection with an alcohol swab or sterile gauze for 5 minutes after administration.

Edex: Wipe the intended injection site with an alcohol swab prior to injection. Use a 1/2 inch, 27- to 30-gauge needle. Inject into the dorsolateral aspect of the proximal third of the penis, avoiding visible veins; alternate side of the penis for injections. Administer over a 5- to 10-second interval. Compress the site of injection with an alcohol swab for 5 minutes after administration.

Intraurethral: Erectile dysfunction:

Muse: Insert immediately after urination. Prior to insertion, remove the product from the foil pouch and remove the protective cover from the applicator stem; ensure medicated pellet is present. While sitting or standing, 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. Gently press down on the button at the top of the applicator until it stops; leave applicator in place for 5 seconds. Gently rock the applicator from side to side then remove the applicator while keeping the penis upright. If there is residual medication at the end of the applicator, reinsert the applicator and repeat prior steps. Once the applicator is removed, hold the penis upright and stretched to its full length, and roll firmly between hands for at least 10 seconds. Standing or walking for about 10 minutes after administration will increase blood flow and enhance erection.

IV: Raynaud phenomenon, refractory or digital ischemia (off-label use): Dilute dose in 250 mL of NS or D5W. Administer 60 mcg over ~3 hours through a peripheral vein (Ref).

Usual Infusion Concentrations: Neonatal

IV infusion: 5 mcg/mL, 10 mcg/mL, or 20 mcg/mL.

Usual Infusion Concentrations: Pediatric

IV infusion: 5 mcg/mL, 10 mcg/mL, or 20 mcg/mL.

Storage/Stability

Caverject Impulse: Store unreconstituted product at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F). Following reconstitution, store at 2°C to 25°C (36°F to 77°F) and use within 24 hours (do not freeze). Discard any unused solution.

Caverject powder: Store 20 mcg vials at 20°C to 25°C (68°F to 77°F). Store 40 mcg vials at 2°C to 8°C (36°F to 46°F) until dispensed. After dispensing, stable for up to 3 months at or below 25°C (77°F). Following reconstitution, all strengths should be stored at or below 25°C (77°F); do not refrigerate or freeze; use within 24 hours.

Edex: Store at 25°C (77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F).

Muse: Store at 2°C to 8°C (36°F to 46°F); may be stored at room temperature (below 30°C [86°F]) for up to 14 days. Do not expose to temperatures >30°C (86°F). Each system is for single use only; discarded after use.

Prostin VR Pediatric: Refrigerate at 2°C to 8°C (36°F to 46°F). Extended storage information at room temperature may be available; contact product manufacturer to obtain current recommendations.

Use

Prostin VR Pediatric: Temporary maintenance of patency of ductus arteriosus in neonates with ductal-dependent congenital heart disease until surgery can be performed (FDA approved in neonates)

Caverject, Caverject Impulse: Diagnosis (adjunct to other diagnostic tests) and treatment of erectile dysfunction (FDA approved in adult males)

Edex, Muse: Treatment of erectile dysfunction (FDA approved in adult males)

Medication Safety Issues
Sound-alike/look-alike issues:

Alprostadil may be confused with alPRAZolam

Prostin VR may be confused with Prostin E2 (dinoprostone)

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Landiolol: Alprostadil may diminish the therapeutic effect of Landiolol. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the adverse/toxic effect of Alprostadil. Risk X: Avoid combination

Reproductive Considerations

Muse is contraindicated in males having sexual intercourse with a pregnant woman unless a condom barrier is being used.

Pregnancy Considerations

Alprostadil is not indicated for use in women.

Monitoring Parameters

Blood pressure, respiratory rate, heart rate, temperature, pO2; signs and symptoms of apnea and necrotizing enterocolitis (Akkinapally 2018). With prolonged administration (>120 hours), monitor for gastric outlet obstruction, cortical hyperostosis, and brown fat necrosis; x-rays may be needed to assess cortical hyperostosis (Akkinapally 2018).

Mechanism of Action

Causes vasodilation by means of direct effect on vascular and ductus arteriosus smooth muscle; relaxes trabecular smooth muscle and dilates cavernosal arteries when injected along the penile shaft, allowing blood flow to and entrapment in the lacunar spaces of the penis (ie, corporeal veno-occlusive mechanism)

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Erectile dysfunction: 5 to 20 minutes

Duration: Ductus arteriosus will begin to close within 1 to 2 hours after drug is stopped; Erectile dysfunction: Intended duration <1 hour

Distribution: Insignificant following penile injection

Protein binding, plasma: 81% to albumin

Metabolism: IV: ~70% to 80% by oxidation during a single pass through the lungs; metabolite (13,14 dihydro-PGE1) is active and has been identified in neonates

Half-life elimination: 30 seconds to 10 minutes

Time to peak:

Acyanotic congenital heart disease: Usual: 1.5 to 3 hours; Range: 15 minutes to 11 hours.

Cyanotic congenital heart disease: Usual: ~30 minutes

Erectile dysfunction: Intracavernosal 30 to 60 minutes; Transurethral: ~16 minutes

Excretion: Primarily urine (90% as metabolites) within 24 hours; feces

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Pulmonary disease: May have reduced capacity to clear the drug.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Caverject | Muse | Prostin vr | Vitaros;
  • (AR) Argentina: Cardiobron | Caverject | Muse | Prostavasin | Vitaros;
  • (AT) Austria: Caverject | Muse | Prostavasin;
  • (AU) Australia: Caverject | Muse;
  • (BE) Belgium: Caverject | Vytaros;
  • (BG) Bulgaria: Caverject | Prostavasin;
  • (BR) Brazil: Aplicav | Caverject | Muse | Prostavasin;
  • (CL) Chile: Caverject | Vitaros;
  • (CN) China: Bi fa er | Bo le si | Caverject | Fo er shu | Kai shi | Prostaglandin e1 | Prostavasin | Pu kang xi | Pu si tai | Qi nuo ning | Sai er | You di er;
  • (CO) Colombia: Cardiobron | Caverject | Dalveol;
  • (CZ) Czech Republic: Caverject | Prostavasin | Vitaros;
  • (DE) Germany: Caverject | Caverject impuls | Muse | Prostavasin | Viridal | Vitaros;
  • (DO) Dominican Republic: Caverject | Muse;
  • (EC) Ecuador: Caverject;
  • (EE) Estonia: Caverject | Muse | Vasostenoon | Viridal;
  • (EG) Egypt: Prostavasin;
  • (ES) Spain: Alprostadil genfarma | Caverject | Muse | Virirec;
  • (FI) Finland: Caverject | Muse | Rigidur | Vitaros;
  • (FR) France: Alprostadil intsel chimos | Alprostadil panpharma | Caverject | Caverjectdual | Edex | Muse | Vitaros;
  • (GB) United Kingdom: Caverject | Muse | Viridal | Viridal duo | Vitaros;
  • (GR) Greece: Caverject | Edex | Prostin vr | Vitaros;
  • (HK) Hong Kong: Befar | Caverject | Muse;
  • (HU) Hungary: Alprostadil altan | Caverject | Prostavasin;
  • (ID) Indonesia: Caverject;
  • (IE) Ireland: Caverject | Muse | Viridal | Vitaros;
  • (IL) Israel: Alprostapint | Caverject | Muse;
  • (IN) India: Prostacel | Prostal;
  • (IT) Italy: Caverject | Muse | Prostavasin | Viridal | Vitaros;
  • (JO) Jordan: Caverject | Prostavasin;
  • (JP) Japan: Altesil | Alyprost | Alyprost chemiphar | Apistandin | Ipceryl | Mediprost | Prink | Prink taiyo | Prostandin | Tandetron | Tandetron yamakawa;
  • (KR) Korea, Republic of: Alproalpha | Alprodex | Befar | Caverject | Dong a prostandin | Muse | Prostandin | Stensuh;
  • (KW) Kuwait: Caverject | Muse | Prostavasin;
  • (LB) Lebanon: Caverject | Vitaros;
  • (LT) Lithuania: Caverject | Prostavasin | Vasaprostan | Vazaprostan | Vitaros;
  • (LU) Luxembourg: Caverject | Prostavasin | Vytaros;
  • (LV) Latvia: Caverject | Prostavasin | Vasostenoon | Vazaprostan | Vitaros;
  • (MA) Morocco: Caverject;
  • (MX) Mexico: Caverject | Muse | Prostavasin | Vitaros;
  • (MY) Malaysia: Caverject | Muse;
  • (NL) Netherlands: Alprostadil medcor | Alprostadil recordati | Caverject | Muse | Vitaros;
  • (NO) Norway: Bondil | Caverject | Caverject impuls | Muse | Vitaros;
  • (NZ) New Zealand: Caverject | Muse;
  • (PE) Peru: Caverject;
  • (PH) Philippines: Caverject | Prostavasin;
  • (PK) Pakistan: Caverject | Prostavasin;
  • (PL) Poland: Prostavasin | Prostin vr | Vytaros;
  • (PR) Puerto Rico: Caverject | Edex | Muse;
  • (PT) Portugal: Caverject | Muse | Vasoprost | Vitaros;
  • (PY) Paraguay: Alprostadil quimfa;
  • (QA) Qatar: Caverject | Prostin VR;
  • (RO) Romania: Alprostadil pint | Alprostadil rompharm | Vasaprostan | Vitaros;
  • (RU) Russian Federation: Arteris vero | Caverject | Coverject | Edex | Prostavasin | Prostin vr | Vazaprostan;
  • (SA) Saudi Arabia: Caverject | Muse | Vitaros;
  • (SE) Sweden: Bondil | Caverject | Rigidur | Rigidur Duo | Virilan | Vitaros;
  • (SG) Singapore: Caverject | Muse;
  • (SI) Slovenia: Caverject;
  • (SK) Slovakia: Caverject | Prostavasin | Vitaros;
  • (TH) Thailand: Caverject | Prostin vr;
  • (TN) Tunisia: Caverject;
  • (TR) Turkey: Jectera;
  • (TW) Taiwan: Alprosm | Caverject | Promostan;
  • (UA) Ukraine: Albioprostadil | Caverject | Edex | Vasaprox alpha | Vazaprostan;
  • (UY) Uruguay: Cardiobron | Caverject;
  • (VE) Venezuela, Bolivarian Republic of: Caverject;
  • (ZA) South Africa: Muse;
  • (ZM) Zambia: Caverject
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