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1st time injection - alprostadil

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Posted 12/10/2013 2:48 PM (GMT 0)
Got my PSA result today (4.5 mos)...<0.1
Dr. prescribed 2 doses of 20mcg alprostadil(caverjet) for my ED prob.
At the clinic during Dr. show how, a smaller dose of 10mcg was injected...respond only 70% errection for about 50mins, so he gave me a double up prescription of 20mcg, as a 1st time user I m worried that the double up doses will develop priaprism.
Could fellow members who had experiences on this drug advise on the ideal dosage pls...many thanks
Posted 12/10/2013 3:11 PM (GMT 0)
I wouldn't worry so much about priaprism as I would about a trip to the ER. My steps with Trimix went from "just ok" at .10, to road trip to the ER 4 hours later at .13.

But some here have to inject amounts that I find difficult to even consider, so ... Keep notes of your reactions and location sites, as moving from one side to the other (my uro specifies alternating injection side) could easily give different results.
Posted 12/11/2013 4:18 AM (GMT 0)
hmmmm ... 70% for 50 minutes at 10mcg -- that's a great response and above the penetration threshold (considered to be 60%). It would seem to me that doubling the dose is going too far.

IMO you should increase the dose by a small amount each time, and even try each dose amount more than once just to be sure of the response. Be patient; you'll find the right dose eventually. Just so you know, I do not have any experience with caverject; only with Trimix. BTW, my Doc had me start at home on a dose lower than what he used in the office, because he said I'd have less anxiety at home and wouldn't need as much.

Good Luck -- Tigerfan
Posted 12/11/2013 4:38 AM (GMT 0)
I would next try 15 mcg (at most), not 20 mcg. I have found 2-3 mcg can make a big difference and the same dose that gives a 90%/1hr response one time can give a 110%/3hr response the next.

From the labeling for Edex (alprostadil)...

DOSAGE AND ADMINISTRATION
edex® in the Treatment of Erectile Dysfunction
The dosage range of edex® for the treatment of erectile dysfunction is 1 to 40 mcg. The intracavernous injection should be given over a 5 to 10 second interval. In a study with a dose range of 1 to 20 mcg of edex®, the mean dose was 10.7 mcg at the end of the dose titration period. In two studies with a dose range of 1 to 40 mcg of edex®, the mean dose was 21.9 mcg at the end of the dose titration period. Doses greater than 40 mcg have not been studied. A ½ inch, 27 to 30 gauge needle is generally recommended for the intracavernous injection. The patient is advised not to exceed the optimum edex® dose which was determined in the doctor's office. The lowest possible effective dose should always be used.

Initial Titration in Physician's Office
Erectile Dysfunction of Vasculogenic, Psychogenic, or Mixed Etiology
Dosage titration should be initiated at 2.5 micrograms of alprostadil. If there is a partial response, the dose may be increased by 2.5 micrograms to a dose of 5 micrograms and then in increments of 5 to 10 micrograms, depending upon 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-microgram dose, the second dose may be increased to 7.5 micrograms, followed by increments of 5 to 10 micrograms. The patient must stay in the physician's office until complete detumescence occurs. It there is no response, then the next higher dose may be given within 1 hour. If there is a response, then there should be at least a 1-day interval before the next dose is given.
Posted 12/11/2013 5:08 AM (GMT 0)
Thanks for the reply, likewise I also think 20mcg is way too much.
At the clinic, after 15mins of the 10mcg injection Dr. took a look on my willy, he suggested can be better, In fact I was asking for a 15mcg prescription but the pharmacy don't have such pre-prepared syringe. Think I will increase to 13mcg... for my dosage.
Thanks again...bros
Posted 12/11/2013 4:02 PM (GMT 0)
I guess things are changing. I had not heard of pre-filled syringes until a thread just a few weeks ago. I get a vial and draw up what I want. I guess pre-filled is easier, and they can likely charge more for it.

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Posted 12/11/2013 6:09 PM (GMT 0)
142,

That was me ( you may now recall ) a couple weeks ago.

Remember I was having problem with Priapism....Well, after talking/working with Dr. & pharmacy, come to find that they were filling those prefilled syringes with 50 units of Trimix ( in error ) that turns out to be about 4 times as much as I really need..As you say, about 12 or 13mcg is about right.

Two of those nights of Priapism I should have gone to hospital but didn,t. Fortunately, got away with it !

Y'all and he are certainly correct to proceed with caution.

regards,

Posted 12/12/2013 1:42 AM (GMT 0)
is that pre-filled syringe EDEX? My understanding from my Uro is that there is much less of a chance of having to make the ER run with alprostadil. I have never had a problem with it at all. Some of the guys have had problems with the ache that it can cause.

To be safe I would not double up on the dose. Just keep increasing the dose to you get the erection that you need for the amount of time that you need it.

Cajun Jeff
Posted 12/13/2013 7:45 AM (GMT 0)
Thanks Jeff & bros..
Yah...you all are right..l injected 13mcg only managed to obtain a 80% erection..after penetration for around 20 mins my willy was in seious ache..Hmmm...look like I m oso 1 of e 37% patient not suitable for asprostadil..And gosh..it can sustain erection for more than 2hrs...What an aching experience with this drug.
Posted 12/13/2013 9:08 PM (GMT 0)
Yep sounds like your going to need bimix.
Posted 12/13/2013 9:24 PM (GMT 0)

Cajun Jeff said...
Yep sounds like your going to need bimix.

Not necessarily. The synergistic effect of the three drugs in Trimix allows the same effect with smaller doses of alprostadil. The reason doctors prescribe trimix is that many men who can't use alprostadil can use trimix. For those who can't tolerate the smaller dose in trimix there is bimix which doesn't cause an alprostadil ache but doesn't work as well. Going straight to bimix would seem to be missing a step.

At least that's how I understand it.
Posted 12/13/2013 10:36 PM (GMT 0)
Many people here have had success with bimix.
Posted 12/14/2013 1:43 AM (GMT 0)
Thanks to all the suggestions bros
Will be meeting the urologist on tues to discuss the prescriptions..
Posted 12/19/2013 12:15 AM (GMT 0)
Season Greetings to all !!!
Now I come back with prescription with Tri-mix from the urologist...
The mixture :
prostaglandin(PGE-1) - 5mcg
phentolamine - 0.5mg
papaverine - 20gm
pre-filled in 1ML syringe (my dosage: 1ml per injection)

Looks to me that the proposed dosage will be over my requirement. I m thinking perhaps 0.2 or 0.3ml to avoid landing @ ER
Could experience member user of this mixture care to advice.
Many thanks
Posted 12/19/2013 12:48 AM (GMT 0)
The "dosage" in trimix prescriptions is simply to justify the vial size and how many syringes they issue with the kit (mine is a package deal, vials, syringes, smaller second needle for injection, alcohol wipes). The law requires that instructions be provided on the label. Since you have a prefill that would be a single use, the content would be the dosage. My uro told me to use .10 and move up slowly if needed.

Follow the agreed instructions with the uro.

This pre-filled deal is interesting, but would be a real mess to keep dozens in the freezer, and be a horrible waste for me - use .1, ditch .9. My freezer is too small already.
Posted 12/19/2013 10:43 PM (GMT 0)
As I can see my prescription is quite similar to the tri-mix#1 prescribed in states. Its combination is quite "low". I think to start with 0.1ml & disregard the 0.9ml will not get a good result. I have read thru some of the trimix threads, members on the "lower" mixtures were starting @ 0.2ml. With some increasing to 0.5ml to get better result.
The urologist I m seeing ain't familiar with ED drugs. It seem to me he knows only which drug to prescribe, dosage he is not sure.
My 1st experience on alprostadil nearly land myself in ER if I followed his instruction. Lucky for me, I have this forum members to advice. Thanks ...guys
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