Caverject 20 mcg

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About Caverject

Caverject (ka-ver-jekt) is used to treat men who can not achieve and/or maintain an erection. Caverject Sterile Powder, which contains alprostadil (al-pros-ta-dil), is available by prescription only and should be used only as directed by your doctor. Your doctor may also use Caverject to help establish the cause of your impotency (or erectile dysfunction).

In response to visual or physical sexual stimulation, the nerves, arteries and veins in your penis act together to create an erection. The nerves cause the smooth muscle of the penis to relax and the blood vessels to expand. The blood becomes trapped in the penis and this allows your penis to become hard and erect.

When Caverject is injected into the blood-filled spaces of the penis (corpora cavernosa; kor-po-rah ka-ver-no-sa) it relaxes the smooth muscle of the penis. This allows more blood to flow into the penis and gives you an erection.

When to Use Caverject

You can use Caverject anytime before sexual intercourse. Caverject is injected into a specific area of the penis and should produce an erection in 5 to 20 minutes. Using the dose recommended by your doctor, you should have an erection lasting up to 1 hour. You may use Caverject for as long as your doctor decides is necessary. Do not use Caverject more than once a day, and not more than 3 times a week, with at least 24 hours between each use.

The Best Dose for You

Impotence can have a variety of causes that will be assessed by your doctor. The right dose of Caverject will depend on the nature of your impotence. Also, some people are more sensitive to the effects of Caverject than others. Your doctor must therefore find the best dose for you. To do this, your doctor will give you an initial injection, then slowly increase the dose for the next injections until the lowest dose for an effective erection is found. The maximum daily dose should not be greater than 60 µg.

Home Use of Caverject

After your doctor has assessed the correct dose, you will receive your first few injections in the doctor's office so you (or your partner) can receive training on how to inject yourself safely and hygienically. Once your doctor is assured that you (or your partner) are comfortable with the procedure (and can properly use sterile technique) home therapy can be started.

Caverject is supplied with everything you need, including complete instructions, plus diagrams, to help you.

During treatment, you may need your dose adjusted. Never increase or decrease the dose yourself without consulting your doctor. In fact, it is important to visit your doctor regularly, at least every 3 months during therapy, to ensure Caverject is working safely and effectively.

Who Should Not Use Caverject

Caverject should not be used if you have an allergy to any of its ingredients (lactose monohydrate, sodium citrate dihydrate, benzyl alcohol), or if you have a medical condition such as sickle cell anemia or trait, or certain cancers (e.g., multiple myeloma or leukemia) which might make you prone to painful and excessively long erections known as priapism (pri-ah-pizm).

Caverject should not be used by men who have been advised by their doctor to avoid sexual activity.

Do not use Caverject if you have a penile implant or a deformed penis (e.g., angulation, fibrosis, Peyronie's disease). Check with your doctor if you are not sure if you have or had any of these conditions.

Caverject is for use in men only, and should not be used in women or children. Caverject is only for use in treating impotence; do not use Caverject for other conditions.

Protect Yourself and Others

Always keep medications out of the reach of children. Do not save outdated medicine or medicine no longer needed. Do not use if solution is cloudy, colored or contains particles.

Caverject will not protect you from sexually transmitted diseases (including the human immunodeficiency virus, HIV). An injection of Caverject may cause a small amount of bleeding at the injection site. If you are infected with a blood-borne disease, even a little bleeding may increase the risk of passing blood-borne diseases to your partner(s). Take protective measures at all times.

What You Should Know Before Using Caverject

Substances like Caverject act on the blood vessels and may (when injected directly into the corpora cavernosa of the penis) lead to erections that last a long time and which may be painful and tender (priapism). An erection lasting longer than 3 hours is not a “normal” length of time for the penis to stay rigid. If this occurs, you have probably overdosed. Report this to your doctor immediately. Treat as a medical emergency.

If you are taking medication to prevent blood clotting, (such as warfarin or heparin) you may experience bruising at the injection site. To help prevent this, press down on the injection site with your thumb and hold for 5 minutes.

Discuss with your doctor the use of other medications (both prescription and nonprescription) while taking Caverject.

There is no apparent injectable treatment using multiple drug ingredients or “cocktail” for erectile dysfunction. In addition, there are no data on the efficacy and safety of these combinations.

What You Should Do if You Experience a Prolonged Erection

If you have an erection lasting longer than 2 hours, try to reduce the erection using methods suggested by your doctor. Do not wait, it is easier to reduce the erection if you treat it earlier rather than later. Erections that last more than 6 hours can cause serious and permanent damage.

If your penis is still hard after 3 hours, see your doctor immediately or go to emergency. Write on a piece of paper the name of the drug, the dose and the time you took it and bring this with you to emergency.

Adverse Reactions from Using Caverject

The most common adverse effect is mild to moderate pain in the penis after injection or during an erection. About one-third of patients experience this effect. Other patients may experience a “burning sensation”, “discomfort” or “tension” in the penis.

Occasionally you may have blood blisters (hematoma, ecchymosis) at the site of injection. These relate to improper injection technique rather than the effects of Caverject. If this occurs, ask your doctor to re-instruct you. Pressing down on the injection site will help avoid blood blisters.

Other local adverse effects include: fibrosis (formation of scar tissue in the penile tissues), irritation, sensitivity, penile rash and penile edema (fluid in the tissues).

Rarely occurring are: pain in the testicles or at the base of the penis, erythema (redness of the skin), penile lumps, tenderness, abnormal ejaculation, curved erections, balanitis (inflammation of the tip of the penis) and itching, swelling, inflammation or bleeding at the injection site, urethral bleeding and injuries resulting from poor injection technique.

Rare whole-body effects include: changes in blood pressure, irregular heartbeat, increased pulse rate, dizziness, headache, faintness.

Call your doctor if you notice any of the above or if you experience anything not listed here. Tell your doctor if you have a condition or are taking a medicine that interferes with blood clotting.

Guide to the Correct Use of Caverject (see package insert for illustrations)

The information provided below only applies to the self-injection of Caverject. Do not use these methods for taking any other medication.

This guide does not replace the advice of your doctor. If you have any questions, please ask your doctor.

A case of Caverject has enough drug for 1 injection. The number of cases you need will depend on the length of your therapy.

Caverject Case Supplies

Each blue plastic case contains the following:

  • One vial of Caverject sterile powder in strengths of 20 µg. Ensure you have the correct strength Caverject vial for your dosage.

  • One prefilled syringe containing bacteriostatic water. This is sterile water containing a preservative and is used to dissolve Caverject. This solution does not contain active drug. You will use this syringe after attaching the needle, to inject the drug into your penis.

  • A 27 gauge, 0.5-inch needle. Keep the plastic cover on the needle until ready to inject.

  • Two alcohol swabs. It is important to use the swabs to provide hygienic conditions and prevent infection.

Storage and Handling

  1. You can store unused vials of Caverject Sterile Powder between 2 to 30°C. Do not freeze.

  2. Do not use vials after the expiry date listed on the label.

  3. Once dissolved, the Caverject solution must be used immediately. Do not freeze solution.

  4. Use contents of each vial only once. Throw out unused solution. See “Disposal of Used Materials” at the end of this guide.

    Important: Failure to comply with the following antiseptic measures may lead to infection.

  5. To ensure sterile conditions, never contaminate the needle. The disposable needle and syringe require no sterilization steps if the package is intact.

  6. Do not reuse needles or syringes. Do not give used needles or syringes to others.

Self-injection Method: Preparing Caverject

  1. Wash your hands thoroughly with soap and water.

  2. Pull back on tabs of needle package to expose open end of needle. Do not let this end touch any surface.

  3. Hold syringe tip upwards and remove rubber end cover. Continue to hold syringe upright in one hand. With free hand, pick up needle by covered end.

  4. With needle cover still on, attach open end of needle to syringe tip by pushing down and twisting into place. Make sure the needle fits tightly.

  5. Remove the plastic cap from the vial.

  6. Wipe the rubber stopper of the vial, using one of the swabs provided. Discard the used swab (the second swab is needed later).

  7. Handle the syringe by the barrel only. Remove needle cover carefully from the syringe. Do not allow needle to touch any surface.

  8. Holding the syringe with needle pointing upward, push plunger to the 1-cc (mL) line marked on the syringe. (This will remove a slight amount of overfill in the syringe.)

  9. Pierce needle through the centre portion of the vial's rubber cap. Push down plunger and inject entire contents of syringe (bacteriostatic [bak-te-reo-stat-ik] water) into the vial.

    Carefully hold syringe and vial as a unit, and gently swirl the two (do not shake) until the powder dissolves completely. Do not use if the resulting solution is cloudy or colored, or if it contains particles.

Withdrawing Caverject

  1. To withdraw the medication, turn the vial (and syringe) upside down. Keep tip of needle below the level of the fluid. Then slowly withdraw syringe plunger until the amount of solution is level with the line recommended by your doctor.

  2. If there are air bubbles in the syringe, tap syringe gently to remove them, or inject the solution back into the vial and slowly withdraw again.

  3. Remove needle from bottle and carefully replace needle cover. Do not puncture the vial more than once, you could contaminate the solution.

Self-injecting Caverject

The medication must be injected into either of two areas of the corpora cavernosa (spongy tissue of penis). The corpora cavernosa run down both sides of the penis.

Follow these instructions carefully to ensure you inject the medication correctly:

  1. Perform the self-injection while sitting in an upright or slightly reclining position and under good lighting.

  2. Only use the injection areas described above. Do not inject the very top or underside of your penis. Change the injection site each time you use Caverject. (i.e., choose the right side for this injection, use the left side next time, and so on.) Within either area, the injection point should also be changed each time.

  3. Grasp the head of your penis with your thumb and forefinger. Stretch your penis tautly and hold it firmly against your thigh so that it does not slip. In uncircumcised men, the foreskin must be pulled back to assure proper placement of the injection.

  4. Clean the injection area thoroughly with a new alcohol swab. Put swab to one side; you will need to use it again.

  5. Hold syringe between thumb and index finger. Do not put your thumb on the plunger. With syringe at a right angle (90°) to your penis, insert needle to penetrate the skin at the injection site. This is a sensitive area, so expect a little discomfort. Avoid any area where veins are clearly visible.

    Once the needle pierces the skin and resistance is felt, push needle firmly forward until a distinct “give” is felt and insert the needle all the way in with a steady, continuous motion.

  6. Move your thumb or forefinger to the top of plunger and press down. Inject the entire contents of the syringe using a slow, steady motion.

  7. Withdraw the needle from your penis and replace needle cover. Squeeze both sides of your penis immediately, and apply pressure with the alcohol swab to the injection site for about 3 minutes. If bleeding occurs, maintain pressure until the bleeding stops.

As long as you use your doctor's recommended dose, expect an erection to occur within 5 to 20 minutes after an injection.

A standard treatment goal is to produce an erection lasting up to an hour. If an erection is extremely painful (or persists after 3 hours) or if you have other adverse effects that concern you, consult your doctor immediately.

Technical Information