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mrs. c
New Member

Date Joined Aug 2008
Total Posts : 8
   Posted 10/22/2008 6:57 AM (GMT -6)   
Hello everyone,
My husband was given a script for alprostadil (injections) and it arrived yesterday.  His doctor's appointment is not until 11/7 to find out how to use it.  Our question is this we have read enough (I think) to know how to do the injection but do not know how much.  What is an appropriate beginning dose and should we even attempt this until the doc shows us?

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4849
   Posted 10/22/2008 7:42 AM (GMT -6)   

I'd wait;)

What should I watch for while using this medicine?

Contact your doctor or health care professional immediately if the erection lasts longer than 4 hours or if it becomes painful. This may be a sign of priapism and must be treated immediately to prevent permanent damage.

Do not change the dose of your medication. Call your doctor or health care professional to determine if your dose needs to be changed.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
•allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
•prolonged or painful erection (lasting longer than 4 hours)

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
•bleeding, bruising, or pain at site of injection
•change in blood pressure


Age 53   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Gleason - 6
(biopsy done March 4, 2008-> 2 of 12)
06/25/08 - Da Vinci robotic laparoscopy
10/03/08 - 1st Quarter PSA -> less then .01

Surgeon - Keith A. Waguespack, M.D.

Las Colinas and Plano Offices


James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 10/22/2008 9:20 AM (GMT -6)   
I'd wait, like Steve suggests. I know you are eager and curious about it, but it'd be a good idea to do it under a doctors instruction and care the first time, at least. This way, you get the best odds for success.
James C.
Co-Moderator- Prostate Cancer Forum
Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
Present- 1 year: ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's: 3 mts-0, 6 mts.-0, 9 mts.-0.

Regular Member

Date Joined Jun 2008
Total Posts : 407
   Posted 10/22/2008 9:48 AM (GMT -6)   
I'm six-weeks post-surgery and using MUSE (alprostadil) three times weekly. My medication isn't injected - not injected using a needle. It's inserted into the opening at the end of the penis (urethra) by way of a thin plastsic tube. My Urologist prescribed, with the MUSE, Cialis and also Lidocane ointment. The Physician's Assistant in my Urologist's office carefully explained how to use the MUSE - and I wouldn't have known how to use it properly without that information.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0


Veteran Member

Date Joined Oct 2006
Total Posts : 626
   Posted 10/22/2008 10:30 AM (GMT -6)   

I would wait.  It is important to know where to inject.  When I had my first injection of alprostadil by my surgeon's PA I had a couple of reactions.  First, the alprostadil caused significant penile aching.  Second, it caused my blood pressure to drop and I got light headed and had to lay down with my feet proped up for a while.  The PA said it can cause the blood pressure to drop in some men.  I was injected with just .07 cc's and the erection lasted for over 3 hours.  The response is different from man to man.  In the end I could not use the alprostadil due to the aching and was switched to Bimix.  I did not have to go back to the PA to have the first injection of Bimix as they told me what dosage to start at and how much to increase each time until I found the right dosage.  I have no aching at all with the Bimix.


Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06, 6/25/07, 1/8/08
No more pads as of 1/13/07
Began injections in April '07

Veteran Member

Date Joined Apr 2008
Total Posts : 847
   Posted 10/22/2008 2:30 PM (GMT -6)   
In your situation, I would start now, but with a very low dose, say half what you expect should be your first dose. If in any doubt at all about the measurement, wait.

This will do two things: give you an early indication of whether there will be any problems, and give you some practice in injection technique. Do not expect much (or any!) of an erection the first time. Much better to have too little than too much.

Once you have the first one done without problem, gradually build up the dose until you get the results you want. By the time you get to the doc, you will be in a better position to ask questions.
Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week and 7-month PSAs: 0
Bimix injections working well 

Veteran Member

Date Joined Jul 2006
Total Posts : 686
   Posted 10/22/2008 7:08 PM (GMT -6)   

If you have received the "Caverject Impulse".  It should have included very detailed directions.  The Caverject Kit is a preloaded syringe that has the alprostadil already inside the specially constructed syringe.  With that kit you follow the directions and twist the kit which puts the fluid and powder together.  You then gently turn the kit to mix it together. Most doctors start you with just a 5 mcg (five microgram) injection.  The kit contains 20 mcg and you control the amount by turning until the correct number is in the window.  You might need 10 or 20 mcg to really do the job.

If you do not have the KIT, but an injection bottle and regular diabetic syringes, then you still would probably start with 5 mcg.


PSA up to 4.7 July 2006 , bump noted during DRE
Biopsy 10/16/06
T2A, Psa 4.7
Gleason  4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion found
No continence problems
PSA 90 day (-.01)  , (6 month -.01) , (9 month +.02) , (1 year +.02) ( 18 months .02)
ED still a problem, minor succces with bi-mix
urinary problems at 21 months 

Post Edited (lifeguyd) : 10/22/2008 6:18:14 PM (GMT-6)

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