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Instructions for Use and Handling: Always take this medicine exactly as described in this monograph or as your doctor, pharmacist or nurse has told you. Check with your doctor, pharmacist or nurse if you are not sure. A doctor or nurse will show you how to do the injection for at least the first time. Do not try to do it yourself until you have learnt the correct way or if you can't remember what to do, see your trainer again. These instructions are a reminder only. Keep the antiseptic swab away from the eyes.
How much Alprostadil should you inject: Different people need different amounts of alprostadil to treat erectile dysfunction. Your doctor will advise on the right dose for you and monitor you regularly to check how it is working. The starting dose is 1.25 - 2.5 micrograms.
Most men find that a dose of 5 - 20 micrograms is right for them, however, some men may require a higher dose. To minimise the risk of prolonged painful erection, your doctor will select the lowest effective dose. You should never use more than 60 micrograms. If alprostadil is being used to find the reason for your erectile dysfunction, the dose will be 5 - 20 micrograms.
If the dose that has been prescribed for you does not work well enough, tell your doctor. Do not change your dose unless your doctor tells you to. If you forget how much to use, read the label on the pack or speak to your doctor.
You and your partner: You may like your partner to be involved in preparing and/or giving the injection. If so, you should speak to your doctor about training for your partner. Wash your hands. Dry them on a clean towel. If your partner wishes to be involved in preparing or giving the injection, they should wash their hands too.
1. Check your pack: Make sure that the vial is the correct strength and the expiry date is still valid. The vial, syringe and needles all have protective covers. The flip-off cap on the vial can rotate; this is normal. Check that all the covers are on firmly and if they are not on properly, do not use them - take the whole pack back to your pharmacist. There are two needles in the pack: The larger 22 gauge needle with the grey end is used to mix the solution and alprostadil Powder; The smaller and finer 30 gauge needle with the yellow end is used to inject the mixture into your penis.
If a needle is bent do not use it.
2. To prepare the vial: Flip the plastic cap off the vial. Wipe the rubbery top with one of the wet antiseptic pads
3. Fitting the needle to the syringe: Hold the syringe and twist the white tamper evident cap to break the seal. Take the foil off the larger needle, (22 gauge) with the grey end, keeping the cover on. Join the needle to the syringe by turning the needle clockwise tightly onto the syringe, then remove the needle cover by pushing it away from the syringe with your thumb and forefinger.
4. Mixing the solution with the powder: Push the needle through the rubbery middle of the vial top. Press the plunger down firmly to squirt all the solution onto the powder. Gently swirl the vial until all the powder has dissolved. If the mixture is cloudy or does not dissolve completely, do not use it. Never use tap water or any liquid other than the one supplied in the syringe.
5. Filling the syringe: With the needle still inserted, turn the vial upside down. The needle should support the vial unaided. Make sure the needle tip is underneath the level of the liquid. Gently pull the plunger to draw all the mixture into the syringe. Pull the needle out of the vial.
6. Changing to the injecting needle: Gently twist the larger needle anticlockwise off the syringe. Remove the smaller injecting needle, (30 gauge) with the yellow end from its package, keeping the cover on. Twist the needle clockwise tightly onto the syringe, then remove the needle cover by pushing it away from the syringe with your thumb and forefinger.
7. Setting the dose: Tap the syringe gently to send any air bubbles to the top, then push the plunger to squeeze the air bubbles out, ensuring that at least one drop of solution comes out of the needle. Continue pushing until the plunger is exactly at the right mark for your dose. Your doctor will have shown you where this is.
How do you do the injection: Get undressed and make yourself comfortable. Take some time to relax yourself. If your prescriber has recommended use of the second antiseptic pad, open it now.
Make sure that the injection needle is not bent. A bent and re-straightened needle is more likely to break. Needle breakage, with a portion of the needle remaining in the penis, has been reported and, in some cases, required hospitalisation and surgical removal. If the needle is bent, do not use it and throw it away. Do not attempt to straighten it out. Attach a new, unused sterile needle to the syringe.
Take hold of the penis from the front, with the first two fingers underneath close to the testicles and the thumb on top. Gently squeeze the penis between your thumb and finger so that the injection site bulges out. If there is a foreskin on the penis, make sure it is stretched. The injection will go into the part of the penis.
If recommended by your prescriber wipe the skin over this area with the second pad and let it dry.
Keeping a firm grip on the penis and taking the syringe in your free hand, push the needle straight through the skin all the way into the bulgy part avoiding veins or other obvious blood vessels. Push the plunger firmly and if the alprostadil does not come out fairly easily, move the needle slightly and try again. Do not force the alprostadil liquid from the syringe.
Pull the needle out. On the needle mark, press gently with the pad or your thumb, as recommended by your prescriber. Massage the penis to help the alprostadil spread through it.
Do not keep any mixture in the syringe to use for a second injection.
How to throw away the syringe and needle safely: Ensure that the syringe, vial and needles are disposed of in a closed, puncture-resistant container, such as a sharps bin. Ask your doctor or pharmacist for instructions on how to properly dispose of the container after use if you are at all unsure.
How often can you use Alprostadil: Do not use alprostadil more than once in 24 hours or more than three times in a week. Change the exact place and side of the penis that you inject alprostadil each time you use it.
Your erection after injecting Alprostadil: It will take a little while for your erection to come on after the injection. With the right dose of alprostadil, your erection should be strong enough for you and your partner to enjoy lovemaking. Usually, your erection should not last longer than an hour. If you would like it to last longer, talk to your doctor. If your erection lasts longer than four hours you should seek medical advice (see Adverse Reactions).
What if you use too much Alprostadil: Tell your doctor straight away as you may need treatment, particularly if you experience an erection that lasts for longer than four hours.
If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.
