Vitaros

Vitaros is a prescription topical cream containing alprostadil 3mg/g, used for the treatment of erectile dysfunction (ED) in adult men. Unlike oral ED medicines such as sildenafil (Viagra) or tadalafil (Cialis), Vitaros is applied directly to the urethral opening (meatus) of the penis, providing a targeted, locally-acting alternative for men who cannot tolerate or do not respond adequately to PDE5 inhibitors. It is supplied in single-use, pre-filled applicators and is licensed in the UK for on-demand use.

How Alprostadil Works

Alprostadil is a synthetic prostaglandin E1 (PGE1) analogue that acts on receptors in the smooth muscle of the cavernous tissue in the penis. When applied topically to the urethral meatus, it is absorbed through the urethral mucosa into the surrounding erectile tissue, where it stimulates an increase in intracellular cyclic adenosine monophosphate (cAMP). This leads to smooth muscle relaxation, dilation of the cavernosal arteries, and increased blood flow into the corpus cavernosum, resulting in an erection. The effect is direct and does not rely on inhibiting a degrading enzyme, distinguishing its mechanism from PDE5 inhibitors.

An Alternative for Men Unable to Take Oral ED Medicines

Vitaros is a valuable option for men for whom PDE5 inhibitors are contraindicated or ineffective. This includes men taking nitrates for angina (for whom sildenafil and similar drugs are absolutely contraindicated), men who have not responded to oral therapies, or those who experience intolerable side effects from oral ED medicines. Men with diabetes, cardiovascular disease, or following radical prostatectomy often have a more organic basis for their ED, and topical alprostadil may be more effective in such cases.

Practical Considerations

Vitaros is applied five to 30 minutes before anticipated sexual activity. The cream is self-contained in a small, single-use aluminium tube applicator, making it discreet and easy to use. A condom must be used if a woman who is pregnant or may become pregnant is the sexual partner, as alprostadil may have foetal effects. Vitaros should be stored in the refrigerator at 2 to 8 degrees Celsius until the expiry date.

Vitaros cream is applied directly to the tip of the penis at the urethral opening, using the pre-filled applicator provided. The medicine should be applied five to 30 minutes before sexual activity to allow sufficient time for absorption and onset of action.

Application Technique

Before applying Vitaros, retract the foreskin if present. Open the applicator and carefully insert the tip into the urethral meatus. Gently squeeze the tube to apply the cream around the inside of the urethral opening, ensuring the cream contacts the mucosal tissue. After application, gently massage the penis for approximately 30 seconds to aid absorption. Do not exceed one application per 24-hour period, and do not use more than two to three times per week. Wash hands before and after use.

Maximising Effectiveness

Sexual arousal and stimulation remain important for Vitaros to work optimally, as the drug facilitates the physiological response to arousal rather than acting independently of it. Maintaining warmth in the area - for instance by gently massaging the penis - can enhance blood flow and improve absorption. If no response is seen after the first application, a subsequent application using a higher strength or a slightly longer pre-sex interval may be tried on the advice of your doctor. Urination after use may help clear any residual cream from the urethra and is generally recommended.

Vitaros is available in a 200 microgram per dose (low strength) and 300 microgram per dose (standard strength) format in the UK. The recommended starting dose is 200 micrograms, applied once per episode of sexual activity, up to a maximum of once in any 24-hour period, and no more than two to three times per week.

If the lower strength does not produce an adequate response, the 300 microgram strength may be used on medical advice. Do not exceed one application per 24 hours. Vitaros is for single use only; each applicator should be discarded after one application. The cream must be stored at 2 to 8 degrees Celsius (refrigerated) to maintain stability.

Common Side Effects

• Local penile burning or stinging sensation (most common)
• Penile redness or warmth
• Urethral discomfort or irritation
• Mild to moderate penile pain during or after use
• Genital pruritus (itching) in partner
• Dizziness or light-headedness
• Headache

Serious Side Effects

• Prolonged erection (priapism): an erection lasting more than four hours requires emergency medical treatment; permanent damage to erectile tissue can result if not treated promptly
• Penile fibrosis (rare, with repeated long-term use)
• Hypotension (significant drop in blood pressure)
• Severe allergic reaction (rare)

Vitaros is generally well tolerated at the site of application, but there are important safety considerations for both the user and their partner.

Risk of Prolonged Erection

As with other alprostadil-containing products, Vitaros carries a risk of priapism, a prolonged and painful erection that is unrelated to sexual desire and does not resolve spontaneously. Any erection lasting longer than four hours must be treated as a medical emergency. Without prompt treatment, typically involving aspiration of blood from the corpus cavernosum or injection of an alpha-agonist, permanent damage to erectile tissue may occur, resulting in long-term or permanent ED. Men who experience a prolonged erection following their first use should seek urgent medical attention and report this to their prescriber before using Vitaros again.

Partner Exposure and Contraceptive Use

Alprostadil is absorbed through vaginal and rectal mucosa and can cause localised side effects such as burning or irritation in a sexual partner. If the partner is pregnant or may be pregnant, a condom must be used without exception, as alprostadil has potential effects on uterine tone and foetal circulation. Vitaros is not recommended for use with a vaginal diaphragm, as the cream may affect the integrity of latex and rubber barrier contraceptives. Men with penile anatomical abnormalities such as Peyronie's disease or severe curvature should use Vitaros only under medical supervision.

• Known hypersensitivity to alprostadil or any excipient in the formulation
• Men for whom sexual activity is medically inadvisable (e.g. severe unstable cardiac disease)
• Penile implants (surgical prostheses)
• Conditions predisposing to priapism (e.g. sickle cell disease, multiple myeloma, leukaemia)
• Penile anatomical deformities that would preclude appropriate application
• Use without condom when partner is pregnant or may become pregnant
• Concurrent use with other erectile dysfunction treatments (vasoactive agents)
• Men under 18 years of age