Vitaros

Vitaros is a topical cream containing alprostadil (prostaglandin E1) applied directly to the tip of the penis for the treatment of erectile dysfunction.

It provides a localised alternative to oral PDE5 inhibitors for men who cannot tolerate or prefer not to take tablets.

Alprostadil relaxes smooth muscle in the corpus cavernosum and dilates penile arteries by activating adenylate cyclase and increasing intracellular cyclic AMP.

This increases blood flow into the erectile tissue, producing an erection. Because the drug acts locally, systemic side effects are minimal.

When Vitaros Is Prescribed

Vitaros is particularly useful for men in whom oral therapies have failed, are contraindicated (for example, due to nitrate use), or cause unacceptable side effects.

It may also suit men who prefer a non-invasive topical approach over penile injections (Caverject) while still benefiting from a prostaglandin-based mechanism.

The cream is supplied in a single-dose Accudose container with an applicator tip. It is applied directly to the urethral meatus and absorbed through the mucosal surface.

Application

Empty the bladder before use. Open the Accudose container and attach the applicator tip. Apply the cream directly to the urethral opening (meatus) at the tip of the penis.

Gently massage the tip for 30 seconds to aid absorption. An erection typically develops within 5 to 30 minutes.

Timing

Apply Vitaros 5 to 30 minutes before intercourse. Do not use more than one dose in 24 hours and no more than two to three times per week.

Condom Use

A condom is recommended to prevent transfer of alprostadil to the partner, which could cause vaginal irritation or discomfort.

Starting Dose

• 300 micrograms of alprostadil per application

Dose Adjustment

• The prescriber may reduce to 200 micrograms if side effects are problematic, or maintain 300 micrograms if well tolerated

Maximum Frequency

• One application per 24 hours
• Two to three applications per week

Special Populations

• No specific dose adjustment for elderly patients
• Not studied in severe hepatic or renal impairment — use with caution
• Not for use with other urethral or intracavernosal ED treatments concurrently

Common (up to 1 in 10 patients)

• Localised penile pain or burning at the application site
• Erythema (redness) of the glans
• Headache
• Feeling of warmth in the penis

Uncommon (up to 1 in 100 patients)

• Dizziness
• Mild urethral bleeding or spotting
• Balanitis (inflammation of the glans)
• Partner vaginal burning or itching (if a condom is not used)

Rare (up to 1 in 1,000 patients)

• Priapism (prolonged erection lasting more than four hours) — seek emergency treatment
• Syncope (fainting)
• Hypotension

Very Rare (fewer than 1 in 10,000 patients)

• Penile fibrosis with repeated use

Localised discomfort usually diminishes with subsequent applications as the tissue adapts.

Priapism

An erection lasting longer than four hours requires urgent medical intervention. Prolonged erection can damage erectile tissue permanently. Seek emergency help without delay.

Partner Protection

Alprostadil can transfer to the sexual partner and cause mucosal irritation. Use a condom to prevent this. If your partner is or may be pregnant, always use a condom.

Penile Conditions

Do not use Vitaros if you have penile implants, significant penile deformity (e.g., severe Peyronie's disease), or active balanitis.

Hypotension Risk

Alprostadil may cause a modest drop in blood pressure. Patients on antihypertensives or those prone to fainting should use it cautiously, especially at first.

Concomitant ED Therapy

Do not use Vitaros together with intracavernosal injections, urethral pellets (MUSE), or oral PDE5 inhibitors on the same day.

Do not use Vitaros if you have:

• A known allergy to alprostadil or any component of the cream
• Conditions predisposing to priapism (sickle cell disease, multiple myeloma, leukaemia, polycythaemia)
• A penile implant
• Urethritis or balanitis
• Severe urethral stricture
• Anatomical penile deformities (severe curvature, cavernosal fibrosis)
• Sexual partners who are or may be pregnant unless a condom is used