What is the recommended dosage of Caverjet (alprostadil) for an adult male patient with erectile dysfunction?

Caverjet Dosage for Erectile Dysfunction

Start with 2.5 mcg intracavernosal alprostadil (Caverject) in the office under medical supervision, then titrate upward in a stepwise fashion (2.5→5→10→15→20→30→40 mcg maximum) until achieving an erection sufficient for intercourse lasting 30-60 minutes. 1, 2

Initial Dose Titration Protocol

All patients must undergo in-office dose titration before home use due to risks of syncope and prolonged erection. 1

Standard Titration Sequence:

• Begin at 2.5 mcg for the first injection 2
• If inadequate response, escalate to 5 mcg, then 10,15,20,30 mcg, up to a maximum of 40-60 mcg 3, 2
• Wait at least 24 hours between dose escalations 2
• The optimal dose produces an erection lasting 30-60 minutes that is sufficient for vaginal penetration 3

Expected Dose Distribution:

Most patients achieve optimal response at relatively low doses. In clinical trials, 23% responded to 2.5 mcg, 12% to 5 mcg, 27% to 10 mcg, 15% to 15 mcg, and 14% to 20 mcg. 3 Only 6-9% required doses of 30 mcg or higher. 3

Special Population Considerations

Diabetic Patients:

• Expect higher dose requirements: 55% of diabetic men needed ≥20 mcg compared to the general population 4
• The median effective dose in diabetics is 20 mcg (range 2.5-60 mcg) 5
• Diabetic patients respond less robustly to treatment due to more severe baseline erectile dysfunction 6, 4
• Despite higher doses needed, 94% of diabetic men can still establish an effective dose through proper titration 5

Asian/Oriental Populations:

• The mean optimal dose in Asian populations was 11.9 mcg, with mean minimal effective dose of 9.9 mcg 3
• These patients may require lower doses than Western populations 3

Home Treatment Phase

Once the optimal dose is established:

• Patients must receive thorough training in proper self-injection technique before home use 1, 4
• The median home dose typically remains stable throughout treatment (no significant dose escalation needed over 6 months) 5
• Expected success rate: 94% of injections result in satisfactory erectile response during home treatment 5
• Mean onset of erection: 11.2 minutes; mean duration: 50.5 minutes 3

Safety Profile and Adverse Effects

Common Side Effects:

• Penile pain occurs in 50-61% of patients at some point, but is usually mild and tolerable 4, 2
• Pain occurs after only 11% of individual injections and typically decreases with continued use 4, 2
• Only 6% of patients in some studies reported penile pain 3

Serious Complications (Rare):

• Prolonged erection: 5-6.5% of patients 4, 2
• Priapism: 1% of patients 2
• Penile fibrosis: 2-3% of patients 4, 2
• Hematoma/ecchymosis: 8% of patients (usually related to injection technique errors) 2

Critical Safety Advantage:

Men treated with alprostadil alone are less prone to progress to ischemic priapism compared to combination therapies with papaverine and phentolamine. 1

Treatment Success Rates

• 87-94% of patients achieve satisfactory sexual activity during home treatment 2, 5
• 86% of partners rate sexual activity as satisfactory 2
• 92.9% of patients achieve optimal response during dose titration 3

Common Pitfalls to Avoid

• Never prescribe for home use without in-office titration and training 1
• Ensure patients understand that proper injection technique is critical—most technical complications decrease with experience 7
• Don't abandon treatment prematurely: efficacy actually improves over time (complete erections rose from 62% at month 1 to 77% at month 6) 7
• Recognize that lack of efficacy may reflect inadequate dose titration rather than true treatment failure 4