CAVERJECT IMPULSE
Dual Chamber System
alprostadil for injection

Read this information carefully before using CAVERJECT [KAV-er-jeckt]. Read the information you get each time you renew your prescription, in case anything has changed. This is a summary and does not replace talking with your doctor when you start this medication and at check-ups. If you have any questions or concerns, talk to your doctor about them.

What is CAVERJECT?

CAVERJECT is a medicine to treat male impotence (erectile dysfunction). CAVERJECT is injected into a specifi c area of the penis and should produce an erection in 5 to 20 minutes. The erection should last for no longer than 1 hour.

CAVERJECT IMPULSE (alprostadil dual chamber system for injection) is for one use only and should be thrown away properly after a single use.

CAVERJECT does not protect you from sexually transmitted diseases (STDs), such as HIV (the virus that causes AIDS). In addition, small amounts of bleeding at the injection site can increase the risk of passing diseases carried by the blood, such as HIV.

What are the causes of and treatments for impotence?

There are several causes of impotence. These include medications that you may be taking for other conditions, poor blood circulation in the penis, nerve damage, emotional problems, too much smoking or alcohol use, use of street drugs, and hormonal problems. Often, impotence is due to more than one cause.

Treatments for impotence include switching medications if you are taking a medication that causes impotence, prescription medications, medical devices that produce an erection, surgical procedures to correct blood flow in the penis, penile implants, and psychological counseling.

You should not stop taking any prescription medications, unless told to do so by your doctor.

The use of other medical treatments for impotence in combination with CAVERJECT is not recommended. Discuss any concerns you may have about combination treatment with your doctor.

Who should not use CAVERJECT?

Do not use CAVERJECT if you have certain conditions that might cause long-lasting erections (lasting more than 4 hours). Long-lasting erections may cause penis damage. These conditions include:

• sickle cell anemia or trait
• leukemia
• tumor of the bone marrow (multiple myeloma)

Do not use CAVERJECT if you

• have a penile implant
• have an abnormally formed penis
• have other penis problems
• were told by your doctor not to have sex

Women and children should not use CAVERJECT.

How should I use CAVERJECT?

You will be treated with CAVERJECT in your doctor's offi ce to fi nd out what dose is best for you. After that, you can inject it yourself at home. Do not use it more than 3 times a week. There should be at least 24 hours between doses. See your doctor for regular check-ups to be sure CAVERJECT is not causing damage and that it is working as well as possible. See the section "Instructions for Use" at the end of this leafl et for details about how to use CAVERJECT.

What are the possible side effects of CAVERJECT?

About 4 in 100 men who use CAVERJECT may get erections that last more than 4 hours. These can cause serious and permanent damage. Call your doctor or seek professional help immediately if you still have an erection 4 hours after injection.

The most common side effect of CAVERJECT is mild to moderate pain after injection.

About one-third of patients report this effect.

You may get a small amount of bleeding at the injection site. This is more likely if you have a medical condition or are taking a medicine that interferes with blood clotting.

Call your doctor if you notice any redness, lumps, swelling, tenderness, or curving of the erect penis. Also, tell your doctor about any penis pain you did not have before or other penis problems you have.

There is a possibility of needle breakage with use of CAVERJECT IMPULSE (alprostadil dual chamber system for injection) . To best avoid breaking the needle, you should pay careful attention to your doctor's instructions and try to handle the device properly. If the needle breaks during injection and you are able to see and grasp the broken end, you should remove it and contact your doctor. If you cannot see or cannot grasp the broken end, you should promptly contact your doctor.

How should I store CAVERJECT IMPULSE (alprostadil dual chamber system for injection) ?

1. Unmixed packages of CAVERJECT IMPULSE (alprostadil dual chamber system for injection) should be stored at room temperature. Temperatures between 59° to 86°F (15° to 30°C) are allowed. Avoid storing CAVERJECT IMPULSE (alprostadil dual chamber system for injection) at very high and very low temperatures.
2. During travel, do not let the medicine freeze or be stored at a temperature above 77°F (25°C). For example, do not store it in checked luggage during air travel or leave it in a closed automobile.
3. After mixing, CAVERJECT IMPULSE (alprostadil dual chamber system for injection) should be used within 24 hours. It should be kept at a temperature of 77°F or below during this storage time.

General advice about prescription medicines

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information Leafl et. If you have any concerns about CAVERJECT, ask your doctor. Your doctor or pharmacist can give you information about CAVERJECT that was written for health care professionals. Do not use CAVERJECT for a condition for which it was not prescribed. Do not share CAVERJECT with other people.

You can get more information about impotence (erectile dysfunction) and its treatment from the National Institutes of Health (Washington, DC), the American Foundation for Urological Diseases (Baltimore, MD), or the Impotence Institute of America (Washington, DC).

INSTRUCTIONS FOR USE

Before you use CAVERJECT, your doctor must train you in how to prepare and give the injection properly.

Before using CAVERJECT, talk to your doctor about what to expect when using it, possible side effects, and what to do if side effects occur. Your dose has been selected for your individual needs. Do not change your dose without consulting your doctor. If you are not sure of the volume or dose to be used, talk to your doctor or pharmacist.

Follow these instructions exactly to prepare and inject a sterile (germ-free) dose of CAVERJECT.

Supplies Needed

CAVERJECT IMPULSE (alprostadil dual chamber system for injection) is packaged with a needle for injection (Figure A) and alcohol swab.

Figure A

CAVERJECT IMPULSE (alprostadil dual chamber system for injection) is available in 10 and 20 mcg strengths.

MAKE SURE YOU HAVE THE RIGHT STRENGTH OF CAVERJECT IMPULSE (alprostadil dual chamber system for injection) .

Prepare the Dose

1. Wash your hands thoroughly and dry them with a clean towel.

2. Remove the device, needle, and alcohol swabs from the blistered tray.

3. Using one of the alcohol swabs, clean the rubber membrane at the tip of the syringe (Figure B).

Figure B

4. Peel the paper lid from the needle (Figure C).

Figure C

5. Attach the needle to the device by pressing the needle on to the tip of the device and turning clockwise until the needle is fi rmly in place. Remove the outer protective cap from the needle (Figure D).

Figure D

6. Hold the device with the needle pointing upward. The white plunger rod is in the extended position (Figure E).

Figure E

7. Turn the plunger rod slowly clockwise until it stops. This automatically mixes the alprostadil powder and the diluent. Turn the device upside down several times to make sure the solution is evenly mixed. The solution should be clear. Do not use it if it is cloudy or contains particles (Figure F).

Figure F

8. Hold the device with the needle upward and carefully remove the inner protective cap from the needle (Figure G).

Figure G

9. Keeping the device upright, press the plunger rod as far as it will go. A few drops will appear at the needlepoint and the solution will be free of bubbles although typically there may be some very small bubbles at the side of the glass cartridge (Figure H).

Figure H

10. Turn the end of the plunger rod clockwise slowly to choose the dose your physician has determined is appropriate for you. The number that appears in the window shows the dose in micrograms. If the number is higher than your prescribed dose, continue to turn the plunger rod clockwise slowly until you reach the correct dose (Figure I).

Figure I

11. Set the device down on a level surface making sure the needle is not in contact with the surface.

Select Injection Site

1. CAVERJECT IMPULSE (alprostadil dual chamber system for injection) will be injected into a corpus cavernosum (spongy tissue) of the penis. One corpus cavernosum runs the length of the right side of the penis. Another corpus cavernosum runs the length of the left side of the penis (see Figures J and K).

Figure J

Figure K

2. Choose an injection site on one side of the shaft of the penis as shown in Figure J.

Avoid visible veins.

3. With each use of CAVERJECT, alternate the side of the penis and vary the site of injection.

Inject Your Dose of CAVERJECT

1. You should be sitting upright or slightly reclined when injecting CAVERJECT.

2. Holding the head of your penis with your thumb and forefi nger, stretch your penis lengthwise along your thigh so that the skin is tight and you can clearly see the selected injection site.

3. Clean the injection site with a new alcohol swab. Do not discard this swab, you will need to use it again (see step 6).

4. Reposition the penis fi rmly against your thigh as in step 2 to keep it from moving during the injection.

5. Holding the device between your thumb and index fi nger, push the needle into the selected site through the skin and into the tissue as far as it will go. Push the plunger rod as far as it will go so the entire dose is injected (Figure L). If the injection solution does not fl ow easily, move the needle slightly and push as before. When using a dose less than the full capacity, a small amount of liquid will remain in the device.

Figure L

6. Grasp the device and pull the needle out of your penis. Push on the injection site with the alcohol swab for about 5 minutes or until any bleeding stops.

7. Carefully replace the outer protective cap on the needle.

Disposal of Injection Materials

After use, dispose of all injection materials safely. Your pharmacist may be able to supply a disposal box especially for disposable injection devices. As with all prescription medicines, do not allow anyone else to use your medicine.

Last reviewed on RxList: 3/5/2008
This monograph has been modified to include the generic and brand name in many instances.