Medically reviewed by Vicky Davis, FNP
Written by Our Editorial Team
Last updated 7/28/2021
Erectile dysfunction is a total buzzkill that affects men everywhere. The longer you live, the higher your chances of dealing with it in your lifetime.
There are many different treatment options, from penile injection to the infamous little blue pill.
But what about treatment options for men who can’t (or don’t want to) take an ED medication?
Today we’re exploring alprostadil cream as an ED treatment. We’ll dive into what alprostadil cream is, if it helps ED, side effects and alternative treatment options.
Your first move in the treatment of ED will likely be oral PDE5 inhibitors. Four PDE5 inhibitors are currently approved by the FDA for the treatment of ED: sildenafil (Viagra®), tadalafil (Cialis®), avanafil (Stendra®) and vardenafil (Levitra®).
If these oral ED medications don’t work for you, penile injections with phentolamine, papaverine and alprostadil are considered the second-line treatment of erectile dysfunction, with alprostadil most commonly used.
Alprostadil can also be administered intraurethral (into the urethra), by inserting a pellet into the urethral meatus and allowing the absorption of the drug into the corpora cavernosa.
Although less invasive than injections, this method results in less of an erectile response than intracavernosal injections, and is also associated with high rates of discontinuation due to urethral pain and bleeding.
That brings us to alprostadil cream. Alprostadil cream (Vitaros®) is a topical application of alprostadil used by patients with erectile dysfunction.
Alprostadil is a naturally occurring prostaglandin used to improve blood flow by dialating blood vessels.
When applied to the penis in topical cream form, alprostadil makes it easier to develop and maintain an erection.
Topical alprostadil cream may serve as an important second-line treatment for ED. It is less invasive than other second-line treatment options, has few side effects, and application is easy and painless.
Studies support the theory that topical alprostadil cream is an effective alternative to conventional ED treatments.
Here’s the rub—at the present time, Vitaros topical cream has not been approved by the FDA for the treatment of ED, and is only available by prescription in the UK and certain other countries.
Studies have shown a clear link between the use of topical alprostadil cream and erectile function. In fact, using alprostadil cream has several advantages.
One advantage of Vitaros is the lack of drug interactions. Vitaros is a good option for men suffering from ED who cannot take first-line ED treatments, such as oral PDE5 inhibitors, due to drug interference.
Oral medications, such as Viagra and Cialis, cannot be taken in combination with nitrates, and should be used cautiously and under the strict supervision of your healthcare providers with alpha-blockers and amlodipine.,
Vitaros doesn’t have any food and alcohol interactions, so another advantage is a higher degree of sexual spontaneity.
You can still enjoy a meal and go out for drinks without worrying about an adverse reaction from your erectile dysfunction medication.
Vitaros also eliminates the need for the invasive nature and side effects of the intraurethral alprostadil pellets.
By eliminating many of these issues and roadblocks, many men may be more likely to use alprostadil cream in favor of other erectile dysfunction medications and treatments.
Vitaros has a few mild side effects, including genital pain, tenderness and erythema (skin redness) at the site of application.
In a 2016 study, over 97% of patients described the side effects of alprostadil cream as mild in intensity and short in duration (60 minutes or less).
Your female partner may also experience some mild side effects from the cream. The most commonly reported complaint among partners was vaginal irritation.
Using a condom can be helpful in preventing vaginal burning or itching.
While we wait for alprostadil cream to become FDA-approved here in the U.S., sildenafil (Viagra) and tadalafil (Cialis) are two alternative options to treat ED.
Sildenafil, or Viagra, is a PDE5 inhibitor and is one of the most commonly known ED medications on the market today.
Ever since its approval in 1998 by the FDA (in the form of Viagra), sildenafil has been prescribed to millions of men across the U.S. (and around the world) for the treatment of ED.
Sildenafil works by increasing the amount of blood flowing to your penis, thereby making an erection easier to obtain when you’re sexually aroused.
However, like almost all medications, sildenafil does have the potential to cause side effects. Side effects of sildenafil can include headaches, muscle aches, nasal congestion, dizziness, facial flushing and more.
Tadalafil, or Cialis®, is another PDE5 inhibitor. Developed in the 1990s and approved in 2003 by the FDA, tadalafil is a significantly longer-lasting ED drug that provides effects similar to sildenafil.
Thanks to its 17.5-hour half life, tadalafil can work for up to 36 hours after it's taken. This makes it the longest-acting of the erectile dysfunction drugs on the market today.
Taking tadalafil can also result in back pains and muscle aches, which are generally the results of the Cialis’ vasodilation effects.
Topical alprostadil cream, sold as the brand name Vitaros, may be a solid treatment for erectile dysfunction — especially with its low side effects profile.
The bad news is that alprostadil cream is not yet FDA-approved, and is only available by prescription in the UK and certain other countries.
While we wait for FDA-approval in the U.S., alternate treatment options include sildenafil, tadalafil and other oral ED medications.
Talk to your healthcare provider about the ED treatment options that may be right for you.
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