Intracavernous injection. It is recommended to use a needle size of 27-30 G, length of 13 mm. The injection site is the dorso-lateral part of the proximal third of the penis.
Selection of the initial dose in the doctor's office
The dose is selected individually for each patient by careful titration under the supervision of a doctor. The following scheme should be followed, taking into account the erectile response, until the dose that causes an erection is sufficient for a sexual intercourse, but not more than 60 minutes. If there is no response to a specific dose, then the next higher dose can be administered after 1 hour. If there is an answer, the interval between doses should be at least day. The patient should be in the doctor's office until come complete detumescentsiya.
|
| Neurogenic etiology (Damage dorsal brain) | Vascular, psychogenic and mixed etiology |
| Initial injection | 1.25 μg | 2.5 μg |
| The second injection | 2.5 μg | With partial response to the first injection: 5 μg In the absence of an answer: 7.5 μg |
| The third injection | 5 μg | With the subsequent increase in the dose of 5-10 μg |
| Value step by step increasing the dose to achievements optimal dose | 5 μg | 5 -10 μg |
Supportive therapy
The dose chosen for self-injection should cause the patient to have an erection sufficient for a sexual intercourse, with a duration of no more than 1 hour.
If the duration of the erection exceeds 1 hour, then the dose should be reduced.Self-treatment at home should begin with a dose set in the doctor's office. If necessary, the dose should be changed only after consultation with the doctor and in accordance with the instructions for selection of a dose. The lowest effective dose should be given. The recommended frequency of injections is no more than three times a week, but not more than once a day. The erection usually comes in 5-20 minutes after the injection.
The average dose of alprostadil at the end of the 6 month of therapy was 20.7 μg. In most patients, the maintenance dose was 5-20 μg. Doses over 60 μg are not recommended.
Additional tool for diagnosis of erectile dysfunction
In the simplest trial for erectile dysfunction (pharmacological test) after intracavernous administration of the drug Kaverdzhekt®, the patient develops an erection. Kaverdzhekt® is also used in addition to laboratory studies, such as duplex or Doppler ultrasound, xenon-133 washout, radioisotope phallography, and penile arteriography, which allows visualization and assessment of the condition of the vessels of the penis.In any case, you should use a single dose of the drug Kaverdzhekt®, which causes a normal erection.
Breeding and self-introduction procedure
For breeding use only Supplied solvent or water for injection with benzyl alcohol 0.9%. After dilution in 1 ml of solvent, the volume of the resulting solution is 1.13 ml. In 1 ml of this solution, the vials with a dosage of 10 μg and 20 μg will contain 10.5 μg or 20.5 μg of alprostadil, respectively, but after injection, 10 μg or 20 μg of alprostadil will enter the body, respectively, because 0.5 μg is lost due to adsorption on the walls of the syringe and vial. After dilution of the drug should not be added to the bottle any substances.
Before administration, the solution must be visually checked for particles or discoloration.
1. Wash your hands with soap and water.
2. Remove the plastic protective cap from the bottle.
3. Using one of the attached alcohol impregnated wipers, wipe the rubber stopper of the bottle (the second napkin will be needed later). The used tissue should be discarded.
4. Unpack the large needle with the marking 22G1V2, not removing from it at the same plastic protective cap. Connect the needle to the syringe by gently screwing it into the thread.
5. Carefully remove the protective cap from the needle.
Fig.1
6. Holding the syringe with the tip of the needle up, bring the syringe piston to the "1 ml" mark (to remove excess water from the syringe.)
7. Push the rubber stopper of the vial into the center of the bottle and press the piston down to insert water into the vial.
8. Gently holding the syringe and the vial as one unit, with gentle circular motions, achieve complete dissolution of the powder. Do not use the drug if the resulting solution is cloudy, or has become stained, or contains any particles.
9. Turn the bottle upside down without removing the syringe. After making sure that the needle tip is located below the liquid level, slowly pull the syringe piston toward yourself until the solution level reaches the mark corresponding to the chosen dose.
10. To remove air bubbles, tap the syringe lightly, or put the solution back into the vial, and then slowly re-dial it into the syringe.
11. Remove the needle from the bottle and gently place the protective cap on it
12. Open the package with a smaller needle (30G1/2), but do not get the needle, but put the package aside.
13 Remove the larger needle from the syringe with the protective cap and set aside to discard.
- Holding a syringe in one hand, take a smaller sized needle from the opened package, without removing the plastic protective cap from it, and connect it to the syringe, as a larger needle was connected.
Fig. 2.
The transverse section of the penis shows the injection site.
Veins, arteries, nerves
Cavernous bodies (two)
Locations injection: needle insertion in one of the cavernous bodies
Urethra
Fig. 3.
Sexual penis, top view: injection sites are shaded.
Places holding injections
The drug should be injected into one of the two areas of the penis, which are called cavernous bodies.
15. Carry out the procedure for self-introduction the drug should be in the sitting position, standing or reclining.
16. Injections should be performed only at the locations indicated in Fig. 2 and 3. Avoid entering the visible veins. Repeated injections should be performed alternately on one side of the penis. Each time, you should choose a new point on the corresponding side for injection.
17. Take the glans penis with the thumb and forefinger. Pull out the penis and hold it firmly with your fingers so that during the procedure it does not slip out.Men who have not undergone circumcision (excision of the foreskin) should remove the foreskin in order to determine precisely the site of the injection.
18. Thoroughly treat the skin at the injection site with an unused cloth impregnated with alcohol. Put this napkin aside.
19. Take the syringe with your thumb and forefinger, without placing your thumb on the piston. With a firm movement, insert the needle at an angle of 90 degrees to the injection site indicated by the doctor.
Fig. 4. Inserting the needle into the injection site.
- Use your thumb or forefinger to press the plunger. With slow confident movement, enter the entire contents of the syringe.
- Remove the needle from the penis.
While holding the penis on both sides, press the napkin, soaked in alcohol, to the place of injection and hold it for about 3 minutes. If there is blood, then you should press the napkin until the bleeding stops.
- After using the contents of this package, all materials should be discarded, adhering to the relevant safety rules.