Prostaglandin Analog

Caverject Impulse

Approved 11 Jun 2002InjectionInjectable

The FDA lists this product in 2 strengths and forms.

Official labelAsk Osler about it

Indications

CAVERJECT IMPULSE is a prostaglandin E1 agonist indicated

For the treatment of erectile dysfunction ( 1.1 )
As an adjunct to other diagnostic tests in the diagnosis of erectile dysfunction ( 1.2 ).

1.1Erectile Dysfunction

CAVERJECT IMPULSE is indicated for the treatment of erectile dysfunction.

1.2Diagnostic Test

CAVERJECT IMPULSE is indicated as an adjunct to other diagnostic tests in the diagnosis of erectile dysfunction.

Contraindications

CAVERJECT IMPULSE is contraindicated:

in men who have a known hypersensitivity to the drug [see Adverse Reactions (6.1) ]
in men who have conditions that predispose them to priapism, such as sickle cell anemia or sickle cell trait, multiple myeloma, or leukemia [see Warnings and Precautions (5.1) ]
for the treatment of erectile dysfunction in men with fibrotic conditions of the penis, such as anatomical deformation, angulation, cavernosal fibrosis, or Peyronie's disease [see Warnings and Precautions (5.2) ]
in men with penile implants.
Known hypersensitivity to the drug ( 4 ).
Men who have conditions that predispose them to priapism, such as sickle cell anemia or sickle cell trait, multiple myeloma, or leukemia ( 4 ).
Treatment of erectile dysfunction in men with fibrotic conditions of the penis, such as anatomical deformation, angulation, cavernosal fibrosis, or Peyronie's disease ( 4 ).
Men with penile implants ( 4 ).

Warnings and precautions

Prolonged erection and priapism have occurred in patients receiving CAVERJECT. To minimize the chances of this occurring, titrate CAVERJECT IMPULSE slowly to the lowest effective dose ( 2.1 ). Advise patients to seek immediate medical assistance for an erection that persists longer than 4 hours ( 5.1 ).

Indications

CAVERJECT IMPULSE is a prostaglandin E1 agonist indicated

For the treatment of erectile dysfunction ( 1.1 )
As an adjunct to other diagnostic tests in the diagnosis of erectile dysfunction ( 1.2 ).

1.1Erectile Dysfunction

CAVERJECT IMPULSE is indicated for the treatment of erectile dysfunction.

1.2Diagnostic Test

CAVERJECT IMPULSE is indicated as an adjunct to other diagnostic tests in the diagnosis of erectile dysfunction.

Contraindications

CAVERJECT IMPULSE is contraindicated:

in men who have a known hypersensitivity to the drug [see Adverse Reactions (6.1) ]
in men who have conditions that predispose them to priapism, such as sickle cell anemia or sickle cell trait, multiple myeloma, or leukemia [see Warnings and Precautions (5.1) ]
for the treatment of erectile dysfunction in men with fibrotic conditions of the penis, such as anatomical deformation, angulation, cavernosal fibrosis, or Peyronie's disease [see Warnings and Precautions (5.2) ]
in men with penile implants.
Known hypersensitivity to the drug ( 4 ).
Men who have conditions that predispose them to priapism, such as sickle cell anemia or sickle cell trait, multiple myeloma, or leukemia ( 4 ).
Treatment of erectile dysfunction in men with fibrotic conditions of the penis, such as anatomical deformation, angulation, cavernosal fibrosis, or Peyronie's disease ( 4 ).
Men with penile implants ( 4 ).

Warnings and precautions

Prolonged erection and priapism have occurred in patients receiving CAVERJECT. To minimize the chances of this occurring, titrate CAVERJECT IMPULSE slowly to the lowest effective dose ( 2.1 ). Advise patients to seek immediate medical assistance for an erection that persists longer than 4 hours ( 5.1 ).

Adverse reactions

The following are discussed in more detail in other sections of the labeling:

Prolonged Erection and Priapism [see Warnings and Precautions (5.1) ]
Penile Fibrosis [see Warnings and Precautions (5.2) ] Most common (≥10%) adverse reactions: penile pain ( 6.1 ). To report SUSPECTED ADVERSE REACTIONS, contact Pfizer at (1-800-438-1985 and www.pfizer.com ) or FDA at 1-800-FDA-1088 or http://www.fda.gov/medwatch .

6.1Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. CAVERJECT IMPULSE was evaluated in 87 patients in an open-label crossover study of 6 weeks treatment duration that compared the formulation of alprostadil for injection contained in CAVERJECT IMPULSE with the formulation contained in CAVERJECT.

Doses used in this study ranged from 2.5 mcg to 20 mcg. Adverse reactions reported for the CAVERJECT IMPULSE formulation included: penis disorder (4.6%), prolonged erection (1.1%), injection site erythema (1.1%), rash (1.1%), dizziness (1.1%), and hematospermia (1.1%). Penis disorder included penile pain, post-injection pain, and pain with erection. CAVERJECT IMPULSE was also evaluated in 63 patients in a single-dose, double-blind, crossover study that compared CAVERJECT IMPULSE with CAVERJECT.

Doses used in this study ranged from 2.5 mcg to 20 mcg. Adverse reactions reported for the CAVERJECT IMPULSE formulation included: penile pain (1.6%) and pruritus (1.6%). In addition to the adverse reactions observed for CAVERJECT IMPULSE in these two studies, the following adverse reactions have been reported in clinical studies of CAVERJECT: Local Adverse Reactions: Local adverse reactions derived from 1861 patients in clinical studies of CAVERJECT, including an 18-month, open-label study, are shown in Table 1.

Table 1. Local Adverse Reactions Reported by ≥ 1% of Patients Treated with CAVERJECT for up to 18 Months Penile pain 37% Prolonged erection 4% Penile fibrosis 3% Injection site hematoma 3% Penis disorder Penis disorder includes: numbness, irritation, sensitivity, pruritus, erythema, skin tear, discoloration, itching. 3% Injection site ecchymosis 2% Penile rash 1% Penile edema 1% The following local adverse reactions were reported in < 1% of patients: injection site hemorrhage, injection site inflammation, injection site itching, injection site swelling, injection site edema, urethral bleeding, penile warmth, numbness, irritation, sensitivity, pruritus, erythema, painful erection, and abnormal ejaculation.

In these studies, no local adverse reactions were reported in the 294 patients who received placebo, except for penile pain (2%). Penile Pain: In the majority of the cases, penile pain was rated mild or moderate in intensity. Three percent of patients discontinued treatment because of penile pain Prolonged Erection/Priapism: Prolonged erection was defined as an erection that lasted for 4 to 6 hours; priapism was defined as an erection that lasted 6 hours or longer.

In clinical studies, the frequency of prolonged erection after CAVERJECT was 4%, while the frequency of priapism was 0.4% [see Warnings and Precautions (5.1) ]. Penile Hematoma/Ecchymosis: In clinical studies, the frequency of penile hematoma and ecchymosis was 3% and 2%, respectively. Systemic Adverse Reactions : Systemic adverse reactions reported by ≥ 1% of subjects in clinical studies of CAVERJECT included: dizziness (1%).

The following systemic adverse reactions were reported in < 1% of patients: testicular pain, scrotal edema, hematuria, pelvic pain, hypotension, vasodilation, vasovagal reaction, diaphoresis, rash, and non-application site pruritus. Three patients (0.2%) discontinued due to symptomatic hypotension. No systemic adverse reactions were reported in the 294 patients who received placebo.

6.2Post-marketing Experience

The following additional adverse reactions have been reported during post approval use of CAVERJECT IMPULSE. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Injury and procedural complication : device malfunction/failure, needle breakage, drug ineffective and drug effect decreased.

Caverject Impulse

Indications

1.1Erectile Dysfunction

1.2Diagnostic Test

Contraindications

Warnings and precautions

Two medicines in one question?

Caverject Impulse

Indications

1.1Erectile Dysfunction

1.2Diagnostic Test

Contraindications

Warnings and precautions

Two medicines in one question?

5.1Prolonged Erection and Priapism

5.2Penile Fibrosis

5.3Hypotension

5.4Injection Site Bleeding When Used with Anticoagulants Patients

5.5Cardiovascular Risk Related to Underlying Medical Conditions

5.6Risks of Use in Combination with Other Vasoactive Medications Injected Intracavernosally

5.7Needle Breakage

5.9Counsel Patients About Sexually Transmitted Diseases

Interactions

Pregnancy and breastfeeding

8.1Pregnancy

Adverse reactions

6.1Clinical Trials Experience

6.2Post-marketing Experience

Composition

Strengths and forms

Official product information

At a glance