Some people might not even be aware that there are different forms erectile dysfunction (ED) treatments can take other than pills, typically phosphodiesterase type 5 inhibitors (PDE5is) such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) or avanafil (Spedra). ‘The expansion of this class has allowed for greater flexibility in prescribing based on individual response.’
However, ED treatments can also come as injections, creams, chewables and suppositories. These treatments are legal, licensed and approved for use in the UK.
On this page, we’ll discuss the different types of ED treatments, how they work and why they may be preferable for some.
How do non-tablet ED treatments work?
Most of the treatments we’ll discuss contain the same active ingredient, alprostadil. All bar one has different active ingredients than Viagra, which contains sildenafil. Alprostadil is a prescription-only, synthetic, man-made version of a naturally occurring chemical in the body called prostaglandin.
Both alprostadil and prostaglandin work by dilating the blood vessels after administration, which allows for increased blood flow. This helps with ED where restriction of the blood vessels is thought to be the leading cause, though it’s important to say that for treatments such as these to work, feelings of arousal must be present.
The other active ingredients we’ll consider are Aviptadil/phentolamine mesilate and, the more well-known, sildenafil.
Injectable ED treatments
There are a number of ED treatments which can be self-administered intravenously into the penis. A doctor or pharmacist may demonstrate how to use these treatments in the first instance.
Caverject is a branded ED treatment which comes in two forms, Caverject Dual and Caverject Vials. The difference between them falls down to their assembly, they work in the same way.
Patients using Caverject Vials have to mix the vial and liquid solution themselves, whereas those using Caverject Dual receive a ‘pre-made’ solution.
Both Caverject Dual Chamber and Vials are applied to the soft tissue either side of the penile shaft, near the base. Once administered, the effects of Caverject can be felt within five minutes. This is one up-side of having these treatments prescribed, in that they don’t take long to kick in.
Another injectable ED treatment is Viridal Duo, which contains the same active ingredients as Caverject - alprostadil. Like Caverject, too, Viridal Duo is typically only approved for self-administration once a medical professional has shown the patient how to use it first. It is administered in a similar way to Caverject and works just as quickly, from between five and 15 minutes.
The last injectable ED treatment we’ll discuss, Invicorp, is slightly different from Caverject and Viridal Duo in that it contains two active ingredients, and neither of these are alprostadil. Invicorp contains Aviptadil and phentolamine mesilate. These active ingredients work by relaxing both muscles and the blood vessels, causing them to dilate which allows for increased blood flow.
Creams for erectile dysfunction
Active ingredients can be administered in different ways. Vitaros Cream, for example, contains alprostadil like the injectables mentioned above, but is used and applied in a different way. Presently, Vitaros is the only approved ED cream in the UK. It’s important not to buy any other creams that have different names, as these might not be legitimate treatments.
Vitaros can take slightly longer than injectables to work: between five and 30 minutes for effects to be noticeable. A pre-loaded plunger is delivered to patients and the cream must be inserted into the urethra canal. The penis must then be held upright for 30 seconds for the cream to properly soak in. Men should urinate prior to use.
Suppository and chewable ED drugs
Lastly, are suppository and chewable ED drugs. MUSE is a suppository treatment which is administered similarly to ED cream, in that it must be inserted into the urethra. MUSE can work within ten minute of application, and contains alprostadil like certain injectable treatments - meaning it works in the same way, by relaxing and dilating the blood vessels.
There is also a chewable ED treatment called Nipatra, which contains sildenafil (the same active ingredient found in Viagra). Patients need to chew a tablet approximately one hour prior to sex and then swallow. Once in the stomach, it is absorbed into the bloodstream and helps the blood vessels to become less constricted. As of 2014, this has been discontinued, and it isn’t known when Nipatra or a similar chewable ED drug will be available again.
How often should I take them?
Directions for injectable ED treatments
For both Caverject Dual and Vials, neither of these treatments should be used more than once in any single 24 hour period, they also shouldn’t be used more than three times a week. Speak with a doctor if you feel the dose isn’t strong enough, or is too strong. Doses can be adjusted where appropriate.
Viridal Duo, another injectable treatment for ED, has similar usage instructions as Caverject. It shouldn’t be used more than two or three times a week and never twice in a day.
The same guidance is applied to, also, to Invicorp.
How often to use creams for erectile dysfunction
Vitaros, an ED cream applied directly into the urethra, comes in pre-loaded plungers. It’s highly important patients never use more than one plunger in a single use, as a stronger dose may increase the chances of side effects.
Vitaros shouldn’t be used more than three times in a single week, and never twice in a single 24 hour period.
How often to use suppository and chewable ED drugs
MUSE, the ED suppository, shouldn’t be used more than once in any single 24 hour period. However, unlike the guidance on creams and injectables, it can be used up to seven times in seven days. This can be useful for men who engage more frequently in sexual activity.
What are the dosages of non-tablet ED treatments?
Injectable ED treatments doses
Caverject Dual Chamber is available as 10mcg and 20mcg doses, and comes in packs of 2, 4, 6, 8, 10 or 12. Similarly, Caverject Vials come in 10mcg and 20mcg doses, but also 40mcg doses where clinically necessary. They can be purchased singularly or up to 12 in a single pack.
Viridal Duo is available in 10mcg, 20mcg or 40mcg doses, and comes in various ‘pack’ sizes.
Invicorp comes in doses of 25mcg/2mg for its active ingredients aviptadil and phentolamine mesilate respectively.
What strengths are creams for erectile dysfunction?
Vitaros is licensed for the 3 mg/g dose. This means each single-use tube of cream contains 300mg micrograms of alprostadil in 100mg of cream.
Suppository and chewable ED drugs dosage information
How do I store them?
Storing injectable ED treatments doses
Caverject, both Dual and Vials, should be stored in a cool and dry environment below 25 degrees. It must not be stored outside its original packaging to prevent spoilage from sunlight. Caverject Dials 40mcg expire after three months, so it’s important to use by this period and discard unused medication properly. (Your pharmacist can help you with this).
The storage instructions for Viridal Duo are similar to those of Caverject, keep away from children, do not store above 25 degrees, store in the original packing and never take after the use-by date.
Unlike both Caverject and Viridal Duo, Invicorp should be stored in the refrigerator between two and eight degrees. It’s highly important it stays within these temperature boundaries, or else the treatment can spoil. Allow for treatment to reach room temperature prior to use, but do not use after 24 hours at room temperature
How do I store creams for erectile dysfunction?
Vitaros must be stored inside a cool refrigerator which is between two and eight degrees. Individual sachets may be removed and stored outside the refrigerator, but must stay below 25 degrees and must be used within three days.
Suppository and chewable ED drugs storage information
MUSE is delivered in cool packaging, and should be placed immediately into a refrigerator to allow the treatment to remain cool. Doing so will ensure the use-by date remains true. It doesn’t have to be stored in a fridge, as long as it is below 30 degrees, but must be used within 14 days in these circumstances.
What to do if you’re unsure
Seeking out safe treatment and understanding how ED drugs work
If you’re suffering with erectile dysfunction for the first time, we highly recommend you speak with your doctor in these initial instances. Particularly if you need to be prescribed non-tabet ED treatments, many of which require a physical demonstration before self-administration can be allowed.
If you’re still unsure, you can speak with a medical professional using our video consultation feature. We work with GMC-doctors and GPhC-prescribers to deliver the best service possible, and they’re waiting to consult with you over at Treated/Live.