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Also known as
MUSE, Medicated Urethral System for Erection, Alprostadil urethral suppository, Transurethral alprostadil, Intraurethral alprostadil, Urethral pellet
Definition
Intraurethral suppository is a single-dose, medicated transurethral system for the delivery of alprostadil to the male urethra for the treatment of erectile dysfunction.1 It consists of alprostadil, a synthetic prostaglandin E1 analog, suspended in polyethylene glycol 1450 (as excipient) and formed into a medicated pellet (micro-suppository) measuring 1.4 mm in diameter by 3 mm or 6 mm in length.2 The pellet resides in the tip of a translucent hollow applicator and is administered by inserting the applicator stem into the urethra after urination.3 The medication works by softening the surrounding tissue and causing blood vessels to expand, which increases blood flow to the penis, resulting in an erection.4 This treatment is commonly known as MUSE (Medicated Urethral System for Erection) and is FDA-approved as a second-line treatment for erectile dysfunction when first-line oral therapies, such as phosphodiesterase type-5 (PDE5) inhibitors, prove ineffective.5
Clinical Context
Intraurethral suppository is clinically indicated as a second-line treatment for erectile dysfunction in males when oral therapy has failed.1 The treatment is particularly valuable for patients who cannot tolerate or have contraindications to phosphodiesterase type-5 (PDE5) inhibitors, such as sildenafil.2 The medication is administered directly before sexual intercourse, with erections typically occurring within 5 to 10 minutes of insertion and lasting approximately 30 to 60 minutes.3
The administration process involves inserting the applicator into the urethra after urination (which helps lubricate the urethra and aid insertion), delivering the alprostadil pellet, and then massaging the penis to help with absorption while holding it upright to prevent leakage.4 Patients should have sexual intercourse within 10 to 30 minutes after the medicine takes effect for optimal results.5
Clinical efficacy studies indicate that the medication works for approximately 35 percent of men with erectile dysfunction.6 Common adverse effects include penile pain (reported by approximately 36% of users), urethral burning, minor urethral bleeding, dizziness, and in rare cases, priapism (painful, prolonged erection requiring immediate medical attention).7 The treatment is contraindicated in patients with Peyronie’s disease, sickle cell anemia, myeloma, leukemia, or urethritis.8
Healthcare providers must carefully evaluate patients before prescribing intraurethral suppositories, considering their medical history, concurrent medications, and the potential for adverse effects. Patient education regarding proper administration technique is crucial for treatment success and safety.9