What is it used for?

• Helping a doctor to diagnose erectile dysfunction.
• Treating erectile dysfunction (impotence).

How does it work?

• MUSE urethral sticks contain the active ingredient alprostadil, which is a type of medicine called a prostagladin.
• Alprostadil is the same as a naturally occurring chemical called prostaglandin E1. This prostaglandin is thought to cause some types of blood vessels to widen by relaxing the thin layer of muscle found in the vessel wall.
• An erection is produced via a complex chain of events, involving signals from the nervous system and the release of active chemicals, including prostaglandin E1 within the tissues of the penis. These chemicals cause blood vessels entering the penis to widen, allowing more blood to enter, and other blood vessels leaving the penis to constrict, stopping blood from leaving the penis.
• Prostaglandin E1 plays an important role in this process and alprostadil, when administered directly into opening at the end of the penis (urethra), will ultimately cause the penis to become rigid and erect by increasing the blood flow into its tissues.
• MUSE urethral sticks are tiny pellets of the medicine measuring 1.4mm in diameter by 6mm in length. They are inserted into the urethra using a special applicator. An erection usually occurs between five and ten minutes after inserting the medicine and lasts for around 30 to 60 minutes.

How do I use it?

• MUSE urethral sticks are administered directly into the opening at the end of the penis known as the urethra. Your doctor will teach you the correct technique for doing this. It is important to follow your doctor's instructions and the instructions provided with the medicine.
• It is important to urinate before use, as a moist urethra makes administration easier and is essential to dissolve the medicine. After administration it is important to sit, or preferably stand or walk, for about ten minutes while an erection is developing. Your erection should last for 30 to 60 minutes. You may get a red warm penis that is sensitive to the touch (this is normal).
• Do not use more than two doses in any 24 hour period. Do not use more than seven doses in any seven days.
• The unopened pouches should be stored in a fridge at 2-8ºC. However, they may be kept out of the fridge below 30ºC for up to 14 days before use.

Use with caution in

• Men with blood clotting disorders or taking anticoagulant medicines such as warfarin.
• Men who have an implant in their penis.
• People with heart or lung disease.
• Not to be used in
• Conditions in which sexual activity is not advisable, for example severe heart disorders.
• Conditions such as sickle cell disease, bone marrow cancer or leukaemia in which there is an increased risk of prolonged erections (priapism).
• Men with inflammation of the urethra, usually due to infection (urethritis).
• Men with inflammation of the end of the penis (balanitis).
• Men with a history of recurrent prolonged (over four hours) erections (priapism).
• Men with physical abnormality of the penis, such as severe curvature, scarring or Peyronie's disease.
• Men with an unusually narrowed urethra, or a structural abnormality of the urethra in which the urethra opens not at the tip of the penis but underneath it (hypospadia).
• Men whose sexual partner is or could be pregnant, unless you use a condom (see below for more information).
• Women.
• Children.

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

• This medicine can be used by couples wishing to conceive and with a partner who is pregnant or breastfeeding.
• However, if your partner is pregnant you should wear a condom during sex, because this medicine may add to the levels of prostaglandin E1 found naturally in semen. This could potentially irritate the vagina and carry a risk to the foetus.
• This medicine will not prevent pregnancy. If you and your partner don't want to conceive you will need to use a reliable form of contraception.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Very common 

• Burning sensation in the urethra.
• Pain in the penis.

Common 

• Headache.
• Dizziness.
• Low blood pressure (hypotension).
• Minor bleeding in the urethra.
• Pain in the testicles.
• Burning or itching in partner's vagina.

Uncommon 

• Fainting.
• Pain in the perineum (between the penis and rectum).
• Swelling of the leg veins.
• Leg pain.
• Increased pulse rate.

Rare 

• Urinary tract infection.
• Prolonged erection (priapism). See warning section above.
• Disorders of the penis, for example formation of fibrous tissue within the penis.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start using this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to make sure that the combination is safe.

This medicine should not be used with any other medicines for erectile dysfunction.

People taking medicines to prevent blood clots (anticoagulants such as warfarin or heparin) may have an increased risk of urethral bleeding after using MUSE.

Alprostadil may enhance the effects of medicines that decrease blood pressure. If you are taking a blood pressure lowering medicine you feel dizzy after using MUSE. If you experience this you should sit or lie down until the symptoms pass. Medicines that can decrease blood pressure include the following (some of these may be taken for reasons other than high blood pressure):

• ACE inhibitors such as enalapril, captopril
• aliskiren
• alpha-blockers such as doxazosin, tamsulosin
• angiotensin II receptor antagonists such as losartan, valsartan
• beta-blockers such as atenolol, propranolol
• calcium-channel blockers such as diltiazem, nifedipine
• clonidine
• diazoxide
• diuretics such as bendroflumethiazide, furosemide
• hydralazine
• methyldopa
• minoxidil
• moxonidine
• nitrates such as amyl nitrate (poppers), glyceryl trinitrate, isosorbide mononitrate.

References:

https://chealth.canoe.com/drug/getdrug/muse

https://www.webmd.com/drugs/2/drug-14329/muse-urethral/details

https://www.rxlist.com/muse-drug.htm#indications

https://www.medicines.org.uk/emc/product/9526/smpc

https://www.netdoctor.co.uk/medicines/sexual/a7168/muse-alprostadil/