(alprostadil) urethral suppository
Please read this pamphlet before using MUSE®
(alprostadil). This pamphlet is a quick reference source on important
information about MUSE for you and your partner. Before administering MUSE,
please review the patient video and education booklet. These materials provide
visual instruction and more detailed information as well as practical tips on
how to use MUSE.
WHAT IS MUSE?
MUSE represents a unique approach for the treatment of
erectile dysfunction, commonly called impotence. It is based on the discovery
that the urethra (the normal pathway for urine) can absorb certain medications
into the surrounding erectile tissues thereby creating an erection. There are 4
dose strengths available: 125, 250, 500, and 1000 micrograms. The MUSE
applicator (Fig.1) contained in each foil pouch is intended for 1
administration only. Your dose of MUSE will be determined by you and your
physician. After administration, the erection process will begin within 5 – 10
minutes, and may last 30 – 60 minutes. However, the actual duration will vary
from patient to patient.
WHAT IS MUSE USED FOR?
MUSE is indicated for the treatment of erectile
dysfunction. Erectile dysfunction is the inability to attain or maintain an
erection sufficient for sexual intercourse.
WHO SHOULD NOT USE MUSE?
You should not use MUSE if you have any of the following:
- Known hypersensitivity to alprostadil (the active
medication in MUSE)
- An abnormally formed penis
- Have been advised not to undertake sexual activity
- Conditions that might result in long-lasting erections,
such as sickle cell anemia or trait, leukemia, or tumor of the bone marrow
- MUSE should not be used for sexual intercourse with a
pregnant woman unless the couple uses a condom barrier.
WHAT ARE THE POSSIBLE SIDE EFFECTS OF MUSE?
The most common side effects that have been observed
using MUSE follow:
- Aching in the penis, testicles, legs, and in the perineum
(area between the penis and rectum)
- Warmth or burning sensation in the urethra
- Redness of the penis due to increased blood flow
- Minor urethral bleeding or spotting due to improper
Side effects reported less frequently:
- Prolonged erection - PLEASE NOTE: IF YOUR ERECTION IS
RIGID FOR MORE THAN 4 HOURS, CALL YOUR DOCTOR PROMPTLY.
- Swelling of leg veins
- Fainting - PLEASE NOTE: AFTER USING MUSE, YOU SHOULD
AVOID ACTIVITIES, SUCH AS DRIVING OR HAZARDOUS TASKS WHERE INJURY COULD RESULT
IF DIZZINESS OR FAINTING WERE TO OCCUR. IN PATIENTS EXPERIENCING THESE
SYMPTOMS, THE SYMPTOMS HAVE USUALLY OCCURRED DURING INITIATION OF THERAPY AND
WITHIN ONE HOUR OF MUSE ADMINISTRATION.
- Rapid pulse.
If you have a history of fainting be sure to discuss this
with your doctor prior to using MUSE. If you do experience dizziness or feel
faint, this may be due to the lowering of your blood pressure. Lie down immediately
and raise your legs. If symptoms persist, call your doctor promptly. Because of
the potential for these side effects, MUSE titration should be carried out
under medical supervision.
Call your doctor for medical advice about side effects. To
report side effects, contact Meda Pharmaceuticals Inc. at 1-888-367-6873 or
contact FDA at 1-800-FDA-1088, fax 1-800-FDA- 0178 or online at
Changing Your Dosage
It is assumed that you and your doctor have determined
the proper dose of MUSE. If you suspect that your dose needs to be increased or
decreased to achieve the response that works best for you, please call your
doctor to determine if your dose needs to be reevaluated. Do not use MUSE more
than twice in a 24-hour period.
WHAT ARE THE POSSIBLE SIDE EFFECTS OF MUSE FOR YOUR
The most common reported side effects observed in women
whose partners use MUSE are mild vaginal itching or burning. Using a
water-based lubricant can help to make vaginal penetration easier. Your partner
may want to consult her health care provider if she has not had sexual
intercourse for an extended period of time.
IMPORTANT INFORMATION FOR YOU AND YOUR PARTNER
MUSE has no contraceptive properties.
Because MUSE has not been tested during human pregnancy,
it is recommended that couples use adequate contraception if the female partner
is of childbearing potential. MUSE should not be used for sexual intercourse
with a pregnant woman unless the couple uses a condom barrier.
Sexually Transmitted Diseases
MUSE will not protect you or your partner from sexually
transmitted diseases like chlamydia, gonorrhea, herpes simplex virus, viral
hepatitis, human immunodeficiency virus (HIV - the virus that causes AIDS),
human papilloma virus (genital warts), and syphilis. Latex condoms can protect
against these sexually transmitted diseases.
HOW SHOULD I STORE MUSE?
It is recommended that MUSE be stored in a refrigerator.
MUSE may be kept at room temperature (less than 30°C/86°F) for up to 14 days
prior to use. It is very important that MUSE not be exposed to temperatures
above 30°C/86°F since this will make MUSE ineffective. MUSE should not be
exposed to high temperatures or placed in direct sunlight.
Storage When Traveling
When traveling, store MUSE in a portable ice pack or
cooler. Do not store in the trunk of a car or in baggage storage areas where
MUSE may be exposed to extremes in temperature.
HOW TO ADMINISTER MUSE:
1. Immediately prior to administration, urinate and
gently shake the penis several times to remove excess urine. A moist urethra
makes administration of MUSE easier. The medicated pellet has been specially
developed to dissolve in the small quantity of urine that remains in the
urethra after urination.
2. Open the foil pouch by tearing fully across from the
notched edge (Fig. 2). Let the MUSE slide out of the pouch. Save the pouch for
discarding the MUSE applicator later.
3. To remove the protective cover from the applicator
stem (Fig. 3), hold the body of the applicator with your thumb and forefinger.
Twist the body and pull out the applicator from the cover, being careful not to
push in or pull out the applicator button. Avoid touching the applicator stem
and tip. Save the cover for discarding the MUSE applicator later.
4. Visually inspect the MUSE. The MUSE system is
see-through, and you will be able to see the medicated pellet at the end of the
stem. Make sure that the pellet is present before insertion (Fig. 4).
5. Hold the applicator in a way which is the most
comfortable for you. (Fig. 5a and 5b)
6. Please review Figure 6a, the anatomy of the penis.
While sitting or standing, whichever is more comfortable
for you, take several seconds to gently and slowly stretch the penis upward to
its full length, with gentle compression from top to bottom of the glans (Fig.
6b). This straightens and opens the urethra. Slowly insert the MUSE stem into the
urethra up to the collar (Fig. 6c). If you feel any discomfort or a pulling
sensation, withdraw the applicator slightly and then gently reinsert.
7. Gently and completely push down (Fig. 7) the button at
the top of the applicator until it stops. It is important to do this to ensure
that the medicated pellet is completely released. Hold the applicator in this
position for 5 seconds.
8. Gently rock the applicator from side to side. This
will separate the medicated pellet from the applicator tip (Fig. 8). If you
apply too much pressure you may scratch the lining of the urethra causing it to
9. Remove the applicator while keeping the penis upright.
10. Visually inspect the applicator tip to see that the
medication is no longer in the applicator. Do not touch the stem. If you notice
some residual medication in the end of the applicator, gently reinsert into the
urethra and repeat steps 7, 8, and 9.
11. Holding the penis upright and stretched to its full
length, roll the penis firmly between your hands for at least 10 seconds. This
will ensure that the medication is adequately distributed along the walls of
the urethra (Fig. 9). If you feel a burning sensation, it may help to continue
to roll the penis for an additional 30 – 60 seconds or until the burning
12. Remember, each MUSE is good for a single
administration only. Replace the cover on the MUSE applicator, place in the
opened foil pouch, fold, and discard as normal household waste.
After you have administered MUSE, it is important to
sit, or preferably stand or walk about for 10 minutes while the erection is
developing. This increases blood flow to the penis and will enhance your
ADDITIONAL INFORMATION AND PRACTICAL TIPS
Factors Which May Enhance Your Erection:
- Being well rested and relaxed
- Sexual foreplay with your partner or self-stimulation
while sitting or standing
- Pelvic exercises (for example, Kegel exercises) these
consist of tightening and releasing your pelvic and buttock muscles. These are
the muscles you use to stop urination
- Various positions that may favor blood flow into the
penis. Please refer to the patient starter booklet and video for illustrative
Factors Which May Reduce Your Erection:
- Anxiety, fatigue, tension, and too much alcohol
- Lying on your back too soon after administration of MUSE
may decrease blood flow to the penis and result in loss of erection
- Urination or dribbling immediately following
administration may result in loss of medication from the urethra
- Using medications that contain decongestants, such as
over-the-counter cold remedies, allergy, sinus medications, and appetite
suppressants, may block the effect of MUSE.
COMMONLY ASKED QUESTIONS ABOUT MUSE
Will insertion of MUSE hurt?
At first, you may feel some minor discomfort from
insertion. Urinating prior to administration will reduce the chance of
discomfort or abrasions and is important for dissolving the medicated pellet.
Be sure to straighten your penis to its full length when inserting the MUSE
applicator. With repeated use, administration will become much easier.
What are the side effects associated with MUSE?
Most of the side effects reported in men are relatively
minor and include burning and aching in the penis and groin. Rarely noted are
prolonged erection, light-headedness, dizziness, fainting, rapid pulse, and swelling
of the leg veins. If you feel dizzy, light-headed, faint, or experience rapid
pulse, lie down immediately and raise your legs. If symptoms persist, call your
doctor promptly. Because of the potential for these side effects, MUSE
titration should be carried out under medical supervision. (See also: “WHAT ARE
THE POSSIBLE SIDE EFFECTS OF MUSE?” on the other side.)
In women, mild vaginal itching and burning have been
After I administer MUSE, can we immediately lie down
and begin sexual activity?
You can begin sexual activity, but having the man lie
down, especially on his back shortly after administration, is not recommended.
This will reduce blood flow to the penis and may reduce the erection. It is
important to sit, stand or walk about for 10 minutes after administration. Many
couples have used this time to incorporate various types of foreplay. After
this initial period, you can assume different positions leading to sexual
intercourse. Some couples have noticed that the erection is better maintained
in positions that favor blood flow into the penis during intercourse.
Please review the video and patient starter booklet
available from your doctor which illustrates various positions that will
enhance your erection.
How long will the effect of MUSE last?
An erection should begin within 5 – 10 minutes after
administering MUSE. The duration of effect is approximately 30 – 60 minutes.
However, the actual duration will vary from patient to patient.
What will the erection be like? How will it compare to
the erections I had when I was younger?
An effective dose of MUSE should produce an erection
sufficient for sexual intercourse. MUSE may not create an erection such as
those you experienced when you were younger. Some patients may experience some
mild pain and aching in the penis or groin area. Also, your erection may
continue after orgasm.
How do I know if I have the correct dose of MUSE?
You and your physician will determine the appropriate
dose of MUSE. If your erection cannot be maintained for the time needed to have
foreplay and sexual intercourse, you may need to have your dose increased.
Similarly, an erection that lasts longer than desired may require a dose
decrease. Call your doctor if you suspect you may require a dosing adjustment.
After my erection is over, will my penis feel sensitive?
Your penis may feel full, warm, and somewhat sensitive to
the touch. These effects are normal and may last a few hours.
Can I reuse MUSE?
No. MUSE is intended for single-dose application only.
How do I dispose of the MUSE applicator?
After you have administered MUSE, replace the cover on
the applicator, place in the opened foil pouch, fold, and discard as normal
If my erection lasts longer than desired, what should
Note: Call your doctor promptly if you have a rigid
erection that lasts more than 4 hours.
An application of ice packs to the inner thigh may
shorten the duration of the erection, since the cold will restrict blood flow
to the penis. If used, ice packs should be applied alternately to each inner
thigh for a period not exceeding 10 minutes.
How often can I safely use MUSE?
MUSE should not be used more than twice per day.
If you have any additional questions about MUSE, please
call the toll free patient information line at Meda Pharmaceuticals Inc.
1-888-367-MUSE (1-888-367-6873), or visit the MUSE product web site,