Alprostadil Cream: Does it Work for ED?

Erectile dysfunction (ED) is a serious buzzkill that can affect guys everywhere. An estimated 30 million men of all ages struggle with the issue in the U.S. — and the longer you live, the higher your chances of dealing with this common form of sexual dysfunction.

The good news is that ED is treatable, with options ranging from prescription medications such as sildenafil (the active ingredient in Viagra®) to vacuum erection devices and injection therapy.

One medication that’s gained attention as a form of treatment for ED is alprostadil. It comes in several formulations, including an injectable solution, a suppository and a topical erectile dysfunction cream. 

If you have erectile dysfunction and prefer not to take oral ED medication, alprostadil cream is one of several treatments for erectile dysfunction worth considering. 

Below, we’ll talk about what alprostadil cream is and how it works as a treatment for erectile dysfunction.

We’ll also discuss the potential side effects of alprostadil cream, as well as alternatives to consider if you’re one of the tens of millions of men affected by ED.

What Is Alprostadil?

Alprostadil is a medication used to treat and manage ED. It belongs to a class of medications known as vasodilators, which work by relaxing blood vessels and improving blood flow throughout the body.

Healthy, rigid erections are all about healthy, consistent blood flow. When you feel aroused, your blood vessels dilate, allowing blood to flow into the corpora cavernosa — two cylindrical areas of erectile tissue inside your penis.

As blood pressure inside your penis increases, you’ll develop an erection firm enough for penetrative sex.

So, how does topical alprostadil cream work? As a vasodilator, alprostadil cream relaxes the muscles and blood vessels of the penis, making it easier for blood to flow and stay in the penis long enough to get an erection.

One popular brand of alprostadil cream is Vitaros®, though it’s not FDA-approved and is currently only available in Europe. Vitaros cream is applied to the tip of the penis shortly before sexual activity. This stimulates local blood flow and makes it easier to get and stay hard.

Currently, alprostadil cream for erectile dysfunction isn’t a first-line treatment, meaning your healthcare provider typically won’t prescribe it if you have ED.

Instead, most men with ED are treated with phosphodiesterase-5 inhibitors (PDE5 inhibitors), which are also taken before sex.

Our guide to erectile dysfunction creams goes into more detail about how these products work for the treatment of erectile dysfunction, as well as their unique advantages and disadvantages.

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How Effective Is Alprostadil Cream for Erectile Dysfunction?

If alprostadil cream is a second-line ED treatment, how effective is it?

We’ll start off by saying that cream for ED doesn’t cure erectile dysfunction or increase sexual desire. With that out of the way, there are definitely benefits to this ED treatment. 

According to several studies, some of which were double-blind and placebo-controlled, alprostadil topical cream works well and is well tolerated in ED patients with mild-to-severe symptoms.

One of the main reasons it’s not a first-line treatment for ED is that the cream doesn’t have FDA approval.

But based on its effectiveness, some in the scientific community think alprostadil topical creams have the potential to be first-choice alternatives for ED patients who don’t respond well to or can’t tolerate PDE5 inhibitors.

A 2016 review of Vitaros topical cream for erectile dysfunction found that it was 83 percent effective with a 300-microgram (mcg or μg) dose in patients with severe ED — significantly better than the placebo group. What’s more, adverse effects were only reported in three percent of the treated population — not bad.

Another 2016 review found that clinical trials of topical alprostadil cream showed it to be effective, increasing the erectile function score on the International Index of Erectile Function (IIEF) by 13 points from baseline.

Side Effects of Alprostadil Cream

Like all medications, side effects are always on the table. The topical alprostadil cream formulation tends to have fewer side effects than alprostadil injections or suppositories, but you’ll want to watch out for certain adverse events.

Here are a few alprostadil erectile cream side effects:

  • Burning sensation at the site of application

  • Penile pain

  • Prolonged erection (priapism)

  • Painful erection (Peyronie’s disease)

  • Vaginal burning or itching (for female partners)

A 2009 study looked at 1,161 male patients with ED. For the first four weeks, they used eight doses of 200-mcg topical alprostadil cream before sex, up to two times per week. Based on their response to the cream, they could decrease to 100-mcg doses or increase to 300-mcg doses for up to nine months, at two doses per week. The results were as follows:

  • Twelve percent of patients stopped using the cream because they were either too sensitive to it or not sensitive enough. 

  • Sixteen percent withdrew from the study for various reasons.

  • Fewer than five percent stopped the treatment because of adverse effects.

  • Seventy-three percent of patients found that the 300-mcg alprostadil dose was effective enough.

  • Seventy-four percent of patients experienced an overall improvement in erectile function using the cream.

In terms of side effects, the study found that:

  • Roughly 12 percent of patients experienced burning at the application site. 

  • Four percent experienced penis pain.

  • About one percent experienced a prolonged erection.

  • Less than one percent reported a prolonged erection of four or more hours. 

  • Around two percent of the patients’ sex partners reported vaginal burning or itching.

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Alternatives to Alprostadil Cream

There are plenty of alternative alprostadil cream treatments for ED. The first place to start is typically with medication, often in conjunction with lifestyle changes and potentially therapy.


As noted, PDE5 inhibitors are typically first-line treatments for ED. The most common PDE5 treatment options include:

Sildenafil was the first PDE5 inhibitor. Introduced in 1998, it treated more than 20 million men during its first six years on the market. Vardenafil was approved in 2003, followed a few months later by tadalafil. And in 2012, vardenafil was introduced.

This class of drugs improves ED by relaxing the smooth penile muscles and increasing blood flow to the penis.

Common side effects of PDE5 inhibitors include:

  • Headache

  • Flushing

  • Nasal congestion or runny nose

  • Indigestion

  • Visual abnormalities (less common)

If you don’t like swallowing pills, you could try chewable ED meds like our hard mints. Alternatively, certain foods and supplements may help increase blood flow to your penis.

Counseling and Therapy

Anxiety and depression can play a role in developing ED. The brain and the body work together to get aroused, sending blood flow to the penis so you can get and maintain an erection. If you’re feeling low or nervous, as with sexual performance anxiety, you might experience ED.

Psychological ED (meaning the cause of ED is mental instead of physical) can be manageable. Therapy or sexual counseling are tools that can help you work through mental hurdles contributing to your ED.

There are more than eight types of therapy, so explore your options to see which might be best for you.

Lifestyle Changes

Some of the latest ED treatments work in tandem with lifestyle changes. Lifestyle factors that could affect ED include:

  • Excess body weight

  • Lack of physical activity

  • Poor diet

  • Smoking

  • Heavy alcohol use

  • Substance use

  • Chronic stress

According to a 2020 review of studies, lifestyle modifications play a significant role in improving sexual health. In fact, sexual health specialists are required to help patients adopt healthy lifestyles before they can propose ED pills as an option.

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Alprostadil Cream: Should You Use It for ED?

If PDE5 inhibitors aren’t working for you, or you just don’t want to take them, alprostadil cream might be an effective alternative. Studies show this topical ED medication is effective in more than 80 percent of ED patients.

When looking for erectile dysfunction solutions, keep in mind:

  • ED is common. It affects around 30 million men in the U.S. alone. 

  • The first line of treatment is PDE5 inhibitors. These medications include Viagra® and Cialis®, among others.

  • Alprostadil cream is a second-line treatment. If you don’t want to take PDE5 inhibitors or don’t tolerate them well, erectile dysfunction cream can serve as a secondary option.

  • Alprostadil cream might have side effects. Potential side effects include application site burning, penis pain, prolonged erections, painful erections or burning in your partner’s genital area.

  • Lifestyle factors can help improve ED. Maintaining a healthy weight, eating a nutritious diet, exercising, keeping low stress levels and avoiding drugs and excessive alcohol can help improve ED and sexual intercourse.

  • Talk to a healthcare provider. Always consult a medical professional before starting any new medication for ED. They can discuss the side effects, potential drug interactions and contraindications.

If you have ED and think a psychological issue might be at play, consider speaking with a mental health provider. 

You can ask a healthcare provider for a referral or connect from home via our online mental health services. You can also access evidence-based medication for ED with our range of erectile dysfunction medications.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment or medication.

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