Are injections better than pills for erectile dysfunction?

Last reviewed: 19 Feb 2019

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Are you looking to treat erectile dysfunction (ED), but would prefer something other than tablets like Viagra? Caverject is an injectable medicine that can reliably produce erections in 5 to 15 minutes without the need to take tablets.

Find out how Caverject works, where to get it, the risks, and how it compares to other options for treating ED.

How does Caverject compare to medications like Viagra?

Viagra is a medicine taken by mouth from a family of drugs known as PDE-5 inhibitors. The main difference between PDE-5 inhibitors and Caverject is that Caverject is normally only prescribed when other treatments have failed to work, or aren't appropriate.

Caverject and PDE-5 inhibitors both work by increasing blood flow to the penis, but due to the direct way in which Caverject is used, there are some key differences:

How long does Caverject take to work?

5-15 minutes

How long does it last?

Depending on the dose, an erection will usually less than an hour.

Do I need to be sexually stimulated for it to work?


How often can you use it?

Daily, but not more than three times per week.

What if I have other conditions?

Caverject cannot be used in certain conditions affecting the blood, or if you have abnormalities of the penis.

How effective is it?

Around 94% of men report successful sexual activity after use.

Is it convenient?

The injections can be time-consuming or painful.

Caverject isn't the first choice – but, if you have tried PDE-5 inhibitors in the past and have not been satisfied with the results, Caverject may be a suitable alternative. Compared to PDE-5 inhibitors, Caverject can work faster and does not rely on the need to be sexually stimulated to have an erection.

Fewer whole-body effects – as the medication in Caverject is released directly into the penis, the chances of experiencing side-effects in other parts of your body is reduced. You may want to consider using Caverject as an alternative to PDE-5 inhibitors if you have experienced side-effects such as:

  • Headaches
  • Flushing
  • Indigestion
  • Nasal congestion
  • Dizziness
  • Abnormal vision
  • Back pain
  • Muscle pain

You may have been told that PDE-5 inhibitors are not suitable for you based on a medical condition you have. Depending on your situation, Caverject may be an alternative that could be safe to use.

How does Caverject help ED?

The active ingredient in Caverject is alprostadil; it is very similar to a natural hormone in your body that controls the blood vessels. For people with ED, it can make it easier to have an erection by widening the blood vessels and increasing blood flow to the penis, usually within five to fifteen minutes after use. Around 94% of men report successful sexual activity after using Caverject.

The medicine comes in two parts: a powder and a liquid solution. The powder is dissolved in the liquid and injected directly into the penis. You will be told what dose is right for you by a doctor and recommended to use either vials with syringes, or a dual chamber injection device. Detailed instructions how to do this are included in the information leaflet in the packaging.

If you have the vial and syringe pack, you will need to:

  • Squirt the liquid from the syringe into the vial with the powder and mix the two together

  • Draw the mixture back into the syringe and adjust the plunger until the correct dose is left in the syringe

If you have the dual chamber device, you will need to:

  • Attach the needle to the tip of the device and twist the plunger to mix the powder from one chamber with the liquid in the other

  • Select the dose by pushing the plunger all the way down and twisting it until the correct dose is displayed in the window

When you are ready to use the medicine:

  • Gently squeeze the penis with your fingers underneath and the thumb on top to push out the side

  • Insert the needle into the side of the penis as shown in the information leaflet, avoiding any obvious veins

  • Release the medication by pressing down on the plunger

  • Pull the needle out and massage the penis to spread the medicine around

Where can you buy Caverject?

Caverject is a prescription-only medicine, but it is not generally available on the NHS. To buy it, you will need a private prescription. This can be done by visiting a doctor in person, or by using an online doctor service.

You can buy Caverject:

  • From a pharmacy with a prescription from:
  • Your local GP
  • A specialist, such as a urologist
  • A private consultation
  • Online with a prescription from:
  • Your local GP
  • A private consultant
  • For about £10-30
  • To pick up the same day or with next-day delivery

Depending on the dose that you need, you can expect to pay between £10 and £30 per vial or device. Also, you may have to pay a fee to see a doctor face-to-face for either a private consultation or for writing a private prescription.

To book a face-to-face consultation, you’ll need to get in touch with your doctor and arrange an appointment. The doctor will ask you questions about ED as well as your general health and other conditions you have or medicines that you are taking. If they're happy for you to use the medicine, they will write you a prescription that you'll need to take to a pharmacy. The pharmacist will check the prescription and order the medicine for you, to pick up the same day or a little while later.

Are there any risks to using Caverject?

Risks to using Caverject include:

  • Poor injection technique
  • Pain
  • Scarring
  • Bruising
  • Colour change
  • Rash
  • Penile abnormalities, like Peyronie’s disease (scar tissue causing the penis to be bent when erect, not straight) or fibrosis
  • Erections lasting too long or when not wanted (priapism)

If you're considering using Caverject, bear in mind that using the syringe or injection device can be quite difficult – this is especially if you have problems with your hands or do not like needles. More people decide to stop using Caverject because of the technique than because of poor results. To make the process easier, it might be worth both you and your partner learning how to prepare and give the injection.

The most common side-effect of Caverject is pain in the penis after the injection – about 30% of people experience pain in their penis at least once after using Caverject. However, it is described as mild or moderate pain in most cases, and only three out of every 100 people stop using the medicine because of the pain.

There is also a risk of scarring, bruising, colour changes or rashes to the skin of the penis following an injection. It is important to follow the instructions carefully to reduce the chances of this occurring.

Long-term use – using Caverject long-term is generally safe, but there is a small risk that over time you could develop abnormalities in your penis that may mean you have to stop using it. Peyronie's disease or penile fibrosis are conditions where scar tissue in the penis can cause pain or bends in the penis. Caverject should not be used if you develop a problem like this.

Priapism – a risk shared by most medicines used to treat ED is having an unwanted erection that lasts a long time. With Caverject, 4% of people have reported having an erection that lasts for four to six hours. In most cases, the erection will go away by itself with less than 1% of people experiencing an erection that has lasted longer than six hours. This is an emergency and medical help should be sought immediately if this happens. The duration of the erection depends on the dose so your doctor will start you on a low dose to try to avoid this problem.

What are the alternatives to Caverject?

The main alternatives and first choice medications for erectile dysfunction are PDE-5 inhibitors:

  • Viagra (sildenafil) – was the first PDE-5 inhibitor on the market. Its effects start 30 to 60 minutes after taking the tablet but can be less effective if taken after a large meal. The effects can last for up to twelve hours with 60 to 80% of people experiencing improved erections during that time. Headache and flushing are the most common side-effects. You can also get generic Sildenafil and now Viagra Connect over the counter.
  • Cialis (tadalafil) – may start to work slightly faster than Viagra, after about 30 minutes. The effects tend to last longer than Viagra too, up to 36 hours, and aren’t affected by the food you eat. 70 to 80% of people taking Cialis experienced improved erections. Headache and indigestion are the most common side-effects. You can also get generic Tadalafil and Cialis Daily.
  • Levitra (vardenafil) – is a slightly newer PDE-5 inhibitor than Viagra or Cialis. It works after around 30 minutes, but the tablet form can be affected by heavy meals. An orodispersable tablet version that dissolves on the tongue is available that isn’t affected by eating, and is good for people that find it hard to swallow tablets. 70 to 80% of people experienced improved erections. Headache, flushing and nasal congestion are the most common side-effects.
  • Spedra (avanafil) – is one of the newest PDE-5 inhibitors. It can more precisely target the penis when it is swallowed so there should be fewer side effects in other parts of the body. 60 to 70% of people taking Spedra have been able to have sex within 15 minutes of taking the medicine. Headache is less common than with the other PDE-5 inhibitors, but it is still the most common side-effect of this medicine.

There are some other treatment option available too:

  • Vacuum erection devices (penis pumps) – can be a suitable alternative for many people, especially those that cannot take medication for health reasons. The device is like a pump; it uses suction to keep blood in the penis and trigger an erection. While it can be very effective at producing an erection, some people have reported lower levels of satisfaction due to pain, numbness or not being able to ejaculate.
  • Penile prosthesis – a device which is implanted into the penis. This method offers a permanent solution to ED without needing the continuous use of medicine. The device is an inflatable implant which can be manually switched on to produce an erection and then switched off again. You may want to consider an implant if all other methods haven’t worked for you. 90 to 100% of people are satisfied with the result.
  • Lifestyle changes – if you are overweight then losing weight is known to help with ED. It can help to quit smoking or doing recreational drugs. If you drink alcohol, try cutting back to see if this helps. Stress is linked with ED, so changes to your lifestyle to bring your stress levels down may help. Regular exercise can help reduce stress, help with weight loss, and reduce ED
  • Controlling your other health conditions – ED is sometimes a symptom of another condition or a side-effect of a medicine. If you have a condition like diabetes, depression, high blood pressure or thyroid problems, talk to your doctor about your situation. By working together to control the condition, you may find that ED will improve. If you suspect that one of your medicines is causing the ED, your doctor may be able to switch it for something else.
  • Psychosexual counselling – can help with erectile dysfunction and psychological therapy may be especially helpful if you have anxiety or depression, and this is something you can do alone or with your partner. Some people report getting help from acupuncture therapy, but there is not much evidence that this works.
  • Herbal remedies – these are not generally considered to be very effective. If you are thinking about using herbal medicine, make sure to buy one with a Traditional Herbal Registration number and speak to your doctor or pharmacist first.

Last reviewed: 19 Feb 2019

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star full star full star full star full star full by Helen, 12 Mar 2018
excellent service, simple to use and speedy delivery of BP meds, well done Dr. Ed!
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Very fast efficient service will definitely use them again
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