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Keep calling your APP after each injection until we find the right dose for you. Do not give yourself your next injection until you have reported the result of your last injection. Don’t take more medication than the dose prescribed.
You’ll give the injection in the middle third of your penis at the 10 o’clock (left side) or the 2 o’clock (right side) position (see Figure 3). To prevent trauma to your penile tissue, always change sides of your penis each time you inject the medication (right side, then left side). Keep a record each time so you don’t forget. Don’t inject into any vein you can see or feel because it could cause a large bruise on your penis. Don’t inject straight down on the top or the bottom of your penis.
Grasp the head of your penis, not the skin. This will allow your penis to be more fully stretched. It’s easiest to inject if your penis is pulled straight out in front of you. If you aren’t circumcised, pull your foreskin back before grasping the head of your penis. This will prevent the needle from going between the skin and erectile tissue.
For your injection to work, the medication needs to go into the erectile tissue. Locate the area to be injected vardenafil vilitra 60 mg (the middle third of your penis). Let go of the head of your penis and pick up the syringe with 2 hands. Look at the syringe to make sure the dose is correct and you haven’t pushed any medication out by accident. Hold the syringe between your thumb, index and middle fingers like a pen or a dart. Don’t change the dose without speaking to your APP. Don’t take more than 1 injection in 24 hours.
| Question/Myth | Truth/Information | Source / Note |
|---|---|---|
| Do ED tablets enhance sexual performance beyond erections? | No, they mainly facilitate erections, not increase stamina | Medical consensus |
| Are ED tablets addictive? | No, they are not addictive but can be psychologically relied upon | Medical advice |
| Can I drink alcohol while using ED tablets? | Moderate alcohol may be safe but excessive use can impair effectiveness or cause side effects | Clinician guidelines |
| Do ED tablets cause blindness? | Rare cases of vision loss reported; consult doctor if vision changes | Approved by FDA |
| Are generic ED pills as effective as brand-name? | Yes, if approved, they contain the same active ingredients | Regulatory agencies |
Don’t give yourself another injection if the medication doesn’t work. Speak with your APP if you aren’t getting the effects you want. Your partner shouldn’t inject you if they did not inject you at your training session. You can inject up to 3 times a week as long as there are 24 hours between each injection. If you’re currently receiving chemotherapy for cancer, ask your oncologist (cancer doctor) when you can safely inject.
Don’t take any other medication for ED without speaking to your APP. Do not go to sleep until your erection is bendable.
Do not take the following medications within 18 hours of an injection (before or after):MedicationDoseSildenafil (Viagra)20 mg to 100 mgVardenafil (Levitra)10 mg to 20 mgAvanafil (Stendra)50 mg to 200 mg Do not inject within 72 hours (3 days) of taking tadalafil (Cialis) 10 mg or 20 mg. Tell your APP all of the medications you’re taking, especially if you’re taking one of the following:Medication for depression, or classified as an MAO inhibitor such as phenelzine (Nardil®)A sleep aid, such as trazodone (Oleptro ER®) Medication for depression, or classified as an MAO inhibitor such as phenelzine (Nardil®) A sleep aid, such as trazodone (Oleptro ER®) Your APP will order your supplies for you from a compounding pharmacy. 1 vial (500 units) of ______________________ medication 24 pseudoephedrine HCl (Sudafed®) 30 mg tablets You’ll also need to buy alcohol pads from your local pharmacy. Your injection medication can’t be ordered from your local retail pharmacy (such as CVS, Rite Aid, Duane Reade, or Costco). They’ll be ordered from a specialty compounding pharmacy approved by MSK. Please sex tablet 100mg call your APP when your supplies run low.
They’ll order more supplies for you and will let you know if refills are included. You’ll need to provide an injection report with each refill request. If refills are included, you can contact the compounding pharmacy directly to set up your billing and shipping. Sometimes, penile injections can cause priapism (an erection that lasts too long). If you have priapism, taking pseudoephedrine HCl can help.
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Kamagra Oral Jelly | 100 mg | 63 + 7 Sachets | 224.18€ 213.50€ | |
| Levitra Generic | 40mg | 270 + 10 Pills | 561.89€ 535.13€ | |
| Cialis Professional | 20mg | 120 + 4 Pills | 291.68€ 277.79€ | |
| Viagra Oral Jelly | 100mg | 21 Sachets | 78.66€ 74.91€ | |
| Cialis Generic | 20mg | 180 + 10 Pills | 254.09€ 241.99€ | |
| Cialis Original | 20mg | 22 + 2 Pills | 129.20€ 123.05€ | |
| Viagra Oral Jelly | 100mg | 90 + 8 Sachets | 258.02€ 245.73€ | |
| Viagra Generic | 50mg | 60 + 4 Pills | 83.93€ 79.93€ | |
| Cialis Generic | 2.5mg | 270 + 10 Pills | 199.64€ 190.13€ | |
| Cialis Professional | 40mg | 30 Pills | 148.94€ 141.85€ | |
| Levitra Professional | 20mg | 10 Pills | 62.37€ 59.40€ |
Read the instructions in the “Treating Priapism (An Erection That Lasts Too Long)” section for more information. If you want to buy the pseudoephedrine HCl at your local pharmacy, you don’t need a prescription, but the boxes are kept behind the pharmacy counter.
The needle should be facing the floor. Don’t place your index finger or thumb on the plunger. Once again, grasp the head of your penis and pull it straight out. Keep pulling on your penis from the time the needle goes into your penis until it comes out. Don’t twist your penis, since this could lead to injecting the wrong area.
Touch the needle to your skin and quickly slide it into the shaft of your penis. Make sure to insert the needle at a slight angle (either the 10 o’clock or 2 o’clock position, as shown in Figure 3). Move your finger so your index finger or thumb can push in the plunger. Quickly push down on the plunger to inject the medication into the shaft of your penis. Be careful not to pull the syringe out as you’re injecting the medication.
Once you have injected all of the medication, quickly pull the needle out of your penis. Don’t use a twisting or jerking motion, because this may cause bruising. Apply pressure at the injection site for 2 to 3 minutes with your thumb on the injection site and your index finger on the opposite side of your penis. If you’re taking a blood thinner or aspirin, hold the pressure for 5 minutes. This will help to decrease any bleeding or bruising. Take the pseudoephedrine HCl card that’s hanging on the shelf to the pharmacist (see Figure 4).
You’ll have to show a photo ID before the pharmacist gives you the box to purchase. Make sure to have pseudoephedrine HCl with you as long as you’re using the penile injections. If you have problems with your heart, talk with your cardiologist about whether it’s safe for you to take pseudoephedrine HCl.
Check the amount of medication in the syringe to make sure it’s the correct dose. If you see any air bubbles, pull more medication into the syringe. They’ll go to the top, towards the needle. Slowly push the air bubbles and the extra medication back into the vial. Look at the syringe again to make sure you have the right amount of medication.
When you have the correct amount, pull the needle out of the vial. Place the cap back on the syringe without touching or bending the needle. If you touch or bend the needle, you’ll need to throw away the syringe and start at step 2. When you place the cap back on the syringe, make sure you don’t push the plunger by accident. This will push the medication into the cap and result in the wrong amount when it’s time to inject yourself.
If you’re using Trimix, put the medication vial back into the refrigerator. If you’re using Bimix or papaverine, you don’t need to keep your medication in the refrigerator. You must inject the medication into a specific area of your penis. This is so you don’t inject into a nerve or blood vessel. Imagine your penis is divided in 3 parts. Priapism is an erection that lasts too long. Priapism can develop without sexual stimulation and doesn’t go away after orgasm. There is a risk of having priapism after penile injection therapy. When you have a full erection, no fresh blood flows into your penis. This means your penis isn’t getting oxygen, which can damage the tissue and lead to permanent ED. If you have an erection at penetration hardness (a 6 or higher on the erection hardness scale) that lasts 2 hours, take 4 (30 mg) tablets of pseudoephedrine HCl (Sudafed). Don’t take extended-release or long-acting tablets, such as Sudafed 12 hour. Ask your pharmacist or APP if you have any questions.
Place the syringe in the sharps container. You don’t need to recap it. It usually takes a few injections to find the right dose for an erection firm enough to have sex. It’s important that you follow the treatment plan your APP gave you. If you’re adjusting your own medication dosing, the office will no longer be able to prescribe your medication. The pseudoephedrine HCl will be shipped by the compounding pharmacy along with the vial of medication and syringes, or you can buy it at your local pharmacy. For more information, read the “Pseudoephedrine HCl (Sudafed)” section above.If your erection becomes less than penetration hardness within an hour of taking pseudoephedrine HCl, call your healthcare provider’s office the next day to speak with your APP. You should not use your penile injections again until speaking to your APP. Your APP will make changes to your penile injection therapy medication dose. If your erection becomes less than penetration hardness within an hour of taking pseudoephedrine HCl, call your healthcare provider’s office the next day to speak with your APP.
| Side Effect | Sildenafil | Tadalafil | Vardenafil | Avanafil |
|---|---|---|---|---|
| Headache | Common | Common | Common | Less common |
| Flushing | Common | Common | Common | Rare |
| Nasal Congestion | Common | Less common | Common | Rare |
| Vision Changes | Rare | Rare | Rare | Very rare |
| Muscle Pain | Rare | Less common | Rare | Rare |
| Priapism | Rare | Rare | Rare | Rare |
If you have an erection that lasts 3 hours (you still have an erection 1 hour after taking the pseudoephedrine HCl), call your APP and plan to go to MSK’s Urgent Care Center or your local emergency room.Monday through Friday between 9:00 a.m. and 5:00 p.m., call your APP.Between 5:00 p.m. and 9:00 a.m., during the weekend, and on holidays, call 212-639-2000 and ask to speak to the urologist on call.Go to MSK’s Urgent Care Center at Memorial Hospital (1275 York Avenue, between East 67th and East 68th Streets) if you’re less than 30 minutes away.
| Drug | Contraindications | Precautions | Interactions | Special Notes |
|---|---|---|---|---|
| Sildenafil | Nitrate use, certain cardiac conditions | Hypotension risk | Nitrates, alpha-blockers | Use with caution in heart disease |
| Tadalafil | Nitrate use, eye disorders | Long duration may cause priapism | Same as sildenafil, antihypertensives | Dose adjustment needed |
| Vardenafil | Nitrate use | Allergies to PDE5 inhibitors | Similar to sildenafil | Avoid high-fat meals |
| Avanafil | Nitrate use | Liver impairment | CYP3A4 inhibitors | Fast onset, fewer side effects |
Your APP will call the Urgent Care Center so they know to expect you. Your APP will give you more instructions during your call.Go to your local emergency room if you’re more than 30 minutes away from MSK’s Urgent Care Center.
Please use the cenforce 150mg tablets grading scale below to rate your level of hardness after injecting. Call your APP and tell them your responses and whether you’re getting the results you want. Your APP will tell you which dose to try next based on your response. Do not change your dose without speaking with your APP. Call your APP after each injection to report your response. Your APP will give you more instructions during your call. Monday through Friday between 9:00 a.m. and 5:00 p.m., call your APP. Between 5:00 p.m. and 9:00 a.m., during the weekend, and on holidays, call 212-639-2000 and ask to speak to the urologist on call. Go to MSK’s Urgent Care Center at Memorial Hospital (1275 York Avenue, between East 67th and East 68th Streets) if you’re less than 30 minutes away. Go to your local emergency room if you’re more than 30 minutes away from MSK’s Urgent Care Center.