Muse (Alprostadil) - Urethral

What Is Muse?

Muse (alprostadil) is a prescription treatment option for erectile dysfunction (ED) in adult males. Muse is a prostaglandin E1 (PGE1).

Prostaglandins are naturally occurring substances that have hormone-like effects on your body.

Prostaglandins also play roles in many normal bodily functions, such as blood flow.

In particular, a PGE1—like alprostadil (the active ingredient in Muse)—is a vasodilator, a medication that works by relaxing the blood vessels and muscles in the penis.

As a result, Muse, as a vasodilator, can help the penis hold enough blood for an erection.

Currently, no generic version of alprostadil exists in a suppository dosage form.

Additionally, as a brand-name product, Muse is the only drug available in the suppository dosage form.

As a suppository, Muse is to be placed into the urinary opening of the urethra (the opening in the penis where urine flows out).

Drug Facts

Generic Name: Alprostadil

Brand Name(s): Muse

Drug Availability: Prescription

Therapeutic Classification: PGE1

Available Generically: No

Controlled Substance: N/A

Administration Route: Suppository

Active Ingredient: Alprostadil

Dosage Form(s): Suppository via the urethra

What Is Muse Used For?

The Food and Drug Administration (FDA) has approved Muse for the treatment of ED.

ED is a sexual-related condition with difficulty getting or maintaining an erection.

ED affects millions of people assigned male at birth and is more common as these individuals age.

Other risk factors for ED may include:

While ED is common, talk with your healthcare provider if it keeps happening or worsens. Your healthcare provider may help you find an underlying cause.

If necessary, they can discuss treatment options to prevent the following potential complications:

  • Mood changes, such as anxiety, low self-esteem, or depression
  • Relationship problems with your partner, sometimes due to intimacy issues or trouble achieving pregnancy

How to Use Muse

You'll need to see your healthcare provider to obtain a Muse prescription. They will determine the proper dosage and show you how to use Muse properly.

Here are some general directions to use Muse:

  1. Go to the restroom to urinate (pee) and shake your penis a few times to remove excess urine. This will moisten the urethra (the tube in the penis where urine flows out) and make it easier to use Muse.
  2. Tear across the notched edge of the foil pouch that contains Muse. Once the pouch is open, slide Muse out. And save this pouch to throw away the Muse applicator in a later step. The Muse applicator will help you insert the alprostadil suppository into the urethra.
  3. Once Muse is out of the pouch, it will look like a key (applicator). The key's blade is protected with a sheath (cover), and only the key's bow is visible. To remove the key's blade, hold the bow with your thumb and forefinger (pointer or index finger) without pushing the button at the top of the bow or removing the button from the applicator.
  4. Using the thumb and forefinger of your other hand, twist the sheath off to reveal the blade, also called the applicator stem. Don't touch the blade or its tip. Save the protective sheath to reinsert the blade and throw away the Muse applicator in a later step.
  5. Before using Muse, look at the blade's tip (stem). You should see the alprostadil suppository here.
  6. With one hand, hold the key (applicator) in the most comfortable way.
  7. Using the other hand, take a few seconds to gently and slowly stretch your penis to its full length—with gentle pressure from top to bottom of the glans (the head or tip of the penis). This helps straighten out and open up the urethra. You can do this while sitting down or standing up, whatever is most comfortable.
  8. Slowly insert the blade (stem) of the applicator into the urethra. If you experience discomfort or a pulling sensation, don't push the stem deeper into the urethra. Instead, slightly withdraw the stem to make it less deep. Then, gently reinsert the stem deeper into the urethra up to the shoulder of the key.
  9. At this point, all you should be able to see is the key's shoulder and bow. All of the blade (stem) is in the urethra. Now, gently and completely push the button at the top of the applicator (key) until it stops. This ensures you release all of the alprostadil suppository into the urethra. Hold the applicator in this position for five seconds.
  10. Gently rock the applicator to move it from side to side. This ensures the alprostadil suppository separates from the tip of the stem. Be careful not to apply too much pressure, or you may scratch inside the urethra, making it bleed.
  11. While keeping your penis upright, gently remove the stem.
  12. Make sure to look at the tip of the stem. You shouldn't be able to see the alprostadil suppository. If you notice parts of the suppository are still in the stem, repeat steps eight through 12.
  13. Hold your penis upright and stretched to its entire length. Place your penis between your hands to firmly roll the penis for a minimum of 10 seconds. This helps the medication adequately spread along the urethral tube. If you feel a burning sensation, continue to firmly roll your penis until the burning sensation goes away (this could take an additional 30 to 60 seconds).
  14. Cover the stem (blade) of the applicator with the protective sheath, and place all contents into the opened foil pouch. Fold the pouch and throw it away. Don't try to use the same applicator again.
  15. Don't use Muse more than two times daily.

Storage

Keep your medications tightly closed and out of the reach of children and pets, ideally locked away.

Store Muse in the refrigerator (36 F to 46 F). You may keep Muse at room temperature (68 F to 77 F) but not above 86 F for 14 days before use. Do not store your medication in the bathroom.

Avoid putting unused and expired drugs down the drain or in the toilet. Visit the FDA's website to learn where and how to discard unused or expired medications.

You can also find disposal boxes in your area. Ask your healthcare provider if you have any questions about the best ways to dispose of your medications.

If you travel with Muse, get familiar with your final destination's regulations. Checking with the U.S. embassy or consulate might be a helpful resource.

It's also a good idea to make a copy of your Muse prescription and keep your medication in its original container from your pharmacy with your name on its label.

Ask your healthcare provider if you have any questions about traveling with your medicine.

Off-Label Uses

Currently, the alprostadil suppository dosage form doesn't have any off-label uses.

However, some experts support using alprostadil intravenous (into the vein) injections for Reynaud's phenomenon, especially when it's linked to systemic sclerosis or when first-choice oral (by mouth) medications aren't effective.

Reynaud's phenomenon is a rare medical condition affecting the blood vessels, typically in the fingers and toes. People with this condition may experience narrowing blood vessels from stressful triggers or cold temperatures.

During these attacks, the blood has nowhere to go. So, the skin of affected areas may turn blue and white.

Reynaud's phenomenon may occur on its own or secondary to scleroderma (systemic sclerosis). Scleroderma is also a rare medical condition involving the thickening and tightening of the skin, inflammation (swelling), and internal scarring in other body areas.

Secondary Reynaud's phenomenon is usually more severe because of damage to the blood vessels.

How Long Does Muse Take to Work?

You'll likely experience an erection within five to 10 minutes of using Muse. Furthermore, your erection may last between 30 to 60 minutes.

What Are the Side Effects of Muse?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or healthcare provider.

You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of Muse may include but may not be limited to:

  • Burning sensation in the urethra (tube where urine flows out)
  • Mild and temporary pain in the penis, urethra, or testicles
  • Mild urethral bleeding or spotting

Severe Side Effects

Get medical help right away if you develop the following serious side effects:

  • Severe allergic reaction: If you have a severe allergic reaction to Muse, you may experience swelling, itchiness, rash, and breathing difficulties.
  • Excessively low blood pressure: Hypotension (low blood pressure) is a possible side effect of Muse and can be excessive and severe. Symptoms may include dizziness and fainting spells if you're experiencing dangerously low blood pressure.
  • Priapism: Priapism is a painful and prolonged erection that doesn't go away. Without immediate treatment, priapism may result in severe injury and damage to the penis. Seek immediate medical attention if your erection lasts more than four hours.

Call 911 if your symptoms feel life-threatening.

Long-Term Side Effects

A possible long-term side effect of Muse is damaging effects from priapism, which may worsen ED.

Without immediate treatment, it may also result in severe injury to the penis, leading to the inability to have an erection; this may be irreversible.

Report Side Effects

Muse may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Muse Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For urethral dosage form (suppositories):
    • For erectile dysfunction:
      • Adults—One suppository inserted into the urethra once a day, 10 to 30 minutes before sexual intercourse. Do not use more than 2 suppositories each day.
      • Children—Use is not recommended.

Modifications

The following modifications (changes) should be kept in mind when using Muse:

Severe allergic reaction: Avoid using Muse if you have a known allergy to it or any of its ingredients. Ask your healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: In rat animal studies, alprostadil subcutaneous (under the skin) injections and intravenous (into the vein) infusions were linked to adverse effects on the fetus. However, in rabbit animal studies, high doses of vaginal alprostadil didn't seem to have adverse effects on the fetus.

Muse hasn't been tested on human pregnancies, so there is insufficient evidence about the safety and effectiveness of Muse in pregnant people and their unborn fetus. For this reason, Muse shouldn't be used for sex with a pregnant person unless a condom barrier is also used.

Discuss with your healthcare provider if you plan to become pregnant or are pregnant. They will help you weigh the benefits and risks of your partner using Muse during your pregnancy.

People of childbearing or reproductive potential: If you are of childbearing or reproductive age, your healthcare provider may recommend an effective form of birth control.

Breastfeeding: Muse shouldn't be used in breastfeeding parents assigned female at birth. We don't know enough about the effects and safety of Muse in human breast milk and nursing babies.

Talk with your healthcare provider if you plan to breastfeed. They will help you weigh the benefits and harms of your partner using Muse while you're nursing your child. They can also discuss the different ways available to feed your baby.

Older adults over 65: Clinical trials didn't study the effects of age on how Muse is absorbed, transported, and broken down in the body. It's unclear whether older adults respond differently from younger adults.

Older adults with several medical conditions or taking several medications should use caution with Muse. Older adults are typically more sensitive to side effects from medications.

Children: Muse shouldn't be used in children.

Sexual preference: Muse hasn't been studied for sex other than vaginal intercourse.

Missed Dose

Muse is typically taken as needed before sex.

Since Muse isn't a scheduled medication, you are unlikely to miss a dose.

Overdose: What Happens If I Use Too Much Muse?

The symptoms of a suspected overdose of Muse include:

  • Excessively low blood pressure
  • Painful and prolonged erection that may cause severe damaging effects to the penis, such as the worsening of ED or the permanent inability to have an erection

If you think you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

What Happens If I Overdose on Muse?

If you think you or someone else may have overdosed on Muse, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Muse, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

Do not use alprostadil suppositories if you have a penile implant unless advised by doctor.

Use a condom when having sexual intercourse with a pregnant female while using this medicine. Although harm to the fetus is unlikely, using a condom will protect the fetus from exposure to this medicine. If a woman can become pregnant, use of contraceptive methods is recommended because the effects of this medicine on early pregnancy are not known.

This medicine may make you dizzy or lightheaded. Do not drive or do anything that could be dangerous until you know how this medicine affects you.

If too much is used, the erection lasts too long and does not reverse when it should. This condition is called priapism. If the erection is not reversed, the blood supply to the penis may be cut off and permanent damage may occur.

Contact your doctor immediately if the erection lasts longer than 4 hours or if it becomes painful. This may be a sign of priapism and must be treated right away to prevent permanent damage.

This medicine will not prevent pregnancy or protect you or your partner from diseases such as syphilis, herpes, or HIV. Use a latex condom during sex for protection.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Use Muse?

Before using Muse, talk with your healthcare provider if any of the following applies to you:

Severe allergic reaction: If you have a severe allergic reaction to Muse or any of its components (ingredients), this medication isn't a viable option for you.

Pregnancy: Muse hasn't been tested on human pregnancies; the safety and effectiveness of Muse in pregnant people and their unborn fetus is unclear. For this reason, Muse shouldn't be used for sex with a pregnant person unless a condom barrier is also used.

People of childbearing or reproductive potential: If you are of childbearing or reproductive age, your healthcare provider may recommend an effective form of birth control.

Breastfeeding: Muse shouldn't be used in breastfeeding parents assigned female at birth. The effects and safety of Muse in human breast milk and nursing babies are unclear.

Older adults over 65: Clinical trials haven't studied the effects of age on how Muse is absorbed, transported, and broken down in the body. It's unknown whether older adults respond differently from younger adults. In general, older adults should use caution.

Children: Muse shouldn't be used in children.

Abnormal penis anatomy (structure): Muse isn't typically recommended for those with abnormal penis anatomy. An example of abnormal penis anatomy may include urethral strictures (narrowing of the urethra tube) or Peyronie's disease (a collagen build-up resulting in a curved penis, making sex painful and difficult).

Medical conditions that increase your clot or priapism risk: Certain medical conditions might raise your risk of experiencing clots or priapism (painful and prolonged erection). Examples of these conditions may include sickle-cell anemia and certain blood cancers (e.g., leukemia).

Low cardiac (heart) fitness: Sex is a vigorous activity that makes your heart work harder. It also raises your heart rate. For this reason, your healthcare provider may want to evaluate your cardiac fitness before giving you a prescription for Muse. If your healthcare provider recommends against sexual activity, Muse isn't viable for you.

What Other Medications Interact With Muse?

Use caution when using Muse with the following medications:

  • Antihypertensive medications: Muse may lower your blood pressure. For this reason, Muse may have additive effects with antihypertensive drugs, such as Microzide (hydrochlorothiazide). Symptoms of seriously low blood pressure may include dizziness and fainting spells.
  • Blood thinners: Possible side effects of Muse may include mild bleeding or spotting of the urethra. Muse might worsen blood thinners' bleeding and bruising side effects, including Jantoven (warfarin).
  • Decongestants: Decongestants, such as Sudafed 12-Hour (pseudoephedrine), may block Muse and reduce your erection.
  • Penile implants: Penile implants are devices placed in the penis. Similar to Muse, penile implants are treatment options for ED. Muse hasn't been studied in those with penile implants, so there is limited information regarding the effectiveness and safety of using Muse and penile implants together.

Talk with your healthcare provider for more detailed information about medication interactions with Muse.

Be sure to also talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC), nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

ED treatment options include medication-free approaches, like penile implants, or drugs, such as Muse.

Muse contains alprostadil, which belongs to the prostaglandin E1 (PGE-1) medication class.

Presently, alprostadil is the only PGE-1 used to treat ED. However, alprostadil is available in several different dosage forms, including injections and suppositories.

Frequently Asked Questions

  • Where is Muse available?

    Muse is available with a prescription from your healthcare provider. Local retail pharmacies may carry Muse. If necessary, the pharmacy may order the medication for you.

  • How much does Muse cost?

    Since Muse isn't available generically, it might be costly without insurance coverage.

    If cost is a concern, Muse's manufacturer offers a savings card. For eligibility questions, visit Viatris's savings card website, or call 1-800-657-7613. Viatris also has a patient assistance program. For program-related questions, visit Viatris's patient assistance website or call 1-888-417-5780.

    Other potential helpful resources include RxAssist, Simplefill, BenefitsCheckUp, Medicare Rights Center, or the State Pharmaceutical Assistance Programs (SPAPs).

  • What if my erection isn't lasting long enough?

    If your erection isn't lasting long enough for sex, reach out to your healthcare provider. They'll likely need to increase your Muse dose.

  • What if my erection is lasting too long?

    If your erection lasts longer than you want, contact your healthcare provider to help you lower your Muse dose.

    If you have a painful erection lasting more than four hours, get medical help immediately to prevent penile injury and damage.

How Can I Stay Healthy While Using Muse?

If you're using Muse, chances are ED has been negatively affecting your quality of life.

While living with ED presents challenges, there are ways to help improve your quality of life. Refer below for some general tips to support your health:

  • Take ED-related medications as recommended by your healthcare provider.
  • Avoid lying on your back or urinating (peeing) right after using Muse to prevent reduced effectiveness.
  • Engage in foreplay or masturbation to enhance your erection before sex. Make sure to do this while sitting or standing. Don't lie down right after using Muse.
  • Talk to your healthcare provider about medication changes to avoid interactions and worsening side effects. Some medications—like the pseudoephedrine decongestant—may block Muse's effects.
  • Avoid excessive amounts of alcohol. Too much alcohol may decrease your erection.
  • Stop smoking.
  • Try to exercise regularly and perform Kegel exercises to enhance your erection.
  • Find ways to help you feel rested and relaxed. Tension and excessive tiredness may reduce your erection.
  • Consider working with a mental health provider to help with mental health issues, like stress or anxiety, which may contribute to your ED condition.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Ross Phan, PharmD, BCACP, BCGP, BCPS
Ross is a writer for Verywell with years of experience practicing pharmacy in various settings. She is also a board-certified clinical pharmacist and the founder of Off Script Consults.