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A list of Frequently Asked Questions is available below to supplement any information from our professional educators.

1. What is MUSE?

2. How do I know which MUSE dose I should start with?

3. How is MUSE distributed?

4. Are patient assistance programs available?

5. Who is a candidate for MUSE?

6. The cost of my prescription increased. Why?

7. Is it safe to receive oral sex while using MUSE?

8. How do I store MUSE before use?

9. Can I use MUSE if I have high blood pressure?

10. Who should and who should not use MUSE?

11. What causes erectile dysfunction (ED)?

12. Is MUSE painful to use?

13. Is there a problem using MUSE if penile abnormalities exist?

14. How does MUSE produce an erection?

15. Will insertion of MUSE (alprostadil) hurt?

16. What are the side effects of MUSE?

17. What are the possible side effects of MUSE for my partner?

18. After I administer MUSE (alprostadil), can we immediately lie down and begin sexual activity?

19. How long will the effect of MUSE last?

20. What will the erection be like? How will it compare to the erections I had when I was younger?

21. How do I know if I have the correct dose of MUSE?

22. After my erection is over, will my penis feel sensitive?

23. Can I reuse MUSE?

24. How do I dispose of the MUSE applicator?

25. If my erection lasts longer than I want, what should I do?

26. How often can I safely use MUSE?

27. Who makes MUSE?

28. Patient Resources


 

1. What is MUSE?
MUSE is a medicated pellet about half the size of a grain of rice that is placed in the urinary opening using a disposable plastic applicator. MUSE is indicated for the treatment of erectile dysfunction (ED). ED is the inability to attain or maintain an erection sufficient for sexual intercourse. Alprostadil is the medicine in MUSE and is a synthetic version of a naturally occurring substance called a prostaglandin E1.

2. How do I know which MUSE dose I should start with?
MUSE should be stored and used according to the MUSE Patient Information insert.MUSE is available in four dosage strengths: 125, 250, 500 and 1000 mcg. Your dose of MUSE will be determined by you and your physician (even if you have previously used injection treatment). The initial dose of MUSE should be administered under the supervision of a health care provider to test responsiveness, to demonstrate proper administration technique, and to monitor your blood pressure. Your ideal dose should be the lowest dose that is sufficient for sexual intercourse.

The use of more than one system at a time has not been tested and is not recommended. Nor more than two systems should be used in a 24-hour period. 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.

The effect can begin within 5-10 minutes after administration and can last for 30-60 minutes, although the actual duration of effect will vary from person to person.

3. How is MUSE distributed?
MUSE is available by prescription only. Talk to your doctor about this medicine and see if MUSE is right for you. Prescriptions can be filled by any licensed pharmacy or pharmacy service.

4  Does Meda have a patient assistance or indigent patient program for product supply?
Meda does not have a patient assistance or indigent patient program for Muse.

5  The cost of my Muse prescription increased. Why?
Occasionally, to cover increasing cost of manufacturing, shipping and other factors, it is necessary to adjust the price. Meda continues to work with managed care organization and government sponsored health plans to ensure that patients have access to reimbursement for Muse.

6  Who is a candidate for MUSE?
Patients with erectile dysfunction, defined as the inability to attain or maintain an erection sufficient to permit satisfactory sexual intercourse. Please consult with your physician; he or she is the best person to evaluate if you are a candidate for MUSE.

7. Is it safe to receive oral sex while using MUSE?
The use of MUSE by the male partner in couples engaging in oral sex has not been tested. The goal of the MUSE clinical studies has been improvement in erectile function resulting in sexual intercourse. During the course of these studies, anecdotal reports of bitter taste, experienced by a few partners, was reported by investigators who presumed that it was associated with oral sex.

The active ingredient in MUSE is alprostadil, a chemically identical version of the naturally occurring prostaglandin E1 (PGE1) found in semen.

About 80% of alprostadil administered by MUSE is absorbed from the urethra within ten minutes after administration. Although alprostadil from MUSE is found in the ejaculate, human semen is a rich source of prostaglandins.

Since prostaglandin causes blood vessels to dilate, partners of patients using MUSE who engage in oral sex before maximal absorption has occurred may be exposed to the blood vessel dilating effects of alprostadil contained in MUSE.

 
8. How do I store MUSE before use? 
It is recommended that MUSE be stored in a refrigerator, but not frozen, and may be kept at room temperature for up to 14 days prior to use by the patient. Exposure to temperatures above 30°C/86°F, extremes in temperature, or direct sunlight may cause MUSE to be ineffective. When traveling, a small cooler with an ice pack should be used for storage.
 
9. Can I use MUSE if I have high blood pressure?
You and your physician should determine the most appropriate dose of MUSE for you. This will be the lowest effective dose. During the first administration of MUSE your physician will instruct you on how to use the MUSE and monitor your blood pressure or look for signs of low blood pressure. In addition, some lowering of blood pressure may occur without symptoms.
 
The majority of men treated in clinical trials evaluating MUSE were also taking other cardiovascular medications, and these men were no more likely to experience symptomatic drops in blood pressure than men not taking cardiovascular medications. However, because MUSE works by causing the walls of blood vessels to relax, the use of MUSE together with anti-hypertensive medications (nitrates) has the potential to increase the risk of low blood pressure (hypotension). Therefore, you should use caution in the administration of MUSE if you are taking anti-hypertensive medications.  
 
10. Who should and who should not use MUSE? 
MUSE is indicated to restore sexual function in males with erectile dysfunction (impotence).
 
Before using MUSE at home, MUSE should be administered in a doctor's office to find the correct dose, monitor for side effects and demonstrate proper administration technique.
 
You should not use MUSE if any of the following apply:
• You have a known allergy to alprostadil
    (the active medication in MUSE).
• You have an abnormally formed penis.
• You have been advised not to undertake sexual activity.
• You have a pre-existing condition that may result in long-lasting erections, such as sickle cell anemia or trait, leukemia, tumor of the bone marrow (multiple myeloma) or other conditions associated with increased clotting of the blood.
 
MUSE should not be used with a pregnant woman unless the couple uses a condom barrier. If the female partner is of childbearing age or could possibly become pregnant in association with the use of MUSE, appropriate contraception should be used.
 
If you have a history of fainting, be sure to discuss this with your doctor prior to using MUSE.
 
If you have previously had an erection that has lasted for 4 hours or more, discuss this with your doctor prior to using MUSE.

11. What causes erectile dysfunction (ED)? 
Erectile dysfunction can be caused by disease of the blood vessels and nerves of the penis, as well as anxiety and fatigue. There may be several different causes of erectile dysfunction which can be grouped as follows:
 
Vascular causes
Poor blood flow into the penis, or inability of the veins to retain the blood in the penis,

Neurological causes
Disease of, or injury to, the nerves that control the muscles in the penis,

Hormonal causes
Low testosterone (hormone that stimulates the growth of male characteristics),

Surgical causes
Following surgery to the prostate (radical prostatectomy), or major abdominal surgery.

Pharmaceutical causes
Drugs, such as some prescription drugs for high blood pressure, depression, arthritis, high cholesterol, ulcer treatment, and over the counter "cold pills"

Lifestyle causes
Tobacco use, excessive alcohol use, using illegal drugs,

Emotional causes
Anxiety, depression, tension, guilt, stress, or problems in your relationship with your sexual partner.

Your doctor can help you determine the cause or causes of erectile dysfunction and guide you on the proper treatment, but you will need to be open in your discussions.

 
12. Is MUSE painful to use?
Pain may be experienced with the use of MUSE. Alprostadil, the active medication in MUSE, may increase the sensitivity of the nerves and be associated with local pain in the penis, urethra, and scrotum. Pain appears to be dose related, and occurred in one or more of the doses in about one third of patients; it occasionally was a cause of discontinuation. The local discomfort is usually mild and transient following MUSE (alprostadil) administration. You should discuss this symptom with your physician for further advice and whether a lower dose may be more comfortable and effective.
 
13. Is there a problem using MUSE if penile abnormalities exist?
MUSE has not been studied in patients with severe curvature or penile scarring. If erections following the use of MUSE are painful or more severe curvature or progression of the scar develops, MUSE should be discontinued and you should consult your physician.

The use of MUSE in patients with penile implants has not been studied.
 
14. How does MUSE produce an erection?
When the penis is flaccid (not erect), the flow of blood into the penis is regulated by the contraction of the muscles in the walls of the blood vessels.

The medication contained in the MUSE pellet relaxes these muscles and thereby allows more blood to fill the penis so that it becomes firm. When the effect of the medicine wears off, the muscles in the walls of the blood vessels again contract and slow the amount of blood flowing into the penis.
 
15. Will insertion of MUSE (alprostadil) hurt?
At first, you may feel some minor discomfort from insertion. Urinating prior to use will reduce the chance of discomfort or abrasions and is important for dissolving the medicated pellet. Be sure to gently stretch your penis to its full length. With repeated use over time, administration will become much easier.

16. What are the side effects of MUSE?
3% of patients in clinical trials were found to have had a symptomatic drop in blood pressure and 0.4% of patients fainted. During post-marketing surveillance fainting occurring within one hour of administration has been reported. Patients should be cautioned to avoid activities, such as driving or hazardous tasks, where injury could result if hypotension or syncope were to occur after MUSE administration. If you feel dizzy after using MUSE, you should lie down with your legs elevated above the level of your head, e.g. on pillows. If you have a history of fainting please tell your physician of these prior episodes before administration of 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 continue, call your doctor promptly.

17. What are the possible side effects of MUSE for my partner?
The most commonly reported side effects observed in women whose partners use MUSE are mild vaginal itching or burning.

18. After I administer MUSE (alprostadil), can we immediately lie down and begin sexual activity?
You can begin sexual activity. However, having the man lie down, especially on his back right 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. Many couples have used this time for 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.

19. How long will the effect of MUSE last?
An erection should begin within 5-10 minutes after using MUSE and should last about 30-60 minutes. However, times will vary from person to person.

20. 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 like the ones you had 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.

21. How do I know if I have the correct dose of MUSE?
You and your physician will determine the right dose of MUSE. Your first doses of MUSE should be given under the supervision of your doctor. In clinical studies, decreases in blood pressure and fainting were reported rarely (3% and 0.4%, respectively), and only occurred during initial in-office dosing.

If you are unable to maintain an erection 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 think you may need a dosing adjustment.

22. After my erection is over, will my penis feel sensitive?
Your penis may feel full, warm and a little sensitive to touch. These effects are normal and may last a few hours.

23. Can I reuse MUSE?
No. MUSE is for single-dose application only.

24. How do I dispose of the MUSE applicator?
After use, replace the cover on the applicator, place it in the opened foil pouch, fold and discard as normal household waste.

25. If my erection lasts longer than I want, what should I do?
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 no more than 10 minutes.

26. How often can I safely use MUSE?
MUSE should not be used more than twice in 24 hours.

27.  Who makes MUSE?
MUSE was developed by VIVUS Inc. and approved by the FDA in 1997 for the treatment of erectile dysfunction. Meda Pharmaceuticals purchased Muse in 2010, along with the manufacturing facility that produces Muse.

28.  Patient Resources
Depending on the primary cause of the erectile dysfunction, a number of organizations exist to provide patient support. These include: 
• American Foundation for Urologic Disease: 1 800 242 2383
• American Diabetic Association: 1 800 232 3472

Prostate Cancer Survivor Support Groups
• US Too: 1 800 808 7866
• Man to Man: 1 800 227 2345
• Patient Advocates for Advanced Cancer Treatments: 616 453 1477


MUSE Right Start Program
1-888-367- MUSE (6873)

The Right Start Program is a free and confidential service designed to help the patient with tips and advice when starting to use MUSE. This program is staffed by trained healthcare professionals who are available to assist patients with questions about MUSE and to guide them through the administration process.

 

 

Important Information:
MUSE (alprostadil) is a medicated pellet that is placed in the urinary opening using a disposable plastic applicator. MUSE should not be used by men who have sickle cell anemia or trait, leukemia or tumor of the bone marrow, allergy to alprostadil (the active ingredient in MUSE), or abnormal penile anatomy. Call your doctor immediately if your erection lasts 4 hours or more.

Men with certain heart problems should not use MUSE. Check with your doctor to see if your heart is healthy enough for sex before using MUSE. You should avoid activities such as driving or other hazardous tasks within one hour of using MUSE because you may become light-headed, dizzy or faint.

Remember that no medicine is for everyone. MUSE should not be used for intercourse with a pregnant woman without a condom. MUSE does not protect against sexually transmitted diseases. Side effects can include penile pain.

 

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