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This will keep the needle from bending as you insert it into the rubber stopper. Holding the vial upright and the syringe downward, insert marley drugs viagra the needle through the circle in the center of the rubber stopper. Push the plunger down to inject the air into the vial (see Figure 1). You must replace the amount of medication you remove from the vial with air. Turn the vial and syringe upside down (see Figure 2). Hold the syringe with the hand you use to write with and the vial with your other hand. Make sure the tip of the needle is in the medication. Rotate the syringe so you’re looking at the numbers and lines on the syringe. 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. You will 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). 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. This will allow your penis to be more fully stretched. It’s easiest to inject if your penis is viagra pills shoppers 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 marley drugs viagra 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 (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 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 that 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 marley drugs viagra 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. 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 that your APP gave you. If you’re adjusting your own medication dosing, the office will no longer be able to prescribe your medication. Please use the 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. Please make sure to include the information below in your injection reports. For your first injection: inject ___________ units of ____________________________ while you’re at home. Use the erection scale above and record your response below. Call your APP after each injection to report your response. Keep calling your APP after each injection until we find the right dose for you. Phone number:________________________________________. Do not change your dose without speaking with your APP. 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. Don’t change the dose without speaking to your APP. 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. 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 take the following medications within 18 hours of an injection (before or after): Medication Dose Sildenafil (Viagra) 20 mg to 100 mg Vardenafil (Levitra) 10 mg to 20 mg Avanafil (Stendra) 50 mg to 200 mg. Your APP will order your supplies for you from a compounding pharmacy. Your supplies will include: 1 vial (500 units) of ______________________ medication 30 syringes (29 gauge, ? inch) 24 pseudoephedrine HCl (Sudafed ® ) 30 mg tablets. You will also need to buy alcohol pads from your local pharmacy. Your injection medication can’t be ordered from your local retail pharmacy (such as marley drugs viagra CVS, Rite Aid, Duane Reade, or Costco). They will be ordered from a specialty compounding pharmacy approved by MSK: MasterPharm www.masterpharm.com Telephone: 866-630-5600 Fax: 718-529-2780 Other: ______________________ ___________________________ ___________________________ ___________________________. They will order more supplies for you and will let you know if refills are included. If refills are viagra pills generic brand included, you can contact the compounding pharmacy directly to set up your billing and shipping. Pseudoephedrine HCl (Sudafed) Sometimes, penile injections can cause priapism (an erection that lasts too long). If you have priapism, taking pseudoephedrine HCl can help. 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. Take the pseudoephedrine HCl card that’s hanging on the shelf to the pharmacist (see Figure 4). You will 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. Treating Priapism (An Erection That Lasts Too Long) 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 that 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 generic viagra hims 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. 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.
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