Viridal Duo

Viridal Duo is a dual-chamber injection system. The cartridge contains alprostadil powder in one chamber and a solvent in the other. When you prepare the injection, the two combine to create the solution. It is used with a reusable Easy-Duo injector device, which is included in starter packs.

Unlike oral ED treatments such as sildenafil or tadalafil, Viridal Duo is injected directly into the corpus cavernosum of the penis. This means it acts locally rather than through the systemic circulation, and does not rely on the same pathway as PDE5 inhibitors. It can be used by men who prefer not to take oral tablets, who cannot take them due to other medications or health conditions, or who have tried them without a satisfactory result.

Viridal Duo contains alprostadil, a prostaglandin E1 analogue that occurs naturally in the body and plays a role in regulating blood vessel tone.

When injected into the erectile tissue of the penis, alprostadil causes smooth muscle relaxation and vasodilation, increasing arterial blood flow into the corpus cavernosum. It also reduces venous outflow, helping maintain the erection once achieved.

Because Viridal Duo acts locally within the penile tissue rather than through the bloodstream, it works to a significant degree independently of sexual stimulation, though arousal can enhance its effect. An erection typically begins within 5 to 15 minutes of injection and lasts approximately 30 to 60 minutes depending on the dose and individual response.

In men with ED, impaired blood flow prevents normal erectile function. Viridal Duo bypasses the mechanisms that oral PDE5 inhibitors rely on, making it effective in cases where tablets have not worked or cannot be used.

Viridal Duo injection:

1. Works directly within penile tissue, acts locally not systemically
2. Works independently of sexual stimulation to a significant degree
3. No significant interaction risk via systemic circulation
4. Suitable whether or not oral ED treatments have been tried
5. Effective across vascular, neurogenic, and psychogenic causes of ED
6. Onset 5 to 15 minutes, duration approximately 30 to 60 minutes
7. Requires training in self-injection technique
8. 
   

Oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil):

1. Taken by mouth and distributed through the bloodstream
2. Require sexual stimulation to produce an erection
3. Drug interaction profile includes nitrates and certain antihypertensives
4. First-line treatment for most men with ED
5. Well tolerated in most men with no contraindications
6. 
   

When Viridal Duo may be the better choice:

1. You prefer not to take oral medication
2. Oral ED treatments are contraindicated due to other medications or health conditions
3. Oral treatments have not produced a satisfactory response
4. You have ED with a neurological component, for example following prostate surgery or with diabetes-related neuropathy
5. You require a reliable on-demand erection without dependence on oral absorption

Your prescriber will advise which treatment is most clinically appropriate based on your presentation and medical history.

iridal Duo is appropriate for adult men with erectile dysfunction, including:

1. Men who prefer an injectable treatment over oral tablets
2. Men who cannot take oral PDE5 inhibitors due to contraindications or drug interactions
3. Men who have tried oral treatments without a satisfactory response
4. Men with diabetes-related erectile dysfunction
5. Men with neurogenic ED, for example following spinal cord injury or prostate surgery
6. Men with vascular causes of ED where oral treatments have been ineffective
7. Men with mixed-aetiology ED involving both vascular and neurogenic components
8. 
   

Viridal Duo is not suitable if you:

1. Are allergic to alprostadil or any other ingredient in the preparation
2. Have conditions associated with a risk of priapism, including sickle cell anaemia, leukaemia, or multiple myeloma
3. Have a penile implant
4. Have significant penile anatomical deformity such as Peyronie's disease with significant curvature

Use with caution if you:

1. Are taking anticoagulants, discuss with your prescriber before use
2. Have a history of prolonged erection
3. Have cardiovascular disease, your prescriber will assess whether sexual activity is appropriate
4. Have diabetes, injection site care requires additional attention

Our online consultation will assess your presentation and medical history before any prescription is issued.

How To Use Viridal Duo

All prescribed medication should be used in accordance with your prescriber's instructions. Your prescriber or a trained healthcare professional should demonstrate the injection technique before you use Viridal Duo for the first time at home. Starter packs include the reusable Easy-Duo injector device, a cartridge, and injection needles.

1. Preparation - Wash your hands thoroughly before handling the medication. Gather your Easy-Duo injector, an unopened Viridal Duo cartridge, and a sterile injection needle. Check the cartridge is intact and within its expiry date before proceeding.
2. Assembling The Easy-Duo - Remove the seal from the injection needle and screw it securely onto the Easy-Duo injector. Unscrew the plunger, then clean the tip of the cartridge with an alcohol wipe and insert it into the chamber of the Easy-Duo. Replace the plunger and hold the assembled device upright.
3. Mixing The Medication - Push the plunger gently until the two grey stoppers meet in the middle. This combines the alprostadil powder and the solvent to activate the medication. Gently tap or shake the device to ensure the components are fully dissolved. The solution should be clear and colourless. Do not use it if it appears cloudy or contains visible particles.
4. Preparing The Dose - Hold the device vertically and tap the cartridge gently so any air bubbles rise to the top. Press the plunger slowly until a small drop of solution appears at the needle tip, expelling any remaining air. Advance the plunger to the dose volume your clinician has prescribed.
5. Injection - Choose an injection site on the side of the penis (the corpus cavernosum), avoiding any visible veins and the underside. Wipe the site with an alcohol wipe. Hold the penis straight out from the body with one hand and hold the Easy-Duo perpendicular to it in the other. Insert the needle in a straight line into the injection site and slowly push the plunger over 5 to 10 seconds to administer the full dose. Remove the needle and apply gentle pressure to the site for approximately three minutes. Rotate the injection site with each use to reduce the risk of localised reactions. Do not inject more than once in any 24-hour period.
6. After Injection - The erection should begin within 5 to 15 minutes. If a full erection has not occurred within 30 minutes, do not inject a second dose in the same session. If an erection lasts longer than four hours, seek urgent medical attention immediately.
7. Disposal And Cleaning - Remove the needle and dispose of it safely in a sharps container. Remove the used cartridge and dispose of it in your regular waste. Wash the Easy-Duo injector with warm water, dry it thoroughly, and store it ready for next use.

Common (may affect up to 1 in 10 people):

1. Pain or discomfort at the injection site during or after injection, usually mild and short-lived
2. Prolonged erection lasting longer than two to three hours, seek medical attention if the erection lasts more than four hours

Uncommon:

1. Bruising or haematoma at the injection site
2. Mild penile swelling or redness at the injection site
3. Penile fibrosis (scar tissue formation) with prolonged or frequent use, correct injection technique and regular review reduce this risk
4. Rare:
5. Priapism (painful erection lasting more than four hours), a medical emergency requiring immediate treatment
6. Hypotension (low blood pressure), more likely at higher doses
7. Systemic side effects are uncommon because Viridal Duo acts locally. However, some absorption into the systemic circulation can occur.
8. Seek urgent medical attention if you develop an erection lasting more than four hours, even if it is not painful. Treatment must be initiated promptly to avoid permanent damage.

1. Do not inject more than once in a 24-hour period, and no more than three times per week
2. Do not combine Viridal Duo with other ED treatments, including oral PDE5 inhibitors or vacuum devices, without specific medical guidance
3. Store Viridal Duo below 25 degrees Celsius, away from direct sunlight. You do not need to refrigerate it but keep it in its original packaging until use
4. Keep out of reach of children
5. Dispose of used needles safely in a sharps container
6. Use a new needle for every injection
7. Do not share your Viridal Duo with anyone else. It has been prescribed for you specifically
8. Inform your prescriber if you notice any changes to the shape of your penis, persistent pain, or skin changes at injection sites
9. Important - Before taking any medication, it is always important to read the Patient Information Leaflet (PIL)