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Trimix or Quadmix—Available by prescription from compounding pharmacies. These are mixtures of prostaglandins and papaverine that increase blood flow and retention into the penis. Prostaglandins are mediators and have a variety of strong physiological effects, such as regulating the contraction and relaxation of smooth muscle tissue. Prostaglandins are not hormones and they are not produced at one discrete site, but rather in many places throughout the human body. Trimix is a mixture of two prostaglandins (phentolamine and alprostadil) plus papaverine (a vasodilator medication) that increase blood flow to the penis and cause strong and lasting erections, with or without sexual stimulation. These compounds appear to act together to increase arterial inflow, dilate smooth muscles,and restrict venous outflow promoting erectile rigidity with greater success and in smaller doses than if these compounds were used as single therapies. An example of a dosage combination for tri-mix is 10 micrograms of alprostadil, 500 micrograms of phentolamine and 15 mg of papaverine. Dosing of tri-mix preparations has not been standardized. Trimix is injected directly into the side of the penis through a fine- gauge “insulin-style” needle in very small amounts (0.1-0.5cc) that increase blood flow to the penis. It results in strong and lasting erections. The main potential side effect are hematomas(bruising), fibrosis if used too frequently and on the same injection site,pain, and dangerously long-lasting erections(priaprism). Priaprism may sound great but this can literally kill your penis by causing gangrene of the tissue after stagnant blood coagulates inside it. I know men who had to go to an emergency room 8 hours after having used too much Trimix and have the blood drained from their penis. To ensure perfect injection technique and dosing, it is imperative to be trained on how to dose this with the help of an urologist. Compounding pharmacies sell two types of Trimix formulations: Freeze dried (powder to be mixed later with water) or pre-mixed vials. Some men find the freeze dried form not to be as effective. It is extremely important to remember never to use Viagra, Cialis, or Levitra before or at the same time as you use Trimix. This is a dangerous combination that can increase the risk of priaprism. Be particularly careful with Cialis since it can stay in your blood stream for a longer time. I know someone who had priaprism since he had forgotten he had taken Cialis two days before using Trimix. Most men who use Trimix love it, even if they have had to learn the hard way about priaprism during one instance.Most of these men did not respond well nor had too many side effects to oral agents like Viagra or Cialis. Some men who do not respond completely with TRIMIX use a quad mixture (QUADMIX) of phentolamine, papaverine, prostaglandin E1 and atropine. Others who may have pain associated with a TRIMIX injection use a bi mixture (BIMIX) of phentolamine and papaverine. A single agent FDA approved drug that only has Prostaglandin E1 can be compounded generically or is also dispensed as injectable alprostadil either as Caverject Impulse® or Edex®. These two products are not as effective as TRIMIX but may be covered by some insurance companies. Their copay may be higher than paying for TRIMIX, though. The injection volume is also 10 times larger than TRIMIX. For instructions on how to inject Trimix, read: Instructions and general information about Trimix Video: How to Inject Trimix For instructions for physicians on how to treat priaprism in the unfortunate case that it happens: Priapism in Emergency Care
How to Prevent Prapism Caused By Tri-Mix
What is priapismPriapism is an involuntary erection which lasts more than 4 hours and is unrelieved by ejaculation. This condition is a true urological emergency and early treatment allows the best chance for functional recovery. How to prevent priapism when taking Tri-Mix or other penile injection therapies (ICP):
- NEVER take Tri-Mix or any ICP injection within same 24hr period as Viagra/Cialis/Levitra or other ED meds.
- Start LOW and go SLOW with your dose. Never start higher than 0.05-0.12ml (5-12 units on syringe) for the FIRST injection. Then gradually increase from there for optimal results.
- If priapism occurs: Apply ice to perineum/scrotal area- You can use a frozen bag of fruit or vegetables if an ice pack is not available.
- Walk/jog upstairs- This can help redirect blood flow from the penis. Over-the counter medications to take: Sudafed (pseudoephedrine) is a decongestant available without a prescription but “behind the counter”, meaning that you have to ask the pharmacist to get it for you. The pharmacist will ask for your identification since this drug is known to be used in the manufacture of illegal methamphetamine, so the government keeps track of frequent users. Do not use other versions of Sudafed that are available since they do not have pseudoephedrine. Chew on a 30 or 60 mg tablet with water if erection has lasted more than 3 hours. Effects should start to be noticed within 30 minutes. Be aware that this drug will disrupt your sleep or may keep you awake for hours. Having sleep aids at hand can help if you are taking Sudafed at night time. 60mg-150mg orally. Note: Do not use Sudafed if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days.