Expired Trimix: Is it Safe to Use and What are the Risks?

Trimix combines three medications used to treat erectile dysfunction (ED). Phentolamine, papaverine, and alprostadil synergistically increase blood flow into the penis to help men get and maintain an erection. They have different pharmacological properties so that you can get the greatest benefit with the least risk of side effects. Penile injections, also called intracavernosal injections, are a safe and effective ED treatment option.

Many men prefer injectable medications to treat ED because they have experienced side effects when using oral medications, or these medications did not work well for them. In fact, 70% of men surveyed highly rate their satisfaction with injectable ED medications. Research suggests that Trimix is over 95% effective for treating ED.¹ Trimix is drawn into an insulin syringe and injected into the penis using a very small insulin needle.

Trimix is a compound that is prepared in a compounding pharmacy. The medications in this compound can break down over time and lose their effectiveness. Each vial of Trimix should be marked with a “beyond-use” date, indicating when the medication is no longer considered to be effective. Beyond-use dates mean the same as expiration dates.

Can you use Trimix after the expiration date?

Medications have a beyond-use date to indicate when they should no longer be used. In some cases, this is because the drug components have broken down and are no longer considered to be fully effective, and in others, the product may have changed chemically or become contaminated.

Improperly stored Trimix or Trimix beyond its use date will break down and no longer be effective. You should not use Trimix after its beyond-use date.

Does Trimix lose its effectiveness?

Yes, Trimix will lose its effectiveness over time. This process is faster if Trimix is left out of the refrigerator for any length of time, or refrigerated, instead of frozen, when you want to keep it for over a month. When traveling, store your Trimix in a cooler with ice packs.

Read more: How long to keep Trimix in a syringe

What is the shelf life for Trimix?

Trimix loses its effectiveness over time, especially if it is not refrigerated. Alprostadil, especially, is the limiting factor in Trimix stability. Stability testing has been completed on various strengths of Trimix ingredients, including alprostadil 5 µg/mL to 45 µg/mL, papaverine 15 mg/mL to 30 mg/mL, and phentolamine 0.4 mg/mL to 5 mg/mL, and a single-strength preparation containing alprostadil 30 µg/mL, papaverine 30 mg/mL, and phentolamine 2 mg/mL. For testing, these medications were compounded and stored in two different settings. Beyond-use dates of 60 and 64 days were obtained when Trimix was frozen at -20 degrees Celsius and 30 days when it was refrigerated at 4 degrees Celsius.

For Trimix preparations from Invigor Medical, patient and pharmacy history has shown that Trimix is effective frozen for up to six months and usable in the refrigerator for longer than the 28 days stated on the label. This agrees with the research that reports that alprostadil becomes less effective over time, losing about 6% of its effectiveness at one month refrigerated and 11% at two months and pharmacist recommendations.

What are the dangers of using Trimix?

When used as directed, Trimix is safe for most men. Potential side effects from Trimix include:

• Priapism: a prolonged, painful injection. Not overusing Trimix or taking it with another ED medication can decrease your risk.
• Bruising at the injection site: Hold pressure on the injection site for 2 to 5 minutes to decrease the risk of bruising.
• Fibrosis or scarring of the penis: Verify you have a good injection technique and alternate injection sites to reduce your risk of scarring.
• Lumps in the penis or curvature: Verify that you have a good injection technique, alternate sites, and do not overuse Trimix to reduce your risk.

Other potential side effects include:

• Diarrhea
• Nausea
• Stomach cramps or vomiting
• An allergic reaction
• A sudden decrease in blood pressure
• Increased heart rate or abnormal heart rhythm.

What happens if you inject too much TriMix?

If you inject too much Trimix or inject Trimix more often than directed, you increase your risk for priapism and penile scarring.

It is important to not inject Trimix more than once every 24 hours. Most doctors will also recommend not injecting Trimix on more than two consecutive days or more than three times in a week.   

If you have questions about how to inject your Trimix or whether it is stored correctly, call or chat with an Invigor Medical specialist. They can give you the answers you need to ensure you are using Trimix safely. Looking to purchase and get a Trimix prescription? Shop Invigor Medical today!

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Burnett AL, Nehra A, Breau RH, et al.: Erectile dysfunction: AUA guideline. J Urol 2018; 200: 633.
2. Patel G, Davis C, Liu Y, Ip K, Debideen KE, Anderson S, Byrne R, Herr D, Rhoads MM, Caputo R, Banov D, Bassani AS. Beyond-use Date of Trimix: A Reproducible Stability Study Using Bracketing Design. Int J Pharm Compd. 2021 Jan-Feb;25(1):73-81. PMID: 33503012.
3. Trissel LA, Zhang Y. Long-term stability of trimix: a three-drug injection used to treat erectile dysfunction. Int J Pharm Compd. 2004 May-Jun;8(3):231-5. PMID: 23924676.

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