Treating Erectile Dysfunction: An Introduction To Trimix

March 25, 2024
intimacy and mental health are linked

Erectile dysfunction (ED) affects a significant number of men, with approximately 30 million men in the United States and 150 million men worldwide grappling with this condition. ED poses challenges in achieving and maintaining a sufficiently firm erection for satisfying sexual intercourse (1). This condition can have a profound impact on an individual’s overall quality of life and intimate relationships. While oral medications such as Viagra and Cialis are frequently prescribed for Treating Erectile Dysfunction, it is essential to recognize that they may not yield successful outcomes for everyone. In cases where other ED treatment alternatives have proven ineffective, Trimix injections offer a promising solution.

Trimix is a custom-blended medication formulated from a combination of three potent active ingredients: alprostadil, phentolamine, and papaverine. This unique composition has demonstrated remarkable efficacy in facilitating erections, providing a targeted response precisely when and where it is needed. If you or your partner are navigating the realm of ED treatment options, this article serves as a valuable resource to help you assess Trimix as a potential remedy for Treating Erectile Dysfunction.

What Is Erectile Dysfunction?

ED is a prevalent medical condition, and its symptoms can vary widely among men, ranging from occasional difficulty in achieving an erection to the complete inability to do so. Some men may achieve an erection, but it does not endure long enough for penetrative intercourse (2).

The process of achieving an erection is intricate and necessitates precise coordination among various physiological factors, including the brain, hormones, nerves, blood vessels, and penile tissues. An erection occurs when blood flows into the spongy tissue within the penis, becoming trapped in specialized spaces known as the corpora cavernosa. As these chambers fill with blood, pressure mounts, leading to penile rigidity.

Although this process may seem straightforward, disruptions at any stage of this pathway can result in ED. Several essential elements must align: you must be mentally prepared and interested in sexual activity, your brain must effectively transmit this desire to your blood vessels, these blood vessels should dilate to permit increased blood flow to the penis, and the penile blood vessels must respond appropriately, allowing the penis to fill with blood and retain it.

ED has a multitude of causes and can manifest at any age, with its prevalence escalating as men grow older. Surprisingly, one in four men seeking treatment for ED is under 40, and nearly half of them report severe symptoms. Moreover, approximately half of men aged 40-70 experience some degree of ED (1).

If you are grappling with ED, it may signify a treatable underlying health issue, particularly one involving your cardiovascular health (3). The predominant cause of ED with a physical origin is damage to blood vessels (2). Frequently, ED serves as a warning sign that conditions like high cholesterol or elevated blood sugar are harming the inner lining of your blood vessels. Addressing this warning promptly provides an opportunity to restore your overall health.

Common factors contributing to ED encompass:

  • High blood pressure: Nearly one in three men with high blood pressure also experiences ED. Elevated blood pressure can harm the inner lining of blood vessels, reducing blood flow to the penis. Regrettably, medications used to manage high blood pressure can also increase the risk of ED (1).
  • Psychological conditions: Depression, anxiety, and other mental health disorders often underlie ED in younger men (3). The presence of nighttime or early morning erections can suggest a psychological cause for ED (2).
  • Smoking: Nicotine and other chemicals in cigarette smoke narrow blood vessels and damage their inner lining, diminishing blood flow to the penis (3). Smokers nearly double their risk of ED (4).
  • Diabetes mellitus: Prolonged high blood sugar levels result in blood vessel and nerve damage, elevating the risk of ED. With the worldwide rise in type 2 diabetes cases, it’s crucial to recognize this potential complication (5).
  • Unhealthy blood lipids: Elevated low-density lipoproteins (LDL cholesterol) and reduced high-density lipoproteins (HDL cholesterol) lead to plaque buildup and inflammation on blood vessel linings (2).
  • Age: ED becomes more prevalent with advancing age (2).
  • Obesity: Obesity directly heightens the risk of ED and other chronic diseases. Fat cells release chemicals that promote inflammation, limiting blood flow into the penis (6).
  • Sedentary lifestyle: Similar to obesity, insufficient physical activity increases the risk of ED and the likelihood of developing other chronic conditions that contribute to ED (7).
  • Medications: Certain prescription and over-the-counter medications, including antidepressants, blood pressure drugs, antihistamines, opioid pain relievers, and many others, can contribute to ED (8).

Diagnosing ED

ED is primarily diagnosed through clinical evaluation. Your healthcare provider may request you to complete an ED questionnaire, aiding in the assessment of the severity of your ED and potential contributing factors. According to guidelines established by the American Urological Association, all men experiencing ED should undergo at least two morning testosterone level measurements.

Low testosterone levels are linked to several symptoms, including weak morning erections, reduced sexual desire, ED, depression, and fatigue. A study has shown an inverse relationship between weak morning erections, ED, low sexual desire, and testosterone levels. As testosterone levels decrease, the severity of these sexual symptoms tends to increase.

Additionally, your doctor may recommend further tests and laboratory examinations based on factors such as your age, specific symptoms, and potential underlying causes of ED.

Treating Erectile Dysfunction: An Introduction To Trimix

What is Trimix?

Trimix is a meticulously prepared sterile medication, customized to meet the specific needs of each individual. Due to its tailor-made composition, Trimix can only be obtained from specialized compounding pharmacies and necessitates a prescription from a licensed healthcare provider.

This unique medication consists of three active ingredients—alprostadil, phentolamine, and papaverine—that collaborate to enhance blood flow to the penis, resulting in a robust and enduring erection. Notably, alprostadil, one of the components in Trimix, is also present in approved ED medications such as Edex and Caverject. The effectiveness of penile injections, including Trimix, is well-documented, with studies showing satisfactory results in 87% to 93% of men who utilize this method to manage ED (9).

The process of injecting medication directly into the penis is termed intracavernosal injection therapy. Despite initial reservations, this highly effective ED treatment option has been in use for approximately 40 years (9). It’s worth noting that the needle used for these injections is exceptionally thin, and as you become more accustomed to the technique, the procedure becomes nearly painless (9).

Trimix boasts several advantages over single-drug injection alternatives, such as alprostadil used in isolation. By combining medications at lower doses, Trimix minimizes side effects, such as pain, which can occur when higher doses of alprostadil are administered (9). Research indicates that individuals who have experimented with both penile injections and oral ED medications tend to express higher satisfaction levels with the injectable approach (10, 11).

How Does Trimix Work for Treating Erectile Dysfunction?

Trimix incorporates three potent active ingredients: alprostadil, phentolamine, and papaverine. These substances are all classified as vasodilators, meaning they widen blood vessels and enhance blood flow to the penis. The unique aspect of Trimix lies in the combination of these vasodilators, which allows for the use of smaller individual doses while achieving greater overall effectiveness. This multi-agent approach surpasses the efficacy of using a single vasodilator (9).

The three medications within Trimix work in concert to optimize effectiveness while minimizing potential side effects (12, 13):

  • Papaverine relaxes the smooth muscles within blood vessels, leading to their dilation and increased blood flow into the penis.
  • Phentolamine similarly relaxes smooth muscle within blood vessels, facilitating dilation and heightened blood flow into the penis.
  • Alprostadil, also known as prostaglandin E1 operates by relaxing the smooth muscle structure of the penis and dilating the blood vessels that supply blood to the penis, thereby promoting penile rigidity for an erection.

When Trimix is injected into the penis, it induces relaxation of the smooth muscles in the corpus cavernosum and dilation of the cavernosal arteries, resulting in an augmented blood flow and the onset of an erection. Typically, Trimix injections are administered shortly before engaging in sexual activity, with an onset of action occurring within 5 to 10 minutes.

It is worth noting that approximately 20% to 40% of men experiencing ED report that oral ED medications, such as phosphodiesterase type 5 inhibitors like Viagra, are not effective for them. This is particularly true for men with conditions such as diabetes, atherosclerosis (hardening of the arteries), smokers, and those with low testosterone levels. In fact, a larger percentage of men discontinue sildenafil (Viagra) use due to a lack of effectiveness rather than side effects (14).

Clinical Trials and Trimix Effectiveness

In a comprehensive study involving 453 men, aged 36 to 91, who had heart or blood vessel disease, researchers set out to compare the effectiveness of sildenafil, a commonly used oral medication, with injectable medications (15).

Phase 1 – Sildenafil:

  • 417 participants received sildenafil.
  • 49% of participants reported a positive response, but 18% experienced serious side effects.
  • Erections occurred within 20 minutes to 1 hour after taking sildenafil and typically lasted 15 to 40 minutes.

Phase 2 – BiMix (papaverine and phentolamine):

  • Only 19% of participants responded positively to the first injection, but this increased to 39% after a second injection, and 7% responded to a third injection.
  • In total, 54% of participants had a positive response to BiMix.

Phase 3 – Trimix:

  • In this phase, 113 participants received Trimix.
  • Initially, 64% reported a positive response, with erections lasting 40 to 180 minutes. Some participants experienced pain, leading to a reduction in their alprostadil dose.
  • After a second injection, 32% of participants had a positive response.
  • Overall, 75% of participants experienced a positive response to Trimix.

Phase 4 – QuadMix:

  • A total of 28 participants received QuadMix.
  • 43% of participants had a positive response, with erections lasting 46 to 86 minutes. Some participants responded to a second injection, resulting in a total response rate of 57%.

Following the initial assessment, the 447 participants who demonstrated a positive response to medications, injections, or a penile implant were monitored over the subsequent two years. The findings indicated that sildenafil citrate worked for 29.3% of men, BiMix for 20.6%, Trimix for 27.3%, QuadMix for 2.7%, sildenafil + injection for 0.4%, and penile prosthesis for 1.1% (15).

In another study involving 40 participants, researchers explored the efficacy of combining Trimix with low-dose daily sildenafil for men who did not achieve satisfactory results with either sildenafil alone or alprostadil alone. The results showed that 70% of participants reported increased hardness, and 66% were satisfied with the combination of Trimix and sildenafil treatment. However, approximately 43% of participants experienced side effects, including penile pain, headache, facial flushing, stomach upset, nasal congestion, and dizziness (16).

In summary, penile injections, such as Trimix, offer a highly effective treatment option for men who do not respond adequately to oral ED medications. For some individuals who do not achieve a satisfactory response with either treatment on its own, combining low daily doses of an oral ED medication with Trimix may enhance overall efficacy.

Picture of a vial for Treating Erectile Dysfunction

How to Use Trimix Injections

Before embarking on Trimix injections, it is crucial to engage in a consultation with a healthcare provider who can determine the appropriate dosage and furnish comprehensive instructions for self-administration. The following steps outline the process:

Preparing and Administering Trimix Injections:

  1. Thaw your medication to room temperature.
  2. Inspect the use-by date and the medication’s appearance; discard Trimix if it becomes cloudy or undergoes any noticeable changes.
  3. Wash your hands thoroughly.
  4. Sterilize the rubber top of your Trimix bottle with an alcohol swab.
  5. Remove the needle cap.
  6. Draw the plunger back on the syringe just past the prescribed dose.
  7. Hold the syringe between your thumb, index, and middle fingers, ensuring the needle remains straight during insertion through the rubber stopper on your Trimix vial.
  8. Inject air into the vial to equalize the pressure.
  9. Take care not to contaminate the needle by avoiding contact with surfaces other than the rubber stopper of your Trimix vial.
  10. Draw up your prescribed dosage from the Trimix vial.
  11. Confirm that there is no air left in the syringe and that you have drawn up the correct amount of medication.
  12. Clean your penis with alcohol and allow it to dry.
  13. Gently pull your penis away from your body to make the skin taut, without twisting it.
  14. Identify the injection site (the side of the penis, approximately at mid-shaft).
  15. Inject your medication into the side of the penis at either the 10 o’clock or 2 o’clock positions, avoiding visible blood vessels.
  16. Touch the injection site with the needle, then insert it into your penis.
  17. Use your index finger to depress the plunger.
  18. After administering the medication, withdraw the needle straight out of the penis.
  19. To prevent the development of scar tissue, rotate the injection site for each subsequent injection.
  20. Apply pressure for 2 to 3 minutes (or 5 minutes if you take a blood thinner).
  21. Place the used syringe in a designated sharps container.

In most cases, penile injections start to take effect within approximately 20 minutes. Activities like standing and external stimulation of the penis can hasten this process by enhancing blood flow into the penis. Typically, erections resulting from penile injections persist for about 30 minutes, though the duration may vary depending on factors such as your overall health, age, and the specific medication doses.

Compounded medications offer several advantages, but they often demand more meticulous storage practices compared to non-compounded medications. Preserving the potency of Trimix necessitates strict adherence to storage instructions. Trimix is susceptible to degradation at room temperature and, as such, must be stored either in a refrigerator or frozen. Each Trimix vial is clearly marked with a beyond-use date, beyond which the medication is not expected to maintain its effectiveness. Expired Trimix should not be used, as it is no longer considered effective (17).

To maintain Trimix’s effectiveness, follow these storage guidelines:

  • Store Trimix in the refrigerator for a period of up to three months.
  • Unopened vials can be safely stored in the freezer, with a shelf life of approximately six months.
  • When you intend to use a new vial, remove it from the freezer and allow it to thaw completely at room temperature. If any ice is visible in the solution, wait until it has melted before using.
  • If Trimix is inadvertently left unrefrigerated for more than three days, it should be discarded. For more specific information about Trimix storage and travel recommendations, consult the instructions provided by your pharmacy.

Trimix Dosage and Adjustments

Trimix injections are meticulously tailored for each individual at a compounding pharmacy, allowing for dosage adjustments based on their specific response and requirements. It is advisable to commence with a lower dosage to mitigate the risk of prolonged erections. Typically, Trimix dosages commence at a low level and are gradually increased as necessary.

  • The initial dose typically falls within the range of 5 units (0.05 mL) to 20 units (0.2 mL) of Trimix. Concentrations may vary depending on the source of your Trimix, so it is essential to carefully read the provided instructions. If you have any doubts regarding the appropriate Trimix dosage, do not hesitate to reach out to your doctor or pharmacist for clarification.
  • Subsequent doses should be augmented incrementally, with no more than five additional units administered at a time. 
  • The maximum allowable dosage for a single Trimix injection is 50 units.

To ensure safe and effective use of penile injection therapy and reduce the risk of complications like priapism, strict adherence to your healthcare provider’s instructions is paramount. Follow these guidelines meticulously when titrating your dose, and never combine medications or increase your injection frequency without prior consultation with your doctor.

To minimize the likelihood of side effects, make sure to inform your doctor of all other medications you are taking, especially ED medications. Combining oral ED medications with penile injections can heighten the risk of side effects.

Generally, penile injections should not be administered more frequently than once within a 24-hour period, on consecutive days, or more than two or three times per week. Injecting Trimix more frequently than recommended can elevate the risk of developing penile scarring.

Treating Erectile Dysfunction: An Introduction To Trimix


Priapism, defined as an involuntary erection lasting longer than four hours and unrelieved by ejaculation, constitutes a urological emergency necessitating immediate treatment to prevent potential damage to the penis.

If you find yourself experiencing an erection persisting beyond two hours, consider employing a combination of non-pharmacological measures and over-the-counter medications as an initial response. These measures may include the application of ice packs to the penis or engaging in vigorous exercises like stair climbing, which can, in some cases, reverse prolonged erections. Research has shown that approximately one-third of men were able to resolve priapism without the use of medications by employing ice packs and vigorous exercise. These methods can be particularly useful for individuals without immediate access to medical treatment (18).

Your doctor may prescribe a medication like pseudoephedrine (Sudafed) to aid in reversing priapism should it occur. It is essential to thoroughly comprehend the proper usage of this “antidote” medication in case the need arises. Pseudoephedrine is available over the counter but is typically kept behind the pharmacy counter. To purchase it, you will need to provide a photo ID, but a prescription is not required. Individuals with high blood pressure or heart conditions should exercise caution when using pseudoephedrine.

For erections lasting longer than three hours, a prescription option like phenylephrine injections may be recommended. Your healthcare provider at Invigor Medical can prescribe this medication alongside Trimix. 

Phenylephrine is the preferred first-line treatment for priapism due to its lower overall risk of causing systemic cardiovascular effects. It boasts rapid onset and a short duration of action, with rare side effects that may include (19):

  • High blood pressure
  • Headache
  • Slowing of heart rate
  • Palpitations
  • Abnormal heart rhythm or rate

Should your erection persist for more than four hours and become painful, it is imperative to seek immediate treatment at a local emergency room.

To gauge your response to your Trimix dosage, consider rating your erection on a scale of 0 to 10, where 0 signifies no erection, 6 denotes an erection suitable for penetration, and 10 indicates a firm erection or 100% response. Discovering your optimal Trimix dosage may entail some trial and error over several injections. Strive for the lowest effective dose that yields an erection firm enough for sexual activity (approximately 6 out of 10) without inducing priapism. Monitoring aspects such as erection quality, time required to achieve an erection, and dose effects can serve as valuable indicators to guide your dosage adjustments.

Potential Trimix Side Effects

While Trimix injections are generally safe and well-tolerated, it is essential to be aware of potential side effects. These may include pain at the injection site, priapism (prolonged erection), penile scarring, bruising or hematoma, low blood pressure, dizziness, and allergic reactions. In the event of an erection lasting longer than four hours, it constitutes a medical emergency, and immediate medical attention should be sought.

Potential side effects from taking penile injections may include:

  • Priapism: This is one of the more serious potential side effects of using ED medications. Prolonged erections can lead to decreased oxygen levels and nutrient supply to sensitive penile tissues. Your doctor will discuss treatment options for priapism and provide guidance on when emergency treatment is necessary. The incidence of priapism when using Trimix varies from 0% to 3.7% (18, 20).
  • Bruising: Bruising or swelling at the injection site may occur, but you can reduce your risk by applying pressure to the injection site for 5 to 10 minutes.
  • Fibrosis or scarring: Scarring of the penis can result in curvature or other penile deformities. To decrease your risk, adhere to the prescribed injection frequency and alternate your injection sites. Some studies suggest that applying pressure to the injection site for 5 to 10 minutes may decrease the risk of scarring.
  • Injection site pain: Stinging, discomfort, or soreness at the injection site is typically mild and self-limited. With practice, you will likely notice a decrease in injection site pain. Approximately 5% of men chose to discontinue their Trimix injections due to pain in one study (21).

Other side effects associated with Trimix include:

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

Men who used Trimix to treat ED reported the following side effects (2):

  • Pain with injection (2.02%)
  • Injection site bruise or swelling (14.83%)
  • Penile fibrosis (4.53%)
  • Prolonged or painful erection (2.80%)
  • Priapism (3.15%)

Contraindications for using penile injections include:

  • Having a hypersensitivity or allergy to any component of the compound
  • Having a medical condition that increases the risk of priapism, a painful erection lasting longer than 4 hours
  • Having sickle cell disease or trait, multiple myeloma, or leukemia
  • Having an anatomical deformity of the penis
  • Taking a blood thinner
  • Having uncontrolled high blood pressure
  • Having an implanted penile prosthesis or penile implant

Trimix is a compounded medication used off-label to treat ED. Off-label use of medications is common and indicates that your doctor has evaluated your treatment alternatives and determined that Trimix is the most suitable option for you.

As Trimix has not undergone evaluation by the U.S. Food and Drug Administration, it is crucial to obtain it from a licensed compounding pharmacy. Pharmacists in compounding pharmacies are experienced and accredited in the use of sterile techniques when compounding medications.

Sign says sexual health

Comparing Trimix With Other ED Medications

Erectile dysfunction (ED) presents several effective treatment options, encompassing oral medications, injections, and surgical procedures. When considering treatment avenues, engaging in a comprehensive discussion with a healthcare provider is essential to ascertain the most suitable ED treatment option tailored to your unique needs and preferences.

Oral ED medications, commonly referred to as phosphodiesterase 5 (PDE5) inhibitors, typically serve as the initial treatment choice for ED. PDE5 is an enzyme responsible for initiating a sequence of reactions to conclude an erection. Oral ED medications work by extending blood flow to the penis, thereby enhancing erections.

Sildenafil (Viagra)

Sildenafil is typically taken on an as-needed basis, with ingestion recommended 30 to 60 minutes before engaging in sexual activity. Its efficacy reaches its zenith around 60 minutes after consumption and persists for up to four hours. Doses vary from 25 mg to 100 mg when taken orally (13). It is crucial to adhere to the guideline of not taking sildenafil more frequently than once every 24 hours.

Sildenafil can be consumed with or without food. However, the presence of a high-fat meal may slow its absorption, prolonging the time it takes to become effective. To optimize its effectiveness, it is advisable to ingest sildenafil before having a meal.

It is important to note that grapefruit and grapefruit juice can interfere with the metabolism of sildenafil, potentially exacerbating its side effects.

The most commonly reported side effects of sildenafil encompass headache, facial flushing, upset stomach, and nasal congestion.

Tadalafil (Cialis)

Tadalafil provides two dosage options: daily or as needed. For as-needed dosing, dosages range from 5 mg to 20 mg when taken orally. Alternatively, one tablet can be taken daily as directed, with dosages ranging from 2.5 mg to 5 mg daily (13).

Tadalafil’s onset of action can take an hour or longer to initiate, but it boasts a considerably longer duration of action compared to sildenafil, lasting up to 36 hours.

The extended duration of action with tadalafil implies that individuals who experience side effects may have them persist for a longer duration compared to short-acting medications. The most frequently reported side effects of tadalafil encompass headaches, upset stomach, nasal congestion, and cough.

Tadalafil can be taken with or without food. Unlike other oral ED medications, its absorption remains unaffected by food intake. It is noteworthy that grapefruit and grapefruit juice have the potential to interfere with tadalafil’s metabolism, thereby increasing the risk of experiencing side effects.

Vardenafil (Levitra, Staxyn)

Vardenafil should be taken approximately 30 to 60 minutes prior to engaging in sexual activity, with its effects enduring for about four to five hours. Dosing for vardenafil ranges from 5 mg to 20 mg, to be taken orally, on an as-needed basis (13). It is imperative to adhere to the guidance not to consume vardenafil more frequently than once within a 24-hour period.

Vardenafil can be consumed with or without food. Nevertheless, the presence of a high-fat meal may decelerate its absorption, elongating the time it takes to become effective. To optimize its efficacy, it is advisable to ingest vardenafil before having a meal.

It is noteworthy that grapefruit and grapefruit juice can interfere with vardenafil’s metabolism, potentially exacerbating side effects.

The most commonly reported side effects associated with Levitra include headaches, flushing, runny nose, and indigestion. It’s important to be cautious when consuming alcohol while taking Levitra, as it may heighten the risk of experiencing side effects.

Avanafil (Stendra)

Avanafil is typically consumed around 15 to 30 minutes before engaging in sexual activity, with its effects persisting for up to six hours. It’s crucial to adhere to the recommendation not to take avanafil more than once in a 24-hour period. The dosage ranges from 50 mg to 100 mg, to be taken orally, as needed (13).

The most frequently reported side effects linked to avanafil encompass headaches, flushing, nasal congestion, and a sore throat.

Suppositories (MUSE)

Prostaglandin E1 (alprostadil) is accessible in suppository form, with dosages available in 125 mcg, 250 mcg, 500 mcg, and 1,000 mcg. MUSE typically becomes effective within 30 to 60 minutes after administration. The most prevalent side effects associated with MUSE encompass urethral burning and pain. In rare instances, this medication may lead to fainting (13).

Vacuum Erection Devices

A vacuum device offers a non-surgical approach to address ED. It involves placing a cylinder over the penis to generate a vacuum, which, in turn, draws blood into the penis through negative pressure. After removing the cylinder, a constriction band is left at the base of the penis to retain blood within. It’s important to note that the band should not remain in place for more than 30 minutes.

Potential side effects associated with the use of a vacuum device encompass penile pain, numbness, and bruising.

Penile Implants and Other Surgical Options

For severe cases of ED that do not respond to other treatment options, surgical interventions like penile implants may be considered. These implants, often semimalleable prosthetics, are inserted into the corpora cavernosa. Alternatives include inflatable prostheses or blood vessel surgery. Potential complications associated with penile implants include infection, erosion, and device malfunction. Proper patient selection is crucial in determining the suitability of this procedure.

Blood vessel surgery may be a viable choice, particularly for younger men with a history of groin injuries and ED.

It’s essential to note that while PDE5 inhibitors are typically regarded as the initial treatment approach for ED, the American Urological Association underscores the importance of ensuring that men are fully informed about all available treatment options, provided they are not medically contraindicated.

Trimix injections offer several advantages over other ED treatments. They boast a high success rate, with studies indicating an approximate overall success rate of 80–90%. Trimix operates locally in the penis, resulting in a reduced risk of systemic side effects compared to oral medications. It also provides a rapid onset of action, typically within 5–10 minutes, and can last for 30–60 minutes. Trimix serves as a convenient alternative for individuals who do not respond to or cannot tolerate oral medications.

Treating Erectile Dysfunction: An Introduction To Trimix

Trimix Availability and Cost

Trimix necessitates a prescription, and individuals seeking more information about it should consult with a healthcare professional on the Invigor Medical platform. If prescribed, your Invigor Medical healthcare provider will electronically transmit the Trimix prescription to one of their partner compounding pharmacies.

It’s crucial to emphasize that Trimix is not accessible at conventional retail pharmacies. Instead, it can exclusively be obtained from specialized compounding pharmacies, which possess the expertise required to prepare Trimix in a sterile environment and tailor it to suit the specific needs of each individual. Therefore, it’s imperative to select a reputable compounding pharmacy that rigorously adheres to stringent quality control standards.

The cost of Trimix varies and hinges on factors such as the source pharmacy, dosage strength, geographic location, quantity, and whether you possess insurance coverage.

For instance, at Invigor Medical, a single Trimix vial is available for $249, while two vials can be purchased for $349. Regarding individual doses, the cost typically falls within the range of $1.50 to $3.50 per dose. If Trimix is administered in a clinical setting, anticipate paying between $20.00 and $40.00.

Keep in mind that since Trimix necessitates a prescription, you should consider the expense of a medical visit when calculating the overall cost. Additionally, when assessing the pricing of Trimix, take into account any associated shipping costs and the expenses associated with injection supplies.

Success Stories and Testimonials from Other Trimix Users

Trimix reviews on provide overwhelmingly positive feedback. Reviewers shared their experiences, noting that while they initially had reservations about injecting Trimix, the results they achieved were so remarkable that they intend to continue using Trimix. This sentiment is particularly strong among individuals for whom oral ED medications yielded unsatisfactory results.

Additionally, one user pointed out that they needed to make some adjustments to the dosage to discover the most effective one for their specific needs. These reviews underscore Trimix’s efficacy and its potential to be a game-changer for individuals seeking effective ED treatment options.


Trimix injections offer an effective solution for individuals dealing with ED, especially those who have found little to no relief from oral medications or have difficulty tolerating them. Comprising three active ingredients—alprostadil, phentolamine, and papaverine—Trimix enhances penile blood flow, resulting in a reliable and prolonged erection. Overall, Trimix is well-tolerated and safe when used according to healthcare provider guidance.

It’s crucial for individuals to adhere to their healthcare provider’s instructions and be aware of potential side effects. By consulting with a healthcare provider and obtaining Trimix from a reputable compounding pharmacy, men experiencing ED can take meaningful steps towards regaining their sexual function and enhancing their overall quality of life.

A noteworthy statistic underscores the importance of seeking treatment: In a study involving 6 million men diagnosed with ED, only approximately 25% received actual treatment. If you’re experiencing ED symptoms, don’t hesitate to reach out to a specialist at Invigor Medical to explore your ED treatment options, including the potential benefits of Trimix.

Treating Erectile Dysfunction: An Introduction To Trimix

Frequently Asked Questions About Trimix

What is Trimix?

Trimix is an injectable medication designed to treat Erectile Dysfunction (ED). It consists of a combination of three drugs: alprostadil, phentolamine, and papaverine. These drugs work in synergy to enhance blood flow and relax penile muscles, ultimately leading to an erection. Trimix is administered via an intracavernosal injection into the base of the penis using a fine needle.

How does Trimix work?

Trimix operates by relaxing the smooth muscle tissue in the penis and expanding blood vessels, thereby increasing blood flow. Alprostadil dilates blood vessels, phentolamine blocks alpha receptors to prevent vasoconstriction, and papaverine helps inhibit the breakdown of cGMP by PDE5 to maximize vasodilation. This combined effect encourages blood flow into the penis, where it is trapped to facilitate the attainment and maintenance of an erection.

How long does Trimix last?

The onset of action for Trimix injections can vary, but erections typically occur within 5 to 20 minutes post-injection. The duration of the erection varies as well but generally allows for successful sexual intercourse, lasting approximately 30 minutes to an hour or even longer.

How often can Trimix be used?

Trimix can be employed up to three times per week, with at least a 24-hour gap between doses. Exceeding this frequency may lead to scarring or permanent damage to the penis. Consult with your healthcare provider to determine your optimal dosing frequency.

What are the side effects of Trimix?

Common side effects of Trimix encompass pain at the injection site, bruising, scarring, difficulty ejaculating, and prolonged erections (priapism). Prolonged erections exceeding 4 hours necessitate immediate medical attention. Less frequent side effects include bleeding, dizziness, heart palpitations, and penile curvature. To minimize the risk of side effects, diligently adhere to your prescriber’s instructions.

Is Trimix safe?

Trimix, when used appropriately under medical supervision, maintains a good safety profile and is generally well tolerated. However, improper injection techniques can elevate the risk of side effects. Follow your healthcare provider’s instructions meticulously for correct injection procedures and dosing.

Does Trimix require a prescription?

Yes, Trimix mandates a prescription from a licensed medical provider. Ensure you obtain Trimix exclusively from a verified and reputable compounding pharmacy.

How is Trimix stored?

Trimix must be stored refrigerated within a temperature range of 36°F–46°F. Extra Trimix vials can be frozen. Protect Trimix from light and extreme temperatures, and dispose of expired medication properly. Detailed storage instructions are typically provided with your Trimix prescription, as requirements may vary between compounding pharmacies.

Does health insurance cover Trimix?

Most health insurance plans do not cover Trimix since it is considered a compounded medication. You may inquire with your provider regarding potential coverage.

Who should not use Trimix?

Individuals with known hypersensitivity to Trimix or any of its components, as well as those with conditions such as sickle cell disease, sickle cell trait, multiple myeloma, leukemia, or other blood disorders, penile implant or prosthesis, penile scarring or anatomical deformities, or a history of priapism, should refrain from using Trimix. Avoid Trimix if you are taking blood thinners. 

Trimix should not be combined with other ED therapies without consulting your healthcare provider. Inform your healthcare provider of any underlying health conditions before commencing Trimix treatment.

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  • Nunes KP, Labazi H, Webb RC. New insights into hypertension-associated erectile dysfunction. Curr Opin Nephrol Hypertens. Mar 2012;21(2):163-70. doi:10.1097/MNH.0b013e32835021bd
  • Burnett AL, Nehra A, Breau RH. Erectile dysfunction: AUA guideline. J Urol 2018;200:633.
  • Capogrosso P, Colicchia M, Ventimiglia E, et al. One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man—Worrisome Picture from the Everyday Clinical Practice. The Journal of Sexual Medicine. 2013/07/01/ 2013;10(7):1833-1841.
  • Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol. Feb 2000;163(2):460-3.
  • Thorve VS, Kshirsagar AD, Vyawahare NS, Joshi VS, Ingale KG, Mohite RJ. Diabetes-induced erectile dysfunction: epidemiology, pathophysiology and management. J Diabetes Complications. Mar-Apr 2011;25(2):129-36. doi:10.1016/j.jdiacomp.2010.03.003
  • Moon KH, Park SY, Kim YW. Obesity and Erectile Dysfunction: From Bench to Clinical Implication. World J Mens Health. May 2019;37(2):138-147. doi:10.5534/wjmh.180026
  • Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. Feb 2007;120(2):151-7. doi:10.1016/j.amjmed.2006.06.010
  • Rew KT, Heidelbaugh JJ. Erectile Dysfunction. Am Fam Physician. Nov 15 2016;94(10):820-827.
  • Mulhall JP, Simmons J. Assessment of comparative treatment satisfaction with sildenafil citrate and penile injection therapy in patients responding to both. BJU Int. Dec 2007;100(6):1313-6. doi:10.1111/j.1464-410X.2007.07266.x
  • Kim SC, Chang IH, Jeon HJ. Preference for oral sildenafil or intracavernosal injection in patients with erectile dysfunction already using intracavernosal injection for > 1 year. BJU Int. Aug 2003;92(3):277-80. doi:10.1046/j.1464-410x.2003.04324.x
  • Coombs PG, Heck MH, Guhring P, Narus JB, Mulhall JP. A review of outcomes of an intracavernosal injection therapy programme. BJU International. 2012;110
  • Steers WD. Pharmacologic treatment of erectile dysfunction. Rev Urol. 2002;4 Suppl 3(Suppl 3):S17-25.
  • Israilov S, Baniel J, Shmueli J, et al. Treatment program for erectile dysfunction in patients with cardiovascular diseases. The American Journal of Cardiology. 2004/03/15/ 2004;93(6):689-693.
  • Al-Adl AM, Abdel-Wahab O, El-Karamany T, Aal AA. Combined intracavernous vasoactive drugs and sildenafil citrate in treatment of severe erectile dysfunction not responding to on-demand monotherapy. Arab Journal of Urology. 2011/06/01/ 2011;9(2):153-158.
  • Trissel LA, Zhang Y. Long-term stability of Trimix: a three-drug injection used to treat erectile dysfunction. Int J Pharm Compd. May-Jun 2004;8(3):231-5.
  • Saffon Cuartas JP, Sandoval-Salinas C, Martínez JM, Corredor HA. Treatment of Priapism Secondary to Drugs for Erectile Dysfunction. Advances in Urology. 2019/08/22 2019;2019:6214921. doi:10.1155/2019/6214921
  • Sidhu AS, Wayne GF, Kim BJ, et al. The Hemodynamic Effects of Intracavernosal Phenylephrine for the Treatment of Ischemic Priapism. J Sex Med. Jul 2018;15(7):990-996. doi:10.1016/j.jsxm.2018.05.012
  • Seyam R, Mohamed K, Akhras AA, Rashwan H. A prospective randomized study to optimize the dosage of Trimix ingredients and compare its efficacy and safety with prostaglandin E1. International Journal of Impotence Research. 2005/07/01 2005;17(4):346-353. doi:10.1038/sj.ijir.3901313
  • Mulhall JP, Jahoda AE, Cairney M, et al. The causes of patient dropout from penile self-injection therapy for impotence. Journal of Urology. 1999;162(4):1291-1294. doi:doi:10.1016/S0022-5347(05)68269-9
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