Trimix and Viagra: Can You Use Them Together?

Erectile dysfunction (ED) is the persistent inability to get and maintain an erection sufficient for satisfactory sexual performance.1 Trimix is an injectable ED medication, and Viagra (sildenafil) is an oral PDE5 inhibitor. Trimix is a combination of three medications—papaverine, alprostadil, and phentolamine—that are injected into the penis to increase blood flow. The success rate for Trimix injection is 53% to 100%.2 

Viagra is a PDE5 inhibitor that stops nitric oxide from breaking down. This keeps the blood vessels entering the penis open longer, allowing more blood to enter. PDE5s are first-line treatment choices for ED. However, the American Urological Society advises that men be offered any ED treatment option after a shared decision-making process.2 

The success rate for Viagra is listed at 50-70%.3 Men with ED who have blood vessel damage from high blood pressure, diabetes, high cholesterol, or smoking may not be as satisfied with their results. Men who have contraindications to using sildenafil, do not want to take a pill, or get unsatisfactory results with sildenafil may choose Trimix to treat their ED.2 

Can you take Trimix and Viagra together?

In a randomized, controlled clinical trial, men who took oral sildenafil and Trimix had higher levels of cGMP and cAMP, which means more blood flow to the penis.1 In another study, 453 participants, aged 36 to 91, were followed for two years.4

  • Sildenafil was offered to 417 patients, and 205 (49%) had good results
  • 248 patients received penile injections, 135 (54.4%) had a positive response to bimix, 85 (75.2%) to Trimix, and 16 (57.1%) to quadmix
  • 12 patients remained unresponsive, four responded to sildenafil+ Trimix, two had a penile implant

Overall, 98.7% of men in the clinical trial achieved an erection sufficient for penetration immediately after the trial and 92.2% on follow-up; 10.7% achieved spontaneous erections.4 In another study, researchers noted that combination therapy allowed users to decrease their Trimix dose, minimizing penile discomfort.5

Sildenafil’s most common side effects include:

  • Stomach upset
  • Headache
  • Flushing
  • Back pain
  • Nasal congestion
  • Muscle aches
  • Visual disturbances
  • Dizziness

Localized Trimix side effects depend on the injection technique. Trimix’s most common side effects include:

  • Priapism 
  • Bruising at the injection site 
  • Fibrosis or scarring 
  • Pain or redness at the injection site
  • Lumps, swelling, tenderness, or curvature of the erect penis 

Priapism is a painful erection that has lasted more than four hours. When blood remains trapped in the penis for too long, oxygen and nutrient levels decrease, which can damage the structure of the penis. Decongestants, ice packs, and vigorous exercise are commonly used to reverse priapism.6 If they do not work, then painful priapism requires emergency treatment. 

Do not combine oral ED medications with injectables, such as Trimix, unless your doctor specifically advises you to do so. Combining medications increases the risk of side effects.  Most urologists advise not to take sildenafil, vardenafil, or avanafil within 18 hours before or after injecting Trimix. If you are taking tadalafil 10mg or 20 mg, wait a full three days before injecting Trimix. 

The words "erectile dysfunction" on a computer screen.

Does Trimix work better than Viagra?

Viagra modifies a chemical cascade that dilates blood vessels and increases blood flow to the penis. Trimix is locally acting. It relaxes the smooth muscle in the penis, allowing it to fill with blood. It isn’t easy to compare the medications based just on their mechanism of action. However, based on clinical trial results and real-world data, Trimix works better than Viagra. 

Comparing the two medications:

TrimixViagra (sildenafil)
Fewer systemic side effectsX
Fewer local side effectsX
Easier to takeX
Success rateAround 95%Around 70%
Not affected by alcohol consumptionX
Quicker onset of actionX

How can I make Trimix work better?

To ensure you are getting the best response from Trimix:

  • Inject it directly into the corpora cavernosa of the penis. 
  • Inject Trimix into alternating sides of the penis to reduce the risk of scarring. 
  • Avoid injecting Trimix into blood vessels. 
  • Do not inject Trimix into the top or bottom of the penis or anywhere near the head of the penis.
  • Hold pressure on the injection site for up to 5 minutes to reduce the risk of bleeding or bruising. 
  • Check your medication’s expiration date.
  • Verify you are taking the prescribed dose. 
  • Check that you are injecting it with needles of the correct length. 

Injection Instructions for Trimix

A discouraged man sitting at the end of a bed, while a woman looks on.

What happens if you inject too much Trimix?

Injecting too much Trimix increases the risk of priapism. Priapism is a prolonged, painful erection. The most common cause of priapism is ED medication use, especially when using ED medications at higher dosages or frequencies than prescribed or using medication that has not been prescribed for you. Overall, the risk of priapism is about 0%–4%, depending on treatment. Priapism is a rare side effect of using PDE5 inhibitors. It is slightly more common (1.4%) after using penile injections.6 Do not inject yourself with Trimix more than once every 24 hours. Most doctors advise limiting Trimix injections to three times a week to minimize the risk of scarring. 

Is there something stronger than Trimix?

Tell your doctor if Trimix is not working well for you. You may need a dosage adjustment or need to try Super Trimix or Quadmix. 

Trimix Strength: Papaverine HCl 30 mg/mL, Phentolamine Mesylate 1 mg/mL, Prostaglandin E1 10 mcg/mL

Super Trimix strength: Papaverine HCl 30 mg/mL, Phentolamine Mesylate 2 mg/mL, Prostaglandin E1 20 mcg/mL

Quadmix Strength: Papaverine HCl 30 mg/mL, Phentolamine Mesylate 2 mg/mL, Prostaglandin E1 20 mcg/mL, Atropine Sulfate 200 mcg/mL

Super Quadmix Strength: Papaverine HCl 30 mg/mL, Phentolamine Mesylate 4 mg/mL, Prostaglandin E1 40 mcg/mL, Atropine Sulfate 400 mcg/mL

Trimix injections for ED have many benefits and a few drawbacks. Both Trimix and sildenafil require a prescription. After consulting with a physician such as the specialists at Invigor Medical, a telehealth clinic, if you are a suitable candidate, a prescription will be sent to a U.S.-licensed compounding pharmacy, allowing you to safely buy Trimix injections online.

Looking to get Trimix? See how Invigor Medical can help 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. Park JK, Park JS, Jeon SB, et al. Why a combined intracavernosal injection with trimix and oral sildenafil is reliable therapy in the ultrasonographic evaluation of erectile dysfunction. BJU Int. Sep 2008;102(8):993-7. doi:10.1111/j.1464-410X.2008.07712.x

2. Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. Journal of Urology. 2018;200(3):633-641. doi:doi:10.1016/j.juro.2018.05.004

3. DeBusk RF, Pepine CJ, Glasser DB, Shpilsky A, DeRiesthal H, Sweeney M. Efficacy and safety of sildenafil citrate in men with erectile dysfunction and stable coronary artery disease. Am J Cardiol. Jan 15 2004;93(2):147-53. doi:10.1016/j.amjcard.2003.09.030

4. Israilov S, Baniel J, Shmueli J, et al. Treatment program for erectile dysfunction in patients with cardiovascular diseases. Am J Cardiol. Mar 15 2004;93(6):689-93. doi:10.1016/j.amjcard.2003.11.049

5. Nandipati K, Raina R, Agarwal A, Zippe CD. Early combination therapy: intracavernosal injections and sildenafil following radical prostatectomy increases sexual activity and the return of natural erections. Int J Impot Res. Sep-Oct 2006;18(5):446-51. doi:10.1038/sj.ijir.3901448

6. 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

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Published: Dec 7, 2022

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