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Trimix Gel vs. Trimix Injections: Which is More Effective?
Erectile Dysfunction

Trimix Gel vs. Trimix Injections: Which is More Effective?

Trimix comprises three medications: papaverine, phentolamine, and prostaglandin. Three medications that work synergistically to increase blood flow into the penis and treat erectile dysfunction (ED). In many cases, ED is due to decreased blood flow to the penis. Contributing factors are aging, obesity, increased blood glucose or cholesterol, high blood pressure, and trauma. ED can be caused by many other factors unrelated to blood flow, such as stress-related or depression. In these cases, Trimix is not the best treatment option.

What is Trimix?

In many cases, men choose phosphodiesterase class 5 (PDE-5) inhibitors, such as Cialis or Viagra, as a first-line treatment for ED. Between 22% and 35% of men do not have satisfactory results when using oral ED medications or have a medical contraindication to using these medications.1 In one study of 116 men in whom both oral ED and penile injectables were successful, one-third of the men preferred penile injectables over oral medications.2 Trimix has proven to be 80% effective for helping men with ED maintain an erection long enough to have sex.

The three medications in Trimix:4

  • Papaverine is a medication that relaxes smooth muscles in blood vessels and dilates them to increase blood flow into the penis.
  • Phentolamine is another medication that relaxes smooth muscles in blood vessels and dilates them to increase blood flow into the penis.
  • Alprostadil is an FDA-approved medication to treat ED that relaxes the smooth muscle that makes up the structure of the penis and dilates blood vessels supplying blood to the penis, which stiffens the penis for an erection.

Trimix is available by prescription only. It is prepared by a compounding pharmacy, which makes it possible to adjust the dosages and provide customized ED treatment for each man.

What is a penile injection?

An estimated 30 million men in the United States and 150 million men worldwide are affected by ED. The American Urological Association considers penile injections one of the most effective non-surgical solutions for treating ED.5 Men may choose penile injections over oral ED medications for many reasons, including side effect profile, contraindications to using the oral ED medications, ease of use, and a lack of systemic side effects.

Penile injections are administered into the side of the penis using a short, very fine needle. The medication is quickly injected into a cavernous space on the side of the penis, and pressure is applied for at least 5 minutes. In most cases, penile injections begin to work in 10 to 15 minutes, and their effects last for 30 to 60 minutes.

How often can you use Trimix injections?

Follow your doctor’s dosing instructions, but generally, penile injections should not be used more than once in 24 hours, more than two days in a row, or more than two or three times in a week. To minimize side effects, advise your doctor of all other medications you are taking, especially ED medications. Taking oral ED medications with penile injections can increase the risk of side effects. Some oral ED medications can stay in your system for several days, so let your doctor know if you have taken one of these medications within the week before the planned use of Trimix.  

What are Trimix gels?

Trimix gels have been available in two forms: a topical and an intraurethral gel. According to one study, while Trimix topical gel is more stable and easier to use than Trimix injections, the results are frequently unsatisfactory due to poor absorption. Intraurethral Trimix gel is applied to the top of the penis at the urethral opening. In a study that involved 42 men with ED, after using intraurethral gel, 40.4% of men had an erection firm enough for penetrative sex. The authors suggest that more research and larger studies are needed.6

What is the average cost of Trimix gel?

No current prices were available with an online search. Trimix gel is only available by prescription from a compounding pharmacy, but according to some online sources, the manufacturer may have stopped producing it.

How long does it take for Trimix gel to work?

Trimix powder is mixed with a gel. An adaptor piece is attached to the end of the syringe. The adaptor is held firmly against the urethral opening, and the medication is pushed into the urethra. Gently pinch the tip of the urethra and massage the glans around the end of the penis. Like Trimix injections, Trimix gels are expected to work in about 10 minutes and last for about 30 minutes.

A doctor

While Trimix gels are not rated as very effective, Trimix injections are well-tested and very effective. The success rate for penile injections, such as Trimix, ranges from 54% to 100%, with marked differences noted across the wide range of medication combinations and doses available. Satisfaction rates for penile injections range from 46% to 98.8%.5

Learn more about Trimix Injections


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. 


1. Guay AT, Perez JB, Jacobson J, et al. Efficacy and safety of sildenafil citrate for treatment of erectile dysfunction in a population with associated organic risk factors. J Androl. 2001;22:793–7.

2. Bennarchik, C. Kottwitz, M. & Geiger, S. (2010). Self-injection, Transurethral, and Topical therapy in Erectile Dysfunction.

3. Coombs, P. G., Heck, M., Guhring, P., Narus, J., & Mulhall, J. P. (2012). A review of outcomes of an intracavernosal injection therapy programme. BJU International110(11), 1787–1791.

4. Jain A, Iqbal OA. Alprostadil. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:

5. Burnett AL, Nehra A, Breau RH et al: Erectile dysfunction: AUA guideline. J Urol 2018; 200: 633.

6. Marmar JL, Harkins TJ, Riordan J (May 2008). “Studies with Trimix gel in men who failed phosphodiesterase inhibitors”. Journal of Urology. 179 (4S): 431. doi:10.1016/s0022-5347(08)61264-1

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Published: Jun 17, 2023


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