Trimix Injections for ED: An Overview
Written by Leann Poston, M.D.
The long-term standard of care for treating erectile dysfunction has been to use medications that increase blood flow into the penis such as sildenafil and tadalafil. However, oral medications that work by blocking phosphodiesterase to increase nitric oxide and relax the walls of blood vessels do not work for all men. Trimix injections are an additional option, an injectable that delivers medications right to the site. You may have visions of large needles and pain when thinking about injectables, but the reality is a small insulin needle and a high level of satisfaction with this treatment option—70% or so.
Trimix injections are made up of three medications —phentolamine, papaverine, and alprostadil—used to treat erectile dysfunction. Trimix has proven to be 80% effective for helping men with ED maintain an erection long enough to have sex (Coombs et al., 2012). Trimix does not affect the libido, prevent pregnancy, or protect against sexually transmitted diseases such as human immunodeficiency virus.
Trimix is considered a second-line medication to treat ED for men who cannot take phosphodiesterase inhibitors such as Cialis and Viagra, have had severe side effects when taking these medications, or have not had successful results with oral ED medications (Coombs et al., 2012).
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Is Trimix safe to use?
Injectables for the treatment of erectile dysfunction were first developed in 1983, and since then, researchers have labeled Trimix as safe and effective. Trimix should not be used by men who are allergic to any of its components, have a condition that predisposes to priapism (prolonged erection), have an anatomical deformity of the penis, or are taking any medications that interfere with blood clotting (McVary, 2010).
Why do Trimix injections require a prescription?
There are several reasons Trimix injections require a prescription, including:
- It can have serious adverse effects if it is misused.
- Users must be taught a proper injection technique that minimizes the risk of scarring, bleeding, or infection.
- It is not meant to be a first-line treatment for ED, but rather only for those who have not had success with oral ED medications. Therefore, a prescriber will need to review your ED medical history to ensure Trimix is a suitable option for you (Coombs et al., 2012).
- All medications have side-effects and are not appropriate for every person. It is necessary for a health care provider to review your past medical history, current conditions, and any medications, supplements, and herbal remedies you may be taking to ensure there are no adverse effects or interactions.
- Men must be aware of the risk of fibrosis and prolonged erection (priapism) and how to minimize this risk as well as how and when to seek treatment.
Can I take Trimix if I am taking oral ED medications?
Priapism is defined as an erection that lasts four hours or more. In this condition, blood sits in the penis and is not recirculated for a prolonged period. This can lead to tissue damage in the penis that may permanently destroy its structure if left untreated. The incidence of priapism with Trimax ranges from 0% to 3.7% of users (Seyam et al., 2005). Norepinephrine, pseudoephedrine, and phenylephrine are medications used to relieve the blood congestion in the penis that characterizes priapism and restore normal blood flow.
Risk factors for priapism include medical conditions such as sickle cell anemia and leukemia, using too high a dosage of ED medications, or taking two doses of oral or injectable medications without a sufficient interval between them.
Use Trimix as directed, in the dosages prescribed, and at the frequency mentioned in the prescribing information. Do not self-medicate or make changes to the dosing schedule or amount injected without speaking with a health care provider. Higher dosages increase the risk of side effects. Observe all other precautions, contraindications, and information provided by your prescriber.
Do Trimix injections have side effects?
All medications have side effects. The most common side effects from Trimix use include:
- Stinging, pain, or soreness at the injection site, which usually is temporary and goes away after a few minutes. In one large study conducted by Mulhall et al. (1999), only 4.9% of men discontinued treatment due to pain from injections.
- Slight bleeding at the injection site immediately after injection. Applying pressure after injection can mitigate this issue.
- Bruising that can occur at the injection site (though proper injection technique will minimize or prevent this from happening)
- Infection due to poor hygiene or failure to follow proper injection protocols.
Less common side effects include:
- Diarrhea, nausea, stomach cramps, or vomiting
- Allergic reactions (hives, swelling, itching, etc.)
- A sudden drop in blood pressure
- Increased heart rate
- Abnormal heart rhythm
- Fibrosis or scarring at the injection site
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The most serious Trimix injection side effects tend to result from too high a dose or overuse – injecting Trimix more frequently than the prescribing instructions state. Follow the directions carefully and ask questions if anything is unclear.
How is Trimix dosed?
There is no generic or one-size-fits-all answer to the question of how many units of Trimix any individual should be prescribed. A health care provider will evaluate your risk and benefit profile and determine a dosing schedule that is most appropriate for your circumstances.
Most often, this roughly translates into:
- A starting dose of between 5 units (0.05 mL) and 20 units (0.2 mL) units of Trimix.
- Increasing subsequent dosages by no more than 5 units at a time.
- Maximum dosage of 50 units of Trimix at a time.
Read Also: How many units of Trimix should I take?
Trimix should never be used more than once in a 24 hour period, more than two days in a row, or more than two to three times a week. Using Trimix with oral ED medications increases the risk of adverse effects such as priapism. Advise your health care provider if you have taken any oral ED medications in the week prior to the intended use of Trimix.
To get the best results from Trimix and minimize any side effects, ensure that your medical history form is complete and accurate. Verify that you know the dosage and dosing schedule for all medications. You know what steps to take if you should have an allergic reaction or prolonged erections and that you know the proper injection technique for penile injections and how to minimize the risk for infection.
How much do Trimix injections cost?
Trimix is typically sold in vials of a set volume. The cost of Trimix injections will vary based on each user’s dosage. Practitioners typically prescribe a low dose to start with to elicit any possible side-effects such as an allergic reaction and to determine the minimum effective dose necessary to treat ED.
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Cost also depends on factors such as pharmaceutical overhead costs, costs of shipping, and the limited shelf life of the medication. Trimix lasts for about three months in the refrigerator and about one year when frozen. Trimix is generally not covered under most insurance plans as it is a compounded medication. However, it is worthwhile to check with your insurance to verify whether it is covered. There are many factors to consider when buying Trimix. Sometimes what appears to be the most cost-effective option is not.
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How to buy Trimix injections
There are two main options for determining whether you are a candidate for Trimix and to get a prescription – a visit to your doctor or an online telemedicine consultation. These options are both valid, legal methods to obtain a prescription and ultimately buy Trimix injections. They each have their pros and cons. Many men prefer the telemedicine option, such as speaking with a health care provider at Invigor Medical, for its convenience and comprehensiveness.
Read Also: A guide to where to buy Trimix injections
Learn more about the pros and cons of each option and also learn why buying Trimox from a website that does not require a prescription can be a dangerous choice in terms of costs, security, and health risks. Finally, there are additional factors to consider such as credentialing, licensure, reputation, and safety protocols. Before choosing a compounding pharmacy to fill your prescription, verify that it is licensed through the State Board of Pharmacy. Invigor Medical uses the Olympia Compounding Pharmacy in Florida, whose license (#PH27414) can be verified through the Florida Department of Health.
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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.
- Coombs, P. G., Heck, M., Guhring, P., Narus, J., & Mulhall, J. P. (2012). A review of outcomes of an intracavernosal injection therapy programme. BJU International, 110(11), 1787–1791. https://proxy.oplin.org:2447/10.1111/j.1464-410X.2012.11080.x
- McVary, K. (2010). Contemporary Treatment of Erectile Dysfunction: A Clinical Guide. United Kingdom: Humana Press.
- Seyam, R., Mohamed, K., Akhras, A. et al. A prospective randomized study to optimize the dosage of trimix ingredients and compare its efficacy and safety with prostaglandin E1. Int J Impot Res 17, 346–353 (2005). https://doi.org/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. J Urol. 1999 Oct;162(4):1291–1294.