Trimix Injections For ED: The Risks And Benefits

Trimix injections are a combination of three medications that are used to treat erectile dysfunction. Injecting medications into the penis may sound extreme and more than a little painful. As you learn more about Trimix injections, you may find this option may be a better one than you might think at first glance, especially if you are in the 22-35% of men who have not been helped by oral ED treatment or have a medical contraindication to using medications such as Viagra (Guay et al., 2001). In one study of 116 men in whom both oral ED and penile injectables were successful, one-third of the men preferred the penile injectables over the oral medications (Bennarchik et al., 2010). 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 Shots 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 buy Trimix injections online safely.

What Are Penile Injections?

Men who do not get the expected results from oral ED medications may be candidates for penile injections. After being trained, men can draw up the medication in a syringe attached to a tiny insulin needle. Men inject the medication into the side of the penis, and they hold pressure for up to five minutes to prevent a bruise from forming. An erection usually results within a few minutes. There are several forms of penile injectables:

• Alprostadil (Caverject, Edex): Insurance sometimes covers alprostadil, but it is expensive. Approximately 15 to 50 percent of men complain of pain with injections. FDA-approved and comes in a kit.
• Trimix (alprostadil, papaverine, and phentolamine combination): Trimix injections are stronger and there are fewer reports of pain compared with alprostadil alone. The efficacy and side-effects of Trimix vary depending on the dosage of each of the three ingredients.
• Bimix (papaverine and phentolamine): Bimix is very effective but has a higher incidence of priapism and fibrosis than alprostadil alone.
• Quadmix: (alprostadil, papaverine, phentolamine, atropine): Rarely used (Köhler, 2020)

Trimix, Bimix, and Quadmix are not F.D.A approved. The benefit is that they are cheaper than alprostadil, but they require a compounding pharmacy to prepare the prescription. Because of the higher incidence of side effects from Bimix and Quadmix, alprostadil alone and Trimix are usually the initial treatment choices. Alprostadil has a lower risk for priapism and fibrosis, while Trimix is lower cost and less likely to cause pain with injection (Bennarchik et al., 2010).

Benefits Of Trimix Injections

Multiple studies have found intercavernous injections to be effective, reasonably priced, and easy to administer. A long-term predictor of successful treatment is men who persist with using intercavernous injections for longer than two months. Men who stopped using penile injections and chose alternative treatment within the first two months of use were the least likely to benefit from their use (Gupta et al., 1997).

In a study of 65 men, on a score of one to ten, men rated the pain from injection a 0.8/10 with a range of 0-3 and 40 percent of men reporting no pain at all. Study participants rated the pain from the medication being injected as 1/10 with a range of zero to five, with 64.6 percent reporting no pain (Albaugh & Ferrans, 2009). In another study, 12-15% of men reported pain with injection. Most men reported that pain decreased over the course of treatment (Bennarchik et al., 2010).

Drawbacks Of Trimix Injections

The biggest drawback is that men must inject the medication. If you are squeamish about self-injecting, then any other factor, no matter how positive, is not likely to change your mind. Men should not use intercavernous injections if they have conditions that increase their risk for priapism such as sickle cell disease, multiple myeloma, and leukemia. They should also not use intra-cavernous injections if they have Peyronie’s disease (abnormal curvature of the penis), cavernosal fibrosis, or a health condition in which sexual activity is not advisable (Bennarchik et al., 2010).

In one study on the effectiveness of injectables for ED, in the vast majority of cases, ED was secondary to decreased blood flow or other vascular causes, followed by neurogenic and psychogenic causes. Men in the study received either alprostadil, Trimix, Bimix, or alprostadil with papaverine. Men who left the study gave the following reasons:

• Ineffectiveness: Mostly within the first month, but persisted throughout
• Penile scarring or nodules: After the first six months of treatment
• Inconvenience or lack of spontaneity
• Pain or fear of injectables (Gupta et al., 1997).

Priapism

Priapism is an unwanted erection lasting over four hours. The number one cause of priapism is medications used to treat ED. Priapism is considered a medical emergency because a sustained erection can cause damage to the structure of the penis. Do not inject yourself with these medications without a prescription and after a discussion with your physician. Men who borrow the medication from others, or buy Trimix online without a prescription, with no established safe dosage based on their medical history, are the most likely to run into trouble (Köhler, 2020). The incidence of priapism with Trimix ranges from 0% to 3.7% of users (Seyam et al., 2005). 

Drugs that stimulate the sympathetic nervous system, such as pseudoephedrine and terbutaline, are frequently prescribed to constrict blood vessels and speed the drainage of blood from the penis. If men do not find relief within 15 minutes, they should call their physician for further instructions or go to the emergency room for treatment (Bennarchik et al., 2010). 

Fibrosis

Cavernous fibrosis is another potential side-effect of an intra-cavernous injection. It occurs most commonly with injectables containing papaverine. Cavernous fibrosis occurs in less than one percent of men using alprostadil and approximately four percent with Trimix. The risk of fibrosis depends on the dosage and frequency of injection. Temporarily discontinuing treatment will resolve fibrosis most times (Bennarchik et al., 2010). 

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). To minimize the side effects of Trimix, it is essential to start slow and use a low dose. It is also important that you follow up every six months and that you report all complications or concerns.

Side Effects From Trimix

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 extensive 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 the 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

The most serious Trimix injection side effects result from too high a dose or overuse—injecting Trimix more frequently than the prescribing instructions state or injecting more Trimix than prescribed by your physician. Follow the directions carefully and ask questions if anything is unclear.

Mentioned Product

Trimix Injections

Trimix Injections are used as a second-line treatment when oral ED medications don’t work.

Learn About Trimix Injections

Learn more about the pros and cons of each option and also learn why buying Trimix 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.

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. 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. https://pubmed.ncbi.nlm.nih.gov/11545291/
2. Bennarchik, C. Kottwitz, M. & Geiger, S. (2010). Self-injection, Transurethral, and Topical therapy in Erectile Dysfunction. https://link.springer.com/chapter/10.1007/978-3-319-31587-4_14
3. McVary, K & Kohler, T. [Eds]. Contemporary Treatment of Erectile Dysfunction: A Clinical Guide. (n.d.). Germany: Springer International Publishing. https://link.springer.com/book/10.1007/978-3-319-31587-4
4. Albaugh, J. and Ferrans, C.E. (2009), ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Patient‐Reported Pain with Initial Intracavernosal Injection. The Journal of Sexual Medicine, 6: 513-519. https://doi.org/10.1111/j.1743-6109.2008.01037.x
5. Köhler, T. [Mayo Clinic]. (2020). Penile Injections for Erectile Dysfunction Treatment. [Video file]. Retrieved from https://www.youtube.com/watch?v=Jub5zTCtT90
6. 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
7. 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://pubmed.ncbi.nlm.nih.gov/22564343/#:
8. McVary, K. (2010). Contemporary Treatment of Erectile Dysfunction: A Clinical Guide. United Kingdom: Humana Press. https://link.springer.com/book/10.1007/978-3-319-31587-4?noAccess=true
9. 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. https://www.auajournals.org/doi/abs/10.1016/S0022-5347%2805%2968269-9
10. Gupta, R., Kirschen, J., Barrow, R. C., & Eid, J. F. (1997). Predictors of success and risk factors for attrition in the use of intracavernous injection. The Journal of urology, 157(5), 1681-1686. https://pubmed.ncbi.nlm.nih.gov/9112505/

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