Erectile dysfunction (ED), or the inability to get and sustain an erection, affects nearly 18 million US men.¹ This represents nearly half of all men aged 40 and up.² Even more surprising, about 26% of men seeking ED treatment are under the age of 40.³ 

Many effective treatment options for ED exist, yet many men choose not to try them. When researchers analyzed the insurance claims for 6.2 million men, only one-fourth of men diagnosed with ED filled their prescriptions.⁴ Treatment costs, access, and medication side effects are all probable reasons for not treating ED. 

Oral ED medications can have significant unwanted side effects because they must be absorbed from the gut, processed by the liver and kidneys, and distributed throughout the body. Because Trimix and Super Trimix are locally injected, they have far fewer side effects.

How Does Super Trimix Work? 

Super Trimix is a combination of three medications that all increase blood flow into the penis. Each medication works slightly differently, which allows them to have a synergistic effect when treating ED without the increase in side effects that would be expected when using multiple medications with the same mechanism of action. 

Super Trimix is injected into the corpora cavernosa, two large sponge-like chambers inside the penis that fill with blood to generate an erection. Super Trimix’s formula combines three medications: papaverine, alprostadil, and phentolamine, which all increase blood flow into the corpora cavernosa. 

Papaverine

Papaverine relaxes smooth muscle lining blood vessels that supply blood flow to the penis and smooth muscle lining the corpora cavernosa. As a result, papaverine increases blood flow into the penis and decreases outflow from the penis. This traps blood in the shaft of the penis and generates an erection. Papaverine acts along several metabolic pathways to increase penile blood flow. 

Papaverine has a higher risk of fibrosis and therefore is not used alone.⁵  It is used in conjunction with phentolamine and prostaglandin to improve ED treatment outcomes while minimizing side effects.

Alprostadil

Alprostadil or prostaglandin E1 also relaxes smooth muscles. It can be injected into the corpora cavernosa or used by itself as an intraurethral pellet. Alprostadil is currently the only FDA-approved injectable medication for ED treatment. 

Alprostadil’s most common side effects include:⁵

• Pain
• Blood in the urine

Alprostadil injections can cause priapism, but its rate of priapism is the lowest of the injectables, at 0.36% to 4%.

Phentolamine

Phentolamine is an alpha-adrenergic antagonist that blocks impulses from the sympathetic nervous system. The sympathetic nervous system constricts blood vessels in the penis, which reduces blood flow into the penis. Phentolamine relaxes the smooth muscle in blood vessels and the corpora cavernosa, allowing them to fill with blood. It is commonly used with papaverine. 

What Strengths Does Super Trimix Come In? 

Super Trimix is a sterile compounded medication that is filled by specialized compounding pharmacies. Since Super Trimix is custom formulated, it can be adjusted to better meet your needs. 

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

How Do You Inject Super Trimix? 

Super Trimix is typically dispensed in a vial with insulin syringes that you use to give yourself the injection. Injected 5 to 10 minutes before sexual activity, erections generally last 30 to 60 minutes. 

Following your healthcare provider’s instructions: 

• Thaw your medication to room temperature
• Before filling the syringe, pull the plunger back, push the needle through the rubber stopper, and inject air into the vial
• Draw up your dosage from your Super Trimix vial
• Clean your penis with alcohol and let it dry
• Inject your medication into the side of the penis at the 10 o’clock and 2 o’clock positions, about mid-shaft
• Avoid injecting your medication into any visible blood vessel
• Rotate your injection site each time to help prevent scar tissue from developing
• After injecting your medication, apply pressure for 2 to 3 minutes

Injection instructions for Super Trimix

What Are The Common Side Effects Of Super Trimix? 

When used as prescribed and with a careful injection technique, Trimix side effects are uncommon. 

Some people will experience pain, bruising, or a small amount of bleeding while using Super Trimix. When injecting Super Trimix, avoid injecting into a blood vessel and hold pressure on the injection site for five minutes. Doing so will reduce your risk of bleeding and bruising. 

Scar tissue may develop, especially if Super Trimix is repeatedly injected in the same location. Therefore, it is very important to change your injection site each time you inject Super Trimix. Do not inject Super Trimix into your urethra or into blood vessels; vary your injection sites along the corpora cavernosa on each side. 

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 3% to 4%. 

When 65 men were asked to rate injection pain from Trimix, their average pain rating was 0.8 out of 10, ranging from 0 to 3. Forty percent of men reported no pain at all.⁶ In another study, 12% to 15% of men reported injection pain, but most said the pain decreased over the treatment course.⁷ 

Super Trimix may also cause a curvature of the penis called Peyronie’s disease. A buildup of scar tissue causes the curvature. Peyronie’s disease is treatable when caught early. It can cause erection problems and pain. Contact your healthcare provider if you notice lumps or fibrous bands under the surface of your penis.

How Can I Make Super Trimix Work Better? 

Super Trimix usually starts working in about 5 to 10 minutes, and its effects last an average of 30 minutes or so. To ensure that Super Trimix is working optimally:

• Check the medication expiration date
• Verify your dosage
• Inject medication into the corpora cavernosa- injecting in another location will reduce Super Trimix’s effect
• If you feel a lot of resistance when injecting your Super Trimix, verify whether your injection depth and location are correct
• If you know you are injecting Super Trimix correctly and are not getting optimal results, contact your healthcare provider to ask about a dosage increase

Is There Something Better Than Trimix? 

Quadmix and Super Quadmix are ED injectables that are made up of the following medications: 

• Papaverine HCl 30 mg/mL, Phentolamine Mesylate 2 mg/mL Prostaglandin E1 20 mcg/mL, Atropine Sulfate 200 mcg/mL
• Papaverine HCl 30 mg/mL, Phentolamine Mesylate 4 mg/mL Prostaglandin E1 40 mcg/mL, Atropine Sulfate 400 mcg/mL

Quadmix is sometimes used for men who do not respond to Trimix. 

Besides injectables, there are oral ED medications such as sildenafil, vardenafil, avanafil, and tadalafil. These medications are phosphodiesterase class 5 inhibitors (PDE5) that increase nitric oxide levels, which allow blood vessels and smooth muscle in the corpus cavernosa to dilate and fill with blood. Unlike Super Trimix, oral ED medications require sexual stimulation to work. Success rates with Trimix and Super Trimix approach 90% to 95%. Oral ED medications successfully treat 60% to 70% of men with moderate ED. All four PDE5 oral ED medications available in the US have similar levels of effectiveness at any dosage or dosage schedule.⁸

Common side effects associated with PDE5 inhibitors include:

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

Injectable ED medications are the most effective non-surgical ED treatment available. Men who experience side effects with oral ED medications, find they are ineffective, or prefer an injectable over an oral medication, are likely to experience treatment success with Trimix or Super Trimix.⁸ Like all medications, there are risks and benefits associated with using Trimix. However, knowing how to properly use the medication can help you maximize the benefits and reduce the risks. 

What Happens If You Inject Too Much Super Trimix? 

If you inject too much Super Trimix or use Super Trimix along with another ED medication, you have an increased risk of priapism. Priapism is a prolonged erection. It prevents fresh blood from flowing into the penis and, therefore, can damage the penis tissue. Priapism is rare and manageable, but untreated, it can be extremely painful and can result in impotence. 

Priapism is commonly treated with phenylephrine injections, a medication that constricts blood vessels and reduces blood flow into the penis, allowing for detumescence. However, if priapism persists for 3 to 4 hours or pain increases, seek emergency care. 

The Bottom Line

According to the American Urological Association, while oral ED medications are considered first-line, men should be offered all treatment options as long as they are not medically contraindicated. Trimix users are typically men who have tried oral ED medications, but many men are prescribed Trimix or Super Trimix as a first-line treatment due to the side effects associated with oral ED medications. 

Super Trimix is a highly effective compounded medication that is a well-tested solution for ED. 

Start a treatment plan with Trimix injections 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. 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

2. Najari BB, Kashanian JA. Erectile Dysfunction. JAMA. 2016;316(17):1838-1838. doi:10.1001/jama.2016.12284

3. 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;10(7):1833-1841. doi:10.1111/jsm.12179

4. Burnett AL, Rojanasarot S, Amorosi SL. An Analysis of a Commercial Database on the Use of Erectile Dysfunction Treatments for Men With Employer-Sponsored Health Insurance. Urology. 2021;149:140-145. doi:10.1016/j.urology.2020.11.051

5. Sami S, Stern N, Di Pierdomenico A, Katz B, Brock G. Erectile Dysfunction: A Primer for in Office Management. Med Sci (Basel). Aug 29 2019;7(9)doi:10.3390/medsci7090090

6. Albaugh J, Ferrans CE. ORIGINAL RESEARCH; ED PHARMACOTHERAPY: Patient-Reported Pain with Initial Intracavernosal Injection. The Journal of Sexual Medicine. 2009;6(2):513-519. doi:10.1111/j.1743-6109.2008.01037.x

7. Bennarchik CK, M. & Geiger, S. Self-injection, Transurethral, and Topical therapy in Erectile Dysfunction. 2010;8. Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. J Urol. Sep 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004

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