Trimix or Quadmix
These drugs are both available by prescription from compounding pharmacies. These are mixtures of prostaglandins and papaverine that increase blood flow and retention into the penis. Prostaglandins are mediators and have a variety of strong physiological effects, such as regulating the contraction and relaxation of smooth muscle tissue. Prostaglandins are not hormones and they are not produced at one discrete site, but rather in many places throughout the human body.
Trimix is a mixture of two prostaglandins (phentolamine and alprostadil) plus papaverine (a vasodilator medication) that increase blood flow to the penis and cause strong and lasting erections, with or without sexual stimulation. These compounds appear to act together to increase arterial inflow, dilate smooth muscles,and restrict venous outflow promoting erectile rigidity with greater success and in smaller doses than if these compounds were used as single therapies.
An example of a dosage combination for tri-mix is 10 micrograms of alprostadil, 500 micrograms of phentolamine and 15 mg of papaverine. Dosing of tri-mix preparations has not been standardized.
Trimix is injected directly into the side of the penis through a fine- gauge “insulin-style” needle in very small amounts (0.1-0.5cc) that increase blood flow to the penis. It results in strong and lasting erections. The main potential side effect are hematomas(bruising), fibrosis if used too frequently and on the same injection site,pain, and dangerously long-lasting erections(priaprism). Priaprism may sound great but this can literally kill your penis by causing gangrene of the tissue after stagnant blood coagulates inside it. I know men who had to goto an emergency room 8hours after having used too much Trimix and have the blood drained from their penis. To ensure perfect injection technique and dosing, it is imperative to be trained on how to dose this with the help of an urologist.
Compounding pharmacies sell two types of Trimix formulations: Freeze dried (powder to be mixed later with water) or pre-mixed vials. Some men find the freeze dried form not to be as effective.
It is extremely important to remember never to use Viagra, Cialis, or Levitra before or at the same time as you use Trimix. This is a dangerous combination that can increase the risk of priaprism. Be particularly careful with Cialis since it can stay in your blood stream for a longer time. I know someone who had priaprism since he had forgotten he had taken Cialis two days before using Trimix.
Most men who use Trimix love it, even if they have had to learn the hardway about priaprism during one instance. Most of these men did not respond well nor had too many side effects to oral agents like Viagra or Cialis.
Some men who do not respond completely with TRIMIX use a quad mixture (QUADMIX) of phentolamine, papaverine, prostaglandin E1 and atropine. Others who may have pain associated with a TRIMIX injection use a bimixture (BIMIX) of phentolamine and papaverine.
A single agent FDA approved drug that only has Prostaglandin E1 can be compounded generically or is also dispensed as injectable alprostadil either as Caverject Impulse® or Edex®. These two products are not as effective as TRIMIX but may be covered by some insurance companies. Their copay may be higher than paying for TRIMIX, though. The injection volume is also 10 times larger than TRIMIX.
For instructions on how to inject Trimix, read: Instructions and general information about Trimix
For instructions for physicians on how to treat priapism the unfortunate case that it happens:
Priapism in Emergency Care
A 10 cc bottle of Trimix can cost from $70 to $100 in compounding pharmacies. If a dose of 0.15 cc is needed per erection, this bottle can be good for 67 erections. In comparison with Cialis and Viagra ($16 a pill), this option seems economical. Ask us if you need a referral to compounding pharmacies.
You will need a prescription written as : TRIMIX (10 micrograms of alprostadil, 500 micrograms of phentolamine and 15 mg of papaverine) , 5 mls, as directed. Make sure you ask for insulin syringes (30 gauge, 1/2 inch needles), and alcohol swabs with your order.