Trimix Penile Injection Therapy

About Tharapy

Trimix is an injectable three-drug prescribed medication used to treat erectile dysfunction. The active ingredients in the mixture are usually Alprostadil(Prostaglandin), Papaverine(Vasodilator), and Phentolamine(Alpha-blocker). The injection must be compounded by a pharmacy and administered via intracavernosal injection.

Storing your medication

Trimix should be stored in the refrigerator and away from light. This can keep the medication good for a few additional months. Don’t use the medicine if:

  • It has particles or is cloudy.
  • The rubber stopper comes off of the vial.

Injecting Instruction

  1. Grasp the head of your penis, not the skin. This will allow your penis to be more fully stretched. It’s easiest to inject if your penis is pulled straight out in front of you. If you aren’t circumcised, pull your foreskin back before grasping the head of your penis. This will prevent the needle from going between the skin and erectile tissue. For your injection to work, the medication needs to go into the erectile tissue.
  2. Locate the area to be injected (the middle third of your penis). Wipe it with an alcohol wipe. Let go of the head of your penis and pick up the syringe with two hands.
  3. Remove the cap covering the needle. Look at the syringe to ensure the dose is correct, and you haven’t pushed any medication out by accident.
  4. Hold the syringe between your thumb, index, and middle fingers like a pen or a dart. The needle should be facing the floor. Don’t place your index finger or thumb on the plunger.

Injecting Instruction

5. Once again, grasp the head of your penis and pull it straight out. Keep pulling on your penis from the time the needle goes into your penis until it comes out. Don’t twist your penis since this could lead to injecting the wrong area.

6. Touch the needle to your skin and quickly slide it into the shaft of your penis. Remember to avoid any veins. Ensure inserting the needle at a slight angle (either the 10 o’clock or 2 o’clock position, as shown in Figure 3).

7. Move your finger so that your index finger or thumb can push in the plunger.

8. Quickly push down on the plunger to inject the medication into the shaft of your penis. Be careful not to pull the syringe out as you’re injecting the drug.

9. Once you have injected all of the medication, quickly pull the needle out of your penis. Pull it straight out. Don’t use a twisting or jerking motion because this may cause bruising. Apply pressure at the injection site for 2 to 3 minutes with your thumb on the injection site and your index finger on the opposite side of your penis. If you’re taking a blood thinner or aspirin, hold the pressure for 5 minutes. This will help to decrease any bleeding or bruising.

10. Place the syringe in the sharps container. You don’t need to recap it.

Choosing an injection site

  • You must inject the medication into a specific area of your penis. This is so you don’t inject into a nerve or blood vessel.
  • Imagine that your penis is divided into three parts. You will give the injection in the middle third of your penis at the 10 o’clock (left side) or the 2 o’clock (right side) position (see pictures below).
  • To prevent trauma to your penile tissue, always change sides of your penis each time you inject the medication (right side, then left side). Keep a record each time, so you don’t forget. Don’t inject into any vein you can see or feel because it could cause a large bruise on your penis. Don’t inject straight down on the top or the bottom of your penis.

    Erection Scale

    It usually takes a few injections to find the correct dose for an erection firm enough to have sex. You must follow the treatment plan that Dr. Davis gave you. Don’t adjust your dosing. 

     Please use the grading scale below to rate your level of hardness after injecting. Call Dr. Davis to tell your responses and whether you’re getting the results you want. Dr. Davis will tell you which dose to try next based on your answer.

    Important Points

    • Don’t take more medication than the dose prescribed.
    • Don’t change the dose without speaking to Dr. Davis.
    • Don’t take more than one injection in 24 hours.
    • Don’t give yourself another injection if the medication doesn’t work. Speak with Dr. Davis if you aren’t getting the effect you want.
    • You can inject up to 3 times a week as long as there are 24 hours between each injection.
    • If you’re currently receiving chemotherapy for cancer, ask your oncologist (cancer doctor) when you can safely inject.

    Important Points

    • Don’t take any other medication for ED without speaking to Dr. Davis. 
    • Do not take the following medications within 18 hours of injection (before or after):
      1. Sildenafil(Viagra) 20-100mg
      2. Vardenafil(Levitra) 10-20mg
      3. Avanafil(Stendra) 50-200mg
    • Do not inject within 72 hours (3 days) of taking Tadalafil (Cialis) 10 mg or 20 mg.
    • If you’re using Tadalafil (Cialis) 5 mg daily, ask Dr. Davis how you should use this medication along with your injections.
    • Tell Dr. Davis all of the medications you’re taking, especially if you’re taking one of the following:
      • Medication for high blood pressure.
      • Medication for depression, or classified as an MAO inhibitor such as phenelzine (Nardil®).
      • Sleeping aid, such as trazodone (Oleptro ER®).

        If you develop priapism

        • If you have an erection at penetration hardness (a six or higher on the erection hardness scale) that lasts 2 hours, take 4 (30 mg) tablets of pseudoephedrine HCl (Sudafed). Don’t take extended-release or long-acting tablets, such as Sudafed 12 hours.  You can buy it at your local pharmacy. 
        • If you have an erection that lasts 3 hours (you still have an erection 1 hour after taking the pseudoephedrine HCl), call us and plan to go to Urgent Care Center or your local emergency room.
            • Monday through Friday between 9:00 am and 5:00 pm, call us.
            • Phone number: 972-867-5888
        • If you have an erection that lasts 4 hours, this is a medical emergency. You should treat it with the same urgency as a heart attack. Erections lasting longer than 4 hours can cause permanent damage to your erection tissue.

        Go to the emergency room immediately. 

        Side effects

        • bleeding or bruising at the site of medication administration,
        • unusual discharge from the penis,
        • pain in the groin/penis/urethra/testicles/legs,
        • redness of the penis,
        • prolonged erection,
        • headache,
        • dizziness,
        • back pain,
        • skin problems
        • cold symptoms