Welcome to the final installment of our educational four-part blog series on Trimix. In Parts 1–3, we covered what Trimix is, how injections are administered, and possible side-effects and safety considerations. Now, in Part 4, we focus exclusively on two critical topics often asked by patients and providers alike: Dosage and Storage of Trimix.
Dosage: Frequently Asked Questions
What is Trimix and why is dosage individualized?
Trimix is a compounded injection that combines three active ingredients — alprostadil, papaverine, and phentolamine — designed to support penile function when first-line oral therapies may not be suitable. Because the formulation is tailored to each patient’s response, health status, and goals, the “right dose” varies significantly from one person to another.
What is the typical starting dose and how is it adjusted?
There is no one universal starting dose. We typically recommend a conservative starting point (0.05 mL) and gradual increases under provider guidance until the desired effect is achieved — while avoiding excessive response or side-effects. However, patients should only use the dose recommended by their prescriber in consultation with us. Check out our Trimix Dosage Chart for guidelines. Actual Trimix dosage should always be customized by practitioner and pharmacist.
Trimix Injection – Trimix Dosage Chart
| Injection Attempt | Volume Injected | Approx. Dose (depending on concentration) | Notes |
|---|---|---|---|
| IBD1 (Initial Test Dose) | 0.05 mL | Low Dose | Administered in clinic to assess response and side effects. |
| 2 | 0.10 mL | Increased slightly | If no or minimal response from 0.05 mL. |
| 3 | 0.15 mL | Moderate Dose | Titrate cautiously based on efficacy and side effects. |
| 4 | 0.20 mL | Moderate-High Dose | Continue increasing only if needed. |
| 5 | 0.25 mL | Higher Dose | Often considered a common maintenance dose for responders. |
| Max | ≤ 0.50 mL | Maximum volume | Exceeding this volume may increase risk of priapism (prolonged erection). |
*This Trimix dosage chart is for educational purposes, always consult with your doctor or pharmacist before administering.
General Guidelines for Use
- Injections are typically administered intracavernosally (directly into the penile shaft) using a small insulin syringe.
- Use should be limited to no more than 3 times per week, with at least 24 hours between doses.
- A starting formulation might be:
- Alprostadil 10 mcg/mL
- Papaverine 30 mg/mL
- Phentolamine 1 mg/mL
However, this may vary depending on patient response and prescriber preference.
- Alprostadil 10 mcg/mL
- Titration is adjusted by changing volume or medication concentration, based on erection quality and duration.
Important Safety Notes
- An erection lasting longer than 4 hours (priapism) requires immediate medical attention.
- Injection sites should be rotated to avoid tissue damage.
- Patients should be trained by a healthcare provider before home administration.
How often may Trimix be used?
A commonly cited protocol is up to 3 injections per week, with at least 24 hours between injections. Using Trimix more frequently than recommended may increase the risk of complications such as priapism or fibrosis.
What happens during dose titration?
Titration means monitoring how you respond — time to erection, duration, ease of injection, and any side-effects — and adjusting the dose accordingly. This is best done in collaboration with your provider and our pharmacists.
What factors influence the ideal dose?
Several factors can affect what dose may be right for you:
- Severity and cause of erectile dysfunction
- Your overall health
- Other medications
- Injection technique
- Prior responses to medication
What are key safety-related dosage questions?
- Onset and duration: Typically, Trimix begins working within 5–20 minutes of injection.
- Prolonged erection: Seek immediate medical attention if an erection lasts more than 4 hours.
- Dose adjustments: Never adjust your dose without consulting your prescriber and our pharmacy.
- Missed injections: Since Trimix is used on-demand, do not attempt to “make up” for missed doses.
Key takeaways on dosage
- Trimix dosing is highly individualized.
- Start low, increase slowly under supervision.
- Never exceed the prescribed injection frequency.
- Keep records of your experience to inform future adjustments.
Storage: Frequently Asked Questions
Proper storage of Trimix is absolutely vital. Because this medication is custom-compounded at Central Ohio Compounding Pharmacy, its stability depends on how it is stored from shipping through use.
What are the general storage guidelines?
Our Trimix formulations should be:
- Frozen before use, typically at -18 °C or lower.
- Once thawed, draw up the required dose and return to the freezer.
- Avoid exposure to heat, direct sunlight, or temperature fluctuations.
How long is Trimix stable?
Trimix compounded at Central Ohio Compounding Pharmacy typically remains stable:
- Frozen: Up to 45 days.
What should you watch for (signs of compromised product)?
Before each injection, inspect your vial for:
- Cloudiness or discoloration
- Particulates or crystals
- Strange odor
If you notice any of these, do not use the vial and contact us for further guidance.
Tips for travel and handling
- Use an insulated cooler with ice packs if transporting Trimix.
- Never leave Trimix in a hot vehicle.
What about disposal?
Expired or unused Trimix should be disposed of according to local regulations. We can provide guidance on proper disposal procedures.
Quick Answers About Trimix
| Question | Answer |
|---|---|
| Can I increase my Trimix dose if the first doesn’t work? | No, consult your prescriber and us before making changes. |
| Is daily use okay? | No. Use no more than 3x/week with at least 24 hours between doses. |
| My vial looks cloudy. Can I use it? | No. Contact us before using any questionable vial. |
| What if my vial warms up during travel? | Use a cooler. If exposed to heat, consult us before using. |
Ohio’s Trimix Compounding Pharmacy for Erectile Dysfunction (ED)
We hope this final installment has given you helpful insight into the proper use and care of Trimix. At Central Ohio Compounding Pharmacy, we compound each Trimix formulation with precision and care, and we are here to support both patients and providers with clear, educational guidance.
If you have any questions about dosing, storage, injection technique, or travel tips for your Trimix medication, please contact our team. We are committed to helping you use your medication safely and most effectively.
Disclaimer: The content in this blog is for educational purposes only and does not constitute medical advice. Always consult your licensed healthcare provider before beginning or changing any medication. Trimix is not FDA-approved as a combination product and should be used only under direct medical supervision.
References:
Chao, R., & Clowers, D. E. (1994). Experience with intracavernosal tri-mixture for the management of neurogenic erectile dysfunction. Archives of physical medicine and rehabilitation, 75(3), 276–278. Link
Elena, B. W., Zachary, M., Haritha, P., Graham, B. A., & Wayne, H. J. (2023). Current status of intracavernosal injection therapy in erectile dysfunction. Expert Opinion on Pharmacotherapy, 24(8), 925–933. Link
Trissel, L. A., & Zhang, Y. (2004). Long-term stability of trimix: a three-drug injection used to treat erectile dysfunction. International Journal of Pharmaceutical Compounding, 8(3), 231. Link
Wiser, H. J., & Köhler, T. S. (2010). Self-injection, transurethral and topical therapy in erectile dysfunction. In Contemporary Treatment of Erectile Dysfunction: A Clinical Guide (pp. 107–125). Totowa, NJ: Humana Press. Link