Erectile dysfunction (ED) is a sensitive and often unspoken issue affecting many men, especially as they age or experience other health complications. Fortunately, several options are available, including Trimix injections, oral medications, sublingual therapies, and mechanical aids. This article, based on a detailed conversation with experienced compounding pharmacists Tony Buchta and John Herr, provides a comprehensive overview of Trimix and related ED therapies.
Understanding Erectile Dysfunction
ED may arise from aging, chronic conditions (like diabetes, heart disease), surgeries (like prostatectomy), or even certain medications. Symptoms include difficulty achieving or maintaining an erection, which can affect quality of life and intimate relationships.
Compounding pharmacies offer customized therapies to address individual patient needs, working closely with prescribers to ensure optimized care.
Comparing ED Therapies: Oral vs. Injection
Oral Medications
Some patients may be familiar with brand-name medications like Viagra® (sildenafil) or Cialis® (tadalafil), which are FDA-approved medications for erectile dysfunction. In certain cases, healthcare providers may prescribe compounded versions of sildenafil or tadalafil in customized strengths or alternative dosage forms. Compounded versions, including sublingual troches, may be appropriate for patients who experience side effects or have difficulty swallowing pills.
Mechanical Devices
Vacuum erection devices (VEDs) can be effective for some but may feel cumbersome or less spontaneous.
Penile Injections (e.g., Trimix)
For patients who don’t respond to oral medications or seek more immediate and potent results, injections may be the answer.
WATCH:
Erectile Dysfunction (ED) Overview Video
Learn the ins and outs of personalized medications prescribed for men suffering from ED from experts pharmacists Tony Buchta, RPh and John Herr, RPh.
Trimix Injections: What Are They?
When oral medications fail to provide results, men (and their partners) look for options that may bring intimacy and pleasure back to their lives.
Trimix is a compounded injectable medication that typically combines three drugs:
- Alprostadil: A prostaglandin that promotes blood flow by relaxing smooth muscle tissue.
- Papaverine: A vasodilator that enhances blood vessel dilation.
- Phentolamine: An alpha-blocker that helps maintain an erection by preventing blood from leaving the penile tissue.
Some patients may use variations such as Bimix (two ingredients) or Quadmix (adding a fourth agent like atropine). These are formulated based on individual tolerability and specific case.
How to Use Trimix Safely
Proper technique and safe handling:
- Storage: Keep Trimix frozen (up to 45 days) or refrigerated for short periods (up to 3 days), as per USP guidelines. Single-dose 1 mL vials are easier to manage and maintain potency.
- Preparation: Use a sterile insulin syringe (measured in units). Always clean the vial top and injection site with alcohol wipes.
- Injection Site: Target the lower third of the penis, avoiding top (blood vessels), bottom (urethra), and tip (nerve endings). Recommended angles are at 10 or 2 o’clock.
- Rotation: Avoid injecting the same spot repeatedly to prevent plaque buildup.
Insider Tip: Patients can draw up their dose ahead of time and store it in the refrigerator if planning use within a few hours.
Penile Injection Technique: What Patients Need to Know
While patients were historically accustomed to receiving their medication in a 5-mL multi-dose vial, it’s now more common to see single-dose 1-mL vials packaged in a set of five. This shift helps ensure dosing consistency and improves convenience for many patients.
Injection Administration:
Watch this video featuring pharmacist and owner of Central Ohio Compounding Pharmacy, Tony Buchta, RPh, as he details the correct technique when administering ED injections into the penis.
As this can be a harrowing experience for most men, this step-by-step guide helps alleviate the anxiety, and instill confidence in important considerations such as:
- Where to inject (typically into the sides of the penis)
- How to rotate injection sites
- Using alcohol swabs for cleanliness
- Proper handling of syringes and vials
Addressing Common Concerns
Fear of Needles
This is natural. Using fine insulin syringes makes the process nearly painless. Some patients start with a test dose at the urologist’s office, which helps ease apprehension.
Travel Convenience
1-mL vials are TSA-compliant and easy to transport. Patients can carry only what they need instead of bulky multi-dose bottles.
Duration of Effect
Effects typically last from 30 to 90 minutes, depending on the dose. It is crucial to follow prescribed dosing and never exceed frequency guidelines to avoid prolonged erections (priapism).
Using an Auto-Injector for ED Injections
For men who have difficulty using a standard syringe — whether due to arthritis, hand tremors, or needle anxiety — an auto-injector may offer a more comfortable and consistent option for administering ED injections like TriMix, BiMix, or QuadMix.
The auto-injector is a reusable device designed to:
- Minimize needle exposure
- Ensure consistent depth and speed
- Improve ease of use, especially for those with limited dexterity
Many patients find that using an auto-injector helps reduce stress and increases confidence with self-injection.
Watch the video below to see how it works:
Additional Tips for Men Starting ED Injections
- Start low, go slow: Begin with a conservative dose to assess effectiveness and side effects.
- Use a mirror: It may help during early injections to ensure correct placement.
- Ask for training: Pharmacists and urologists often provide guidance or resources, including video tutorials and printed instructions.
Streamlined Trimix Injection Prescribing in Ohio with Exclusive Rx Order Forms
At Central Ohio Compounding Pharmacy, we offer Rx Order Forms developed specifically for licensed healthcare providers managing therapies like Trimix and other men’s health specific medications. These order forms are designed to streamline the prescribing process while supporting accuracy and patient safety.
- Pre-filled with Commonly Requested Strengths: Quickly select from evidence-based formulations used in clinical practice.
- Fully Customizable Fields: Tailor ingredients, dosages, and dispensing quantities to meet individual patient needs.
- Efficient and Clear Format: Reduce prescription errors with checkboxes, built-in directions, and patient-friendly instructions.
These forms are available exclusively to verified prescribers. If you are a licensed provider and would like access, please contact our pharmacy team to request authorization and a digital copy.
Central Ohio Compounding Pharmacy: Trimix Injection, Sildenafil, Tadalafil, and More for Erectile Dysfunction (ED)
Compounded ED medications such as oral sildenafil or tadalafil, or trimix injections are a potentially promising option for men who have not had success with other ED therapies. With proper training and support, many find this method empowering when hope was thought to be lost. Compounding pharmacies play an essential role by customizing therapies and guiding patients through safe and confident use.
References
- Carson, C., & Lue, T. F. (2005). Phosphodiesterase type 5 inhibitors for erectile dysfunction. BJU International, 96(3), 257–270. Link
- Montague, D. K., Jarow, J. P., Broderick, G. A., Dmochowski, R. R., Heaton, J. P., Lue, T. F., & Nehra, A. (2005). Chapter 1: The management of erectile dysfunction: an AUA update. The Journal of Urology, 174(1), 230–239. Link
- Mulhall, J. P., Guhring, P., Parker, M., Hopps, C., & Goldstein, I. (1999). Intracavernosal injection therapy: results of a decade of experience. The Journal of Urology, 161(2), 368–373.
- Shabsigh, R., Fishman, I. J., Schum, C. F., & Dunn, J. K. (1998). Intracavernosal injection of papaverine, phentolamine and prostaglandin E1: results of a prospective study and review of the literature. International Journal of Impotence Research, 10(4), 187–192.
- Virag, R., Bouilly, P., & Frydman, D. (1984). Intracavernous injection of papaverine as a diagnostic and therapeutic method in erectile failure. Angiology, 35(2), 79–83. Link
