What to Know About Trimix Injections for Erectile Dysfunction
Key takeaways:
TriMix is a compounded medication. It typically contains a combination of three active ingredients that can help improve blood flow for an erection.
You’ll only be able to fill your TriMix prescription at specialized compounding pharmacies. That’s because it’s made in a sterile environment and tailored to your needs.
Alprostadil is a common TriMix ingredient. It’s also available in FDA-approved erectile dysfunction medications, including Edex and Caverject.
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Table of contents
If you’re experiencing erectile dysfunction (ED), chances are your healthcare team recommended a medication like Viagra (sildenafil) to help. But these medications don’t work for everyone. So, you may be looking for other options.
In some cases, you may be prescribed a medication called “TriMix.” But TriMix isn’t something you can fill at just any pharmacy. That’s because it’s made just for you. It’s available as an injection that you use right before sex.
Keep reading to learn about TriMix, how it works, and how it compares to other ED options.
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What is TriMix?
TriMix is an injection used to treat erectile dysfunction (ED). It’s a sterile compounded medication. This means that it’s made from scratch and can only be filled at sterile compounding pharmacies. It’s also formulated specifically for your needs. Your prescriber may recommend a specific pharmacy they trust to make your medication.
TriMix isn’t approved by the FDA. But some healthcare professionals prescribe it for ED and/or penile rehabilitation, especially after prostate surgery. This is to help you regain the ability to get an erection after your procedure.
TriMix typically contains a combination of three active ingredients: alprostadil, phentolamine, and papaverine. That’s why it’s called TriMix — “tri” meaning three. Similarly, QuadMix contains four ingredients and BiMix contains two ingredients. They’re slight variations of TriMix.
In fact, alprostadil is a common ingredient found in several other FDA-approved ED medications. Examples include Caverject, Caverject Impulse, and Edex. But these medications only contain alprostadil as the active drug.
Compounding pharmacies can make TriMix injections in a number of different strengths. Your healthcare professional might have strengths they typically prescribe to get you started. But since it’s a custom-made medication, it can be adjusted to meet your needs.
How does TriMix work for ED?
The ingredients in TriMix — alprostadil, phentolamine, and papaverine — are all considered vasodilators. They work by widening blood vessels and causing more blood flow to the penis. This can result in an erection.
A holistic approach: Your diet can play a role in the severity of erectile dysfunction (ED) symptoms. Learn about what foods you should avoid if you have ED.
Know your options: Here’s what you should know about treating ED after prostate cancer treatment.
What to avoid: Pharmacists break down common ED medication interactions and how to manage them.
How do you inject TriMix?
Before getting started on TriMix, your prescriber may have you try the medication in their office first. This can help them find the best starting dose based on how you respond to it. They may also use this time to show you how to give yourself the injection.
Be sure to follow their specific instructions. But if you need a refresher, here are a few basic steps to follow:
Gather and prepare your supplies. Set up your medication vial, syringe, two alcohol wipes, and sharps container. If you stored your TriMix injection in the freezer, you’ll need to thaw it before you use it. If you’re using a new vial, remove the cap and inspect the medication. If it’s cloudy or contaminated, don’t use it.
Wash your hands and disinfect the vial. Wash your hands thoroughly with soap and water. Then, wipe the vial’s rubber stopper with an alcohol wipe.
Prepare the syringe. Remove the caps from the syringe and needle without touching the needle. Pull back the plunger past your prescribed dose, then push it back to the correct dose.
Draw up the medication. Insert the needle into the vial and inject the air to balance the pressure. Turn the vial upside down, ensure the needle is in the liquid, and pull back the plunger past the dose, then adjust to the correct amount. Check for and remove air bubbles by pushing excess medication back into the vial if needed. Once you have the correct dose, remove the needle from the vial.
Select and clean the injection site. Hold your penis and choose your injection site, as instructed by your prescriber. When choosing your injection site, remember to rotate where you inject each time to prevent tissue damage. You should also avoid visible veins. Once you’ve made your choice, clean the injection site with an alcohol wipe.
Inject the medication. Pull the penis straight out to stretch the shaft. Hold the syringe like a dart, insert the needle quickly into the shaft, and press the plunger with your thumb or index finger to inject. Pull the needle straight out without twisting. Throw the syringe away in a sharps container without recapping.
Apply pressure. Apply pressure to the injection site using your thumb and index finger for 2 to 3 minutes. This can help reduce bleeding and bruising.
Your prescription label should contain a “beyond-use date.” Think of a beyond-use date (BUD) along the lines of an expiration date. This date can vary depending on how you store your medication.
Don’t use the medication after the BUD. Not only can it lose potency over time, there’s also a risk of contamination. Ask your pharmacist for directions and tips for storing your medication.
How long does TriMix take to work?
TriMix is used shortly before sex. That’s because it usually takes about 5 to 10 minutes to get an erection after injecting TriMix.
But if you don’t get an erection, don’t give yourself another dose unless instructed by your prescriber. And don’t take a different ED medication unless directed to — this can be dangerous. Make sure you’re not using expired medication, since this could be the culprit. But if TriMix isn’t working for you, your prescriber may need to adjust your dose.
How long does TriMix last?
An erection from TriMix usually lasts for about 30 minutes, on average. This can vary. But if your erection lasts over 4 hours, this is considered a medical emergency. More on that below.
What are the common side effects of TriMix?
As with any medication, you might experience side effects from TriMix. Examples of these include:
Pain
Swelling
Bruising
Bleeding
Scar tissue development
Be sure to follow your healthcare team’s instructions when injecting TriMix. Proper injection technique, rotating where you inject, and applying pressure to the injection site afterward can help minimize potential side effects.
Are there any long-term or serious side effects or risks?
TriMix is a compounded medication. This means its safety and effectiveness hasn’t been evaluated by the FDA. There can also be inconsistent quality across pharmacies making it. So, it’s best to work with one that’s experienced and accredited in sterile compounding.
Like many ED medications, there’s a potential risk of priapism. Priapism is an erection that lasts more than 4 hours. It’s considered to be a medical emergency that requires prompt treatment. That’s because it can cause permanent damage to the penis.
In some cases, TriMix injections can also cause Peyronie’s disease. Peyronie’s disease is when scarring in the penis causes a curvature. This can lead to pain and difficulty with erections. Be sure to follow your healthcare team’s instructions to minimize this risk.
How does TriMix compare to other ED medications?
There are several medications available to help with ED. So, what are some of the options, and how does TriMix compare?
Oral ED medications
Phosphodiesterase 5 (PDE5) inhibitors are oral medications that treat ED. Examples include Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil). These medications tend to be tried first. But they don’t work for everyone. And not everyone can take them.
Like TriMix, PDE5 inhibitors help improve blood flow for an erection. But they only work if you’re aroused. This isn’t the case with TriMix.
TriMix also tends to work faster than oral ED medications. It takes time for pills to be absorbed by your body to start working. It takes about 5 to 10 minutes to get an erection after injecting TriMix. And it can take about 45 minutes and 2 hours to get the full effects of the oral medications. However, oral ED medications last longer, giving you more flexibility. They can help you get an erection hours after taking a dose — from 4 to 8 hours for Viagra and 36 hours for Cialis.
And yet, oral ED medications have several advantages. For example, they’re FDA approved to treat ED. This means they’ve been shown to be safe and effective for this use. And pills tend to be easier to use compared to injections. They’re also inexpensive and you can find them at most retail pharmacies.
Injectable ED medications
There are a few FDA-approved injectable medications used to treat ED. As covered earlier, these include Caverject, Caverject Impulse, and Edex. They all contain alprostadil — one of the ingredients in TriMix. They also tend to be higher cost, with average retail prices over $200 for two doses.
Both TriMix and Caverject are available as a vial. A vial of TriMix usually contains multiple doses and has specific storage requirements. A vial of Caverject only contains one dose and you need to mix it with a solution before use. Before mixing, it can be stored at room temperature.
Caverject Impulse and Edex come with injection devices. These devices are dispensed with single-use dual-chamber cartridges containing alprostadil. This can make them easier to prepare. All you need to do is assemble the injection device and it mixes the medication for you.
That said, alprostadil alone may not work for everyone. The other two ingredients in TriMix — papaverine and phentolamine — can work in synergy with alprostadil. So if you aren’t seeing results from a medication like Caverject, your prescriber may see if TriMix can make a difference.
How much does Trimix cost?
It depends. Prices can vary by pharmacy. But cheaper doesn’t always mean better with compounded medications. That’s because meeting the quality requirements for sterile compounding is expensive — especially if it’s done right. So, it’s a good idea to use an accredited pharmacy. Your prescriber may recommend a few pharmacies that they trust.
Is TriMix covered by insurance?
Insurance plans usually have restrictions on covering compounded medications. That’s because they aren’t FDA approved. And some can be very expensive. If TriMix is covered, it may fall into a higher copay tier.
Some compounding pharmacies don’t take insurance. In this case, you’ll need to pay out of pocket for the medication. They may give you a form with your prescription information to submit to your insurance for reimbursement.
Frequently asked questions
No. TriMix helps improve blood flow to the penis for a firmer, longer-lasting erection. It’s not designed to increase penis size.
TriMix’s individual ingredients — alprostadil, papaverine, and phentolamine — have been used for decades to treat ED. Over time, they were combined together to create TriMix.
TriMix is a prescription-only medication. So, you should avoid buying TriMix online without a prescription. But it’s possible that some telehealth prescribers may recommend TriMix as an ED treatment option after an online visit. In this case, they may send your prescription to a compounding pharmacy that will ship TriMix to you.
The bottom line
TriMix is a compounded injectable medication used to help with erectile dysfunction (ED). You’ll need to fill it at a compounding pharmacy because it’s made just for you. TriMix can cause side effects like pain, bruising and/or bleeding, and scarring. Using the proper injection technique, rotating injection sites, and applying pressure after injecting can help minimize these effects.
If you’re experiencing ED and other treatments aren’t working for you, talk to your healthcare team about your options. They may have you give TriMix a try.
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References
Endo Pharmaceuticals. (2024). Edex [package insert].
Floth, A. et al. (1991). Intracavernous injection of prostagland in E1 in combination with papaverine: Enhanced effectiveness in comparison with papaverine plus phentolamine and prostaglandin E1 alone. Journal of Urology.
Dhaliwal, A., et al. (2023). PDE5 Inhibitors. StatPearls.
Memorial Sloan Kettering Cancer Center. (2022). Penile injection therapy.
Pharmacia and Upjohn Company. (2024). Caverject [package insert].
Pharmacia and Upjohn Company. (2024). Caverject Impulse [package insert].
Porst, H., et al. (2024). A comprehensive history of injection therapy for erectile dysfunction, 1982-2023. Sexual Medicine Reviews.
UCSF Medical Center. (2015). Successful self penile injection hints, questions and answers.
United States Pharmacopeia. (2019). USP compounds standards and beyond-use dates (BUDs).
U.S. Food and Drug Administration. (2024). Compounding and the FDA: Questions and answers.
U.S. Government Accountability Office. (2014). Compounded drugs: payment practices vary across public programs and private insurers, and Medicare Part B policy should be clarified.
Worthington, J. F. (n.d.). Help for ED after prostate surgery: The basics. Prostate Cancer Foundation.
