Dear Doctor;
Many men are interested in using Triple Mix (sometimes referred to as TriMix) injections as a treatment for Erectile Dysfunction (ED). They are searching for pharmacies close to home that prepare these injections. Some of them are already your patients and some will be new to you. To make the transition and prescribing more efficient, we’re offering the following information about the preparation, what it contains, how it is used, and what problems may arise.
Triple Mix is a combination of papaverine hydrochloride, phentolamine, and alprostadil. We compound the injections and dispense in vials and prefilled syringes upon the prescription of a doctor.
There are numerous combinations of strengths so we need to know how much of each ingredient is to be used.
Our most common mixture is called Triple Mix 30/1/10. It delivers in each 1 ml;
- PAPAVERINE (vasodilator drug) 30 MG
- PHENTOLAMINE (vasodilator drug) 1 MG
- ALPROSTADIL (alpha-adrenergic receptor antagonist) 10 MCG
Common dose amounts range from 0.08 ml to 0.9 ml per administration, not more than once every 24 hours, usually twice weekly.
This preparation is dispensed in 5 ml vials. A prescription for vials is filled with multiples of 5 ml.
Beyond use dating is around 30 days at refrigerator temperatures. Many of our customers pre-fill their syringes and freeze them. I’m told it only takes a minute or so to thaw the preparation – and that they work for many months. That’s an unofficial and untested statement about stability.
The price is fixed for the 5 ml vial – does not vary by strength..
When prescribing, specify the strengths of each ingredient, the volume to inject each time, the amount of to dispense, and the number of allowed refills.
Merely ordering Triple Mix or TriMix is not sufficient. However, Triple Mix 30/1/10 will be filled with the formula above.
Triple Mix 30/1/12 will be filled with
- PAPAVERINE 30 MG
- PHENTOLAMINE 1 MG
- ALPROSTADIL 12 MCG
in each 1 ml.
Any of the listed ingredients can be changed or left out. An injection with two ingredients is referred to as BiMix. Adding a fourth ingredient (atropine) is referred to as a QuadMix. Again, we need to know which ingredients are to be in the preparation, along with the individual concentrations.
Triple Mix Injection is injected into the intracavernosal area of the penis (our pharmacy includes injection directions with each order) and should produce an erection in 5 to 20 minutes. The erection can be expected to last up to one hour. It is common to administer no more than once in a 24 hour period and not more than 3 times a week
Who should NOT use Triple Mix Injection? Men who have conditions that might result in long-lasting erections should not use Triple Mix Injection. Some of these conditions include sickle cell anemia or trait, leukemia, and tumor of the bone marrow (multiple myeloma). If you have any of these conditions, consult your doctor. Men with penile implants, severe penile curvature, or those who have been advised not to engage in sexual activity should not use
NOTES TO PATIENTS WHO USE THIS PREPARATION: What are the risks of using Triple Mix Injection? Erections that last more than 6 hours can cause serious damage to the penile tissue and may result in permanent impotence. Call the prescribing physician or, if unavailable, seek professional help immediately if you still have an erection 4 hours after injection. Various treatment options for reversing a prolonged erection are available.
A common side effect of Triple Mix Injection is mild to moderate pain during injection. The erection may also be associated with a painful sensation. If you experience severe pain, contact the prescribing physician. Call your doctor if you notice any redness, lumps, swelling, tenderness or curvature of the erect penis. A small amount of bleeding at the injection site may occur. To prevent bruising, apply firm pressure to the injection site for 5 minutes after injecting. Tell your doctor if you have a condition or are taking a medicine that interferes with blood clotting.
There is a very slight possibility of needle breakage with use of any injection. To best avoid breaking the needle, pay careful attention to your doctor’s instructions and handle syringe and needle properly. If the needle breaks during injection and it is possible the grasp the broken end and remove it, do so and and contact the doctor. A doctor must be consulted immediately if the broken end cannot be grasped and the piece removed.
If the above is lacking, I can try to answer your questions.