erctiledysfunctionTriple Mix (or Triple Drug or Trimix) contains three drugs mixed in a sterile injection. They are;  

  • 1. ) Papaverine (pa-PAV-uh-reen)  Definition:.A drug (vasodilator) that causes blood vessels to expand. When papaverine is injected into the soft tissue in the penis, it can produce an erection by increasing blood flow. When mixed with phentolamine, it is usually called a bi-mix.  
  • 2.) Phentolamine (fen-TOLE-a-meen)  Definition: When given by injection, it causes blood vessels to expand (vasodilator), thereby increasing blood flow. When injected into the penis, it increases blood flow to the penis, which can result in an erection.

When used in combination with papaverine it is a bi-mix. When prostaglandin E-1 is added it is a trimix.

  • 3.) Prostaglandin E-1  (pross-tah-GLAN-din). Synonyms: prostaglandin  Abbreviations: PG  Definition: . A potent hormone-like substance that can control blood pressure, muscle contractions, and inflammation. Letters (and numbers) are added to designate the type, e.g., prostaglandin E-1 is a relaxant (vasodilator) also known as alprostadil that is used to produce erections.

There are times when a doctor may only want one or two of the ingredients, but that has become rare. The most common, an effective, preparation contains all three. It is referred to a Trimix, Tri-Mix, or even Triple Mix. Regardless of the name, it is a sterile injection prepared by a compounding pharmacist. 

How is this preparation used?  Most patients find that they get used to the needle sensation over time. The number of injections doesn’t exceed 12 per month, spaced as evenly as possible. The site of injection should alternate between left and right side of the penis.

The doctor gives detailed instructions in the office and assures that the patient is competent to perform the injections before prescribing. Our pharmacy fills a number of these and we supply written information, with diagrams, to support the instructions from the doctor.

Does it work? Approximately 80% of the men who use this preparation experience a useful erection in 10 to 20 minutes. It lasts from 20 to 90 minutes. Erections produced by the injection method will not interfere with capacity to obtain an orgasm.

What about side effects? The most common side effect reported  is a mild to moderate dull ache, which occurs 5 to 20 minutes after injection. This ache is increased by standing, and stops when the erection is gone.

Whenever a needle is stuck into the body, a small bruise may develop at the site of the injection. Sometimes, a small nodule or lump may develop if the same site is injected repeatedly. Rarely, scarring or a plaque of the penis can occur.

Occasionally, the medication may produce a painful, sustained, prolonged erection, known as priapism (a rigid erection lasting more than 4 to 8 hours). This requires immediate medical attention, but is easily reversed when treated early.

Other rare side effects include dizziness and headache. Even less frequently is an increase in the liver enzymes usually associated with the Papaverine injections. In comparison, Prostaglandin E1 is safer as it rarely produces priapism or liver enzyme abnormalities. Since it is a natural product of the body, the enzymes locally present in the penis can break down Prostaglandin E1. However, one of the possible side effects of Prostaglandin E1 is the development of a slight dull ache in the penis, which will usually subside when lying down.

What about injecting in the wrong place? It is unlikely that injecting in the wrong place or into the urethra will cause a problem. However, care should be taken to avoid making an injection directly into any veins in the penis.

Storage and stability. The mixture is not stable for long periods, which is a primary reason it’s not available as a commercial drug product. If kept under refrigeration, the amounts we dispense are easily used up before they lose potency – several weeks.  It is important to note that improper storage does not result in harmful chemicals in the preparation. The main thing to suffer is the potency – the preparation may not be as strong as when fresh. It may not elicit the expected results.

We are often asked about problems if the preparation is left at room temperature. That’s somewhat complicated because what I consider room temperature may not agree with your definition. At best, expect the potency to last about a week at room temperatures.

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