Trimix Injection Therapy


Trimix Injection Therapy is a well-tolerated and effective way for men with erectile dysfunction to obtain an erection.
Men with erectile dysfunction have been using injection therapy for a long time - over 30 years.
Men inject their penis with a medicine that causes an increase in blood flow to the penis thereby allowing an erection to occur.​

Who is a candidate for Trimix Injection Therapy?
  •   Trimix injection therapy is usually a second line option in men who are unable to use oral erectile dysfunction drugs (such as Viagra, Cialis or Levitra) due to side effects or contraindications (such as taking the heart medicine Nitroglycerin).
  •   Trimix injection therapy is often used in patients with severe erectile dysfunction caused by high blood pressure, high cholesterol, smoking, obesity and diabetes

What is the medicine used in Trimix Injection Therapy?
  •   There are various combinations of medicine used in penile injection therapy with the most common ingredients being Alprostadil, Phentolomine and Papaverine.
  •   These medicines cause the blood vessels to the penis to dilate allowing an increase blood flow to the penis causing an erection to occur typically within 5-10 minutes.
  •   Trimix injection therapy causes a spontaneous erection WITHOUT the need for sexual stimulation. This is different from Viagra, Cialis or Levitra where sexual stimulation is needed to cause an erection.


Supplies

  •  Alcohol wipes
  •  1 mL insulin syringe (29 guage, 1⁄2 inch)
  •   Premixed 5mL vial of Trimix (Phentolamine, Papaverine and Alprostadil) 
Important Information

  •   Medicine MUST be stored in the freezer.
  •   Keep medicine away from light
  •   Do NOT use expired medicine
  •   Do NOT use if medicine is cloudy or has particles in the fluid
  •  Please follow the instructions as stated from your physician and compound pharmacist
Preparing Injection
  1. Wash your hands with soap and water or with an alcohol based hand sanitizer
  2. Wipe the rubber stopper on the top of your medicine vial with an alcohol wipe. (You MUST always wipe the rubber stopper with alcohol wipe with each and every injection).
  3. Remove the syringe from the package.

  
  4. Remove the plastic cap from the needle. Make sure nothing touches the needle. If something touches the needle (table, countertop, hand) you must throw away the syringe and use a new clean and sterile syringe.

  1. Pull back on the syringe plunger to your prescribed dose (for example 20 units) and inject this air into the center of the rubber stopper on your medicine vial. Push the plunger down and inject the air into the vial. You MUST do this step each and every time you do an injection. The medicine vial is pressurized so this step releases the ‘vacuum’ in the vial.
  2. Turn the vial and syringe upside down. Hold the syringe with your dominate hand and hold the vial with your other hand. Make sure the tip of the syringe is in the fluid. Be careful not to bend the needle.
 
  1. Pull the plunger down to the just past the prescribed dose (for example if your prescribed dose is 15 units then pull the plunger to 19-20 units).
  2. Slowly push the plunger up to almost the prescribed dose (17 or 18 units). This helps to removes air bubbles.
  3. Remove the syringe from the medicine vial

   4. “Tap” the syringe 3 or 4 times with your finger to release potential air bubbles then push the plunger to the prescribed dose (15 units). You will see some medicine escaping the tip of the needle which is fine.
5. Carefully replace the plastic cap over the needle.

​Choosing Injection Site
  •   It is important to find an injection site away from            nerves, arteries and veins.
  •   Do not inject the top or the bottom of the penis.
  •   Inject in the shaded area.

 Injecting the Medicine
  1. If you are not circumcised pull the foreskin back
  2. Grasp the head of your penis with your thumb and first three fingers and
    pull the penis straight out. Your thumb and first three fingers should
    form a vise-like, non-slip grip of this area
  3. Stretch the shaft of the penis taut to your left or right over the upper
    thigh area and look for visible veins. These are the veins you need to
    avoid during the injection
  4. Clean the base of the penis with a fresh alcohol swab.
  5. Pick up the syringe and remove the plastic cap covering the needle.
  6. Once again, grasp the head of your penis and pull it straight out. Keep
    tension on the penis and no NOT twist penis as this could cause you to
    inject in the wrong location
  7. Hold the syringe like a dart in your dominate hand
  8. Touch the needle to the injection site skin making sure the needle is 90 degrees to the penis and the needle is away from any veins
  9. Quickly slide or dart the needle into the penis.
10. Carefully move your thumb from the side of the syringe to the end of
the plunger
11. Push down on the plunger to inject the medicine into the shaft of your
penis
12. Quickly remove the needle then set the needle and syringe aside.
13. Apply pressure to the injection site for 3-5 minutes using the alcohol
swab. Your thumb is on the injection site and your index finger is on the
opposite side of your penis.
14. Place the syringe in a sharps container.



​Helpful Hints
  •   It may take 4-8 injections to find the dose that causes an erection strong enough for penetration.
  •   You can inject the medicine up to 3 times a week.
  •   There must be 24 hours in between each injection.

Complications

It is important to remember the needle may:
  1. cause bleeding in the skin blood vessel of the penis;
  2. be inserted too shallowly and not penetrate into the erectile tissue;
  3. be inserted too high and injure the nerves, arteries, or veins of the penis;
  4. be inserted too low and injure the urinary channel of the penis’
  5. cause irritation of the skin of the penis;
  6. cause infection of the skin or of the erectile tissue;
  7. cause infection which spreads to another location of the body (heart valves,
    bones, etc.)
  8. cause scarring of the erectile tissue or injury to the blood supply of the
    erectile tissue
​
Priapism

Priapism is an erection that lasts too long. Priapism is a rigid and painful erection lasting 3 or 4 hours. This is a medical emergency. Because your penis is rigid it is not allowing fresh blood to enter the penis which means your penis is not getting oxygen. This lack of oxygen can damage the penis and cause permanent erectile dysfunction. If this occurs go to the nearest emergency department to have your erection reversed.
  • -  Ice pack to penis / scrotum
  • -  Cold shower
  • -  Walk
  • -  Sudafed (pseudoephedrine HCl) 2 tablets (60mg total).
**Do Not take Sudafed extended release or long-acting such as Sudafed 12 hour