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Injections for Erectile Dysfunction

Injections directly into the penis for erectile disfunction are quite common, and not nearly as bad as most men would imagine. For some men, this is the only option if they suffer from certain medical conditions, or take medications that interact with typical oral treatments such as Viagra or Cialis.

What kinds of injections exist for Erectile Dysfunction?

Bi-Mix Injection (Papaverine HCl / Phentolamine Mesylate)

Tri-Mix Injection (Papaverine HCl / Phentolamine Mesylate / Prostaglandin E1)

Quad-Mix Injection (Papaverine HCl / Phentolamine Mesylate / Prostaglandin E1 / Atropine Sulfate)

Prostaglandin E1 (PGE1) is a medication used to manage erectile dysfunction

Brands of Prostaglandin E1: Caverject®, Edex®, Prostin VR®)

Candidates for ICI Injections

Most urologist and primary docs will usually start treatment of Erectile Dysfunction (ED) with oral treatments such as Sildenafil (Viagra), Tadalafil (Cialis) or Vardenafil (Levitra). If the patient doesn't tolerate the medication well, or if they are on medications that interact with these drug classes, the provider usually is only left with injectable options.

Benefits of Compounded Injections

Compared to other drugs that are used in the treatment of ED, some benefits of using TriMix injections include the following:

  • Effects manifest quickly and are long-lasting

  • Administration is simple and relatively painless

  • Studies have indicated that TriMix has a high success rate

What makes them different?

Unlike the oral medications, the intracavernosal injections are strictly local injections so they do not interact with other medications the patient may currently have in their system. They do not spike blood pressure or cause any blood thinning effects outside of the localized region of activity. This makes them especially useful for patients who take medications for diabetes, high blood pressure, heart disease, and many other chronic ailments. They work by relaxing the smooth muscles opening the blood vessels in the penis, thus causing an erection. Each of the individual components may have some effect in causing a penile erection. However, when these components are compounded together into one drug, they can enhance each other's positive effects. The combined effect of these drugs can be significantly greater than what each of them would have manifested by itself. Once injected into the penis, TriMix may cause the relaxation, expansion, and filling of the corpus cavernosum with blood. This may result in satisfactory penile erections that lasts throughout the duration of sexual intercourse.

Side Effects of penile injections for ED

Most patients do not have side effects except minor bruising at the injections sight which is typically caused an a shaky or unsteady hand during injection. The other common side effect is from administering too large a dose. An overdose can cause a condition known as priapism which is when the erection does not subside after a period of 3-4 hours. This can be very serious, and patients should seek emergency care as soon as possible. To avoid this nasty experience be very carful to follow the titration given by your provider, most providers will give an in person training, as well as guidance to figure out the correct dosage. Most patients require some trial and error titrating up in dosage each time before finding their long term dosage.

How to Reconstitute Tri-Mix

How to Inject Bi-Mix, Tri-Mix, Quad-Mix

It may be injected up to three or four times a week but there must be an interval of at least 24 hours between injections. Even though some men may feel anxious or squeamish about self-injecting themselves, this is a relatively painless procedure if done properly with correct technique. Discussed below are the steps that are needed to safely self-administer the TriMix injection.

  • Wash hands thoroughly with soap and water or an alcohol-based solution to maintain proper hygiene.

  • Wipe the top of the rubber stopper thoroughly with an alcohol pad.

  • Insert a syringe into the vial through the rubber stopper and draw out the prescribed amount of TriMix into the syringe. Ensure that there are no air bubbles by tapping the syringe.

  • Find an injection site on the penis. Do not inject at the top or the bottom of the penis. Also avoid injecting directly into any visible veins or arteries on the penis, as well as along the midline. The optimal locations to administer the TriMix injection are at the sides of the penis. Avoid using the same spot repeatedly for injections as this may result in the scarring of penile tissue.

  • Once an injection site has been found, thoroughly wipe it with a fresh alcohol swab.

  • Insert the needle into the penis and slowly depress the plunger to release the TriMix medication into the corpora cavernosa of the penis. Remove and carefully dispose of the syringe when this completed.

  • Apply pressure to the injection site and massage the penis to ensure thorough distribution of the medication throughout the tissues inside the penis.

The effects of TriMix become evident about 5 – 15 minutes after its injection into the penis as it induces a penile erection. Its duration action typically varies depending on the individual, ranging anywhere between half an hour to an hour. However, its effects should not last longer than 3 hours; the prescribing physician should be consulted immediately if the erection becomes prolonged.

How do I get started?

Contact our office to obtain a consultation.

Consultation & training plus the first vial of medication is usually around $400.

Vials usually last patients between 2-4 months.

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