Trimix Injections
For many years, we have used medication to improve blood flow in the penis. Treatment options for erectile dysfunction include pills and injectable medications. Since 1983, erectile dysfunction injections have gained acceptance across the globe. The FDA approved Prostaglandin E1 for treatment in 1995.
Trimix is a combination of three injectable medications:
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Papaverine
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Phentolamine
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Prostaglandin E1 (also known as alprostadil)
Scientists have found that these drugs can induce a penile erection when injected directly into the penis.
Pills like Viagra, Cialis, or Levitra do not work for every man dealing with erectile dysfunction. Penile injection therapy is another viable option. The thought of injecting a needle into your penis may sound intimidating, but about   are highly satisfied with this therapy.
Trimix Dosage
We do the first injection here in our office so we can show you how to do it yourself at home. It also helps us determine the correct dose for your needs. Your starting dose depends on the severity of your ED. Based on your response to the shot done during the teaching visit, we tell you how much to inject at home and when to change your dose.
Typically, we instruct you to increase the dose by five units each time until you get the effect you want. If you are using 50 units and not getting the erection that you need, call us. We will prescribe a stronger mix of medications.
You are allowed a maximum of three injections per week. You must wait 24 hours between injections. This means, if you do not get a good result from a shot, you should not inject more medicine. You need to wait at least 24 hours before trying a higher dose.
We recommend alternating the sides of your penis for each injection. This will help you avoid injecting into the same spot over and over.
Although the satisfaction rate for injection therapy is close to 70%, it is not always a good long-term option for some men. If you are not satisfied with injection therapy, you may want to consider a penile implant.
Trimix Injection Site
Follow these step-by-step instructions on how to properly use your penile injection at home:
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Tear open an alcohol swab and wipe the rubber top of the bottle to clean it.
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Peel open the syringe carefully and remove the protective cover from the needle. It is important that the needle does not touch anything but the rubber bottle cap. 
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Push the needle through the rubber stopper, then flip the vial upside down. Pull on the plunger until you withdraw at least 0.2 mL (20 units) more than the amount you plan to inject into the syringe. For example, if you are injecting 20 units, pull 40–50 units into the syringe. This will help you get the air out of the syringe.
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As you continue to hold the vial upside down, inject whatever air and extra medication that remains in the syringe back into the vial.
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Pull the needle out of the vial and lay the syringe on the edge of a flat surface. Make sure the needle hangs over the edge to keep it from touching anything. 
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Grasp the head of your penis between your index finger and thumb. Gently pull your penis away from your body until the skin is taut. Be careful not to twist your penis.
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When choosing an injection site, avoid any area where a vein is clearly visible. We recommend injecting somewhere in the middle third of the shaft of your penis. Change injection sites slightly from left to right as well as up and down the shaft and back again to ensure that you do not develop scar tissue at one specific site. 
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Wipe the skin at the injection site with an alcohol swab.
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Pick up the syringe with your other hand and position your hand like you're about to throw a dart. 
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Touch the point of the needle to the place you want to inject. Only inject your penis while you're sitting or standing.
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Hold the syringe at a 90-degree angle and push lightly to penetrate the skin near the base of your penis.
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Once you've poked through the skin, you will feel some resistance. Push firmly forward until a distinct "give" is felt. The needle should now be in the right place. The whole length of the needle should be in your penis with just a little showing before the hub. Don’t press the hub of the needle into the skin.
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Hold the syringe between your index and middle fingers. Place a thumb on the plunger and inject the entire contents of the syringe. Take the needle out of your penis. If it is painful or difficult to use the plunger, remove the needle and start over. This is a sign that you are in the wrong place.
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Immediately apply pressure to your penis by squeezing the sides together with your thumb and index finger for two to three minutes or until there is no bleeding.
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Place the needle in a proper disposal container.
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How Long Does It Take For Trimix to Work?
Your penis should swell within five to 15 minutes after injection. Your penis may become fully erect within that time frame, but many men do not achieve a full erection until sexual foreplay is started.
You may notice decreased sensation in your penis or have trouble ejaculating. This is usually related to erectile dysfunction and not caused by the injection itself. Inadequate foreplay and excitement may also play a role.
If you get no response from the treatment, it could a be the result of different factors:
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Wrong technique
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Expired medication
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Inadequate dose
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Scarring or deformity (curvature) of the penis
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Penis infection
Important Things to Remember
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Always keep your medicine in the refrigerator. You may pre-load syringes and keep them in the freezer once you know what dose works for you.
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Never increase the dose by more than 0.05 mL (5 units). Increasing the dose by too much may lead to a painful erection that may not go away, requiring a trip to the emergency room.
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Never inject your penis more than once a day. 
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If you fail to penetrate the erectile tissues after injection, you will feel a burning sensation. This should go away within an hour and no erection will result.
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The needle must never touch any object other than the alcohol-wiped vial stopper or penile skin. If the needle is contaminated, throw out the syringe and start over.
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Do NOT insert a contaminated needle into the vial.
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Do NOT inject any substance other than the medication provided. 
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Do NOT share needles or medications with other people.
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Go to the emergency room for erections that last more than three hours.
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Return to our clinic in three months.
Trimix Side Effects
Some men experience pain or bruising, while others experience none at all. Trimix injections may cause a few side effects: 
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Temporary swelling of the penis skin can occur when you don’t place the needle properly.
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Temporary pain—About 10% of men develop pain or discomfort in the head of their penis shortly after injection. This subsides spontaneously after a few minutes and is more common in men with impotence secondary to nerve problems.
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Bleeding at the injection site—This usually results in a black and blue patch on the skin that disappears in a few days. This occurs when you don’t put enough pressure on the injection site after removing the needle or from puncturing a skin vein.
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Prolonged erection (priapism) — A prolonged erection is an easily managed but potentially serious complication. If you ignore it, you could have severe pain and may need a small operation. It could even make you completely impotent. That means you cannot respond to injections. Therefore, only make SMALL adjustments to your dose, if needed.
If you develop a full erection that lasts more than three hours, go to the emergency room.
Make An Appointment
If you would like to schedule an appointment with one of our specialists, call us at 801-213-2700. You do not need a referral from a physician to see us. 
