Penile Injection Therapy: I notice none... - Advanced Prostate...

Advanced Prostate Cancer

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Penile Injection Therapy

cesces profile image

I notice none of these medications are listed in Goodrx.

Does anyone know how much they cost?

What some of the plusses and minuses are in their use?

"The three main types of medications used in penile injection therapy include:

papaverine

phentolamine

prostaglandin E1 (PGE1) or alprostadil (Caverject, Edex, MUSE)

Sometimes, only one medication is administered. But combinations of these medications are also widely used. Combination medications include BiMix, which is papaverine and phentolamine, and Trimix, which contains all three medications."

67 Replies

Funny you should post this...I just had my first TRIMIX training yesterday...what an adventure. It's very important to determine the correct dosage otherwise you'll end up in the ER. Hence the training sessions.

I was started off with the normal initial dosage of 10 units (1 ml) of the Trimix and this small amount was too much for me....after 2.5 hours of an erection I needed to have the reversal injection. My urologist told me that was a very good sign overall because the nerves are there and are easily activated.

I go back in two weeks and this time I'll be starting with .2ml.

1. It works very well.

2. It's important to determine right dosage.

3. It does sting a bit.

4. Overtime it does lose it's effectiveness.

5. My supplier for cialis and the TRIMIX is MenMD. 2 Vials (5mL) is costing me $170

cesces profile image
cesces in reply to

Why do you use both cialis and TRIMIX?

Do they act on the same receptors?

in reply to cesces

I was prescribed cialis after my RP. I continued taking it daily to encourage blood flow to the area. Its cheap 90 day supply fo $60. I pay out of pocket since insurance won't pay for more than a 20 day supply over the year.

Lulu700 profile image
Lulu700 in reply to

Might I ask ? What did you do during those two hours? Run home and make love?? If not . What’s the point. ? Is this Therapy to preserve the junk for future hope of use ? I hope that you get the results you seek! 👏🏼👏🏼👏🏼👍

in reply to Lulu700

Wife was out. The first appt is to determine the correct dose. They usually start out with 1 cc ( 1 ml). That ended up being way too much...I did go home, too a hot shower which help some. I came back and my Uro determined that I needed the referral med. I go back in 2 weeks..this time starting out with .2 cc (.2 ml).

Boonster profile image
Boonster in reply to

TomTom is exactly right about the importance of the right dosage. My urologist gave me an initial injection of TRIMIX. I wound up in the ER after 6 hours of an erection. The ER doctor said let's wait a while longer before giving any reversal injection. It did start to go down about 20-30 minutes later. I couldn't believe my urologist would give me what turned out to be a massively inappropriate trial dose. Please be careful out there.

MateoBeach profile image
MateoBeach in reply to

1 ml is way too much! I think 0.10 would be a better test starter dose. Your urologist seems poorly educated about it. It does not work via the nerves to the penis but on the vasculature network inside the penis directly.

in reply to MateoBeach

With all do respect...you are incorrect and my Urologist is very good.

Here is just one site stating they start with 15 units so 10 units is less than a typical starting dosage at some institutions

healthcare.utah.edu/menshea...

It's the reason they have a training session..and my Urologist did not let me go long before injecting the reversal.

cesces profile image
cesces in reply to

Not a lot of difference between 1.5 and 1 ml.

But a lot of difference with 10ml

LoL

cesces profile image
cesces in reply to MateoBeach

Maybe you are confusing ml with units?

in reply to cesces

I'm not following you in the least. 15 units would be 1.5 ml(cc)...so 10 units would be 1 ( ml )(cc).Regardless...at University of Utah, they state IN PRINT they start there patients with 15 units (1.5 ml(cc). So to say my urologist doesn't know what he's doing is incorrect...he started me off with 10 units 1 ml (cc). Furthermore, TRIMIX comes in different formulations so you need to know the formulation being used before making a comment on a public forum without knowing all the details of the medication and the patient. That is reckless.

empowerpharmacy.com/drugs/t...

cesces profile image
cesces in reply to

"TRIMIX comes in different formulations so you need to know the formulation being used"

Interesting. Yes of course. I hadn't thought about that.

In forum it's easy to miscommunicate tone. And to over respond.

Who cares what he thinks of your uro. Really. Lololol

in reply to cesces

I do not actually, but I'm seeing a pattern of patient advocates venturing into the medical opinion area without having the least bit of history of a given patient. It's one thing to provide the latest information on available treatments. It's another to tell someone on this site their Dr. Is misinformed regarding a particular treatment. What's missing is yhr medical history which only the doctor truly understands. That is my point.

cesces profile image
cesces in reply to

"It's another to tell someone on this site their Dr. Is misinformed regarding a particular treatment. "

The casual utterance of someone's avatar on a forum. Attempting to say something with emphasis.

Not worth squabbling over.

What I learned from the exchange is to make sure to ask my doc to be conservative on the first shot.

We all benefit from exchange.

in reply to cesces

What your missing is the 10 units is the standard conservative injection...you do not want to be injecting 3 or 4 times at one time...One injection per side and change sides for each injection. No more than 3 injections per week after the dosage is determined per the manufacturer. After all, it's not a pin cushion.

cesces profile image
cesces in reply to

Makes sense to me.

I was just saying it probably isn't worth taking personal umbrage over statements made over such a flawed and imperfect medium of communication.

"One injection per side and change sides for each injection. No more than 3 injections per week after the dosage is determined per the manufacturer. After all, it's not a pin cushion."

Sounds like good advice. Thanks.

in reply to cesces

I took umbrage over the dig at my Urologist. Believe me, you'd like my urologist. Smart. Informed and great personality. He never pushed a treatment on me and insisted I get a second opinion before my RP. He trained at Jefferson which is a Kimmel Cancer Center in Philly and is Associated with John Hopkins.

Anyway, this site is great for educating us regarding the different treatment options available...it's not a substitute for medical diagnosis.

cesces profile image
cesces in reply to

"I took umbrage over the dig at my Urologist."

Just saying it's not worth it.

It's a cartoon avatar on an internet forum.

MateoBeach profile image
MateoBeach in reply to cesces

No. Trimix dosing is in ml ( milliliters) and there is no fixed or defined “unit other than volume for a particular formulation. Dosing must be individualized of course. However, most administer it with insulin syringes which are marked in units of insulin. 100 units of insulin is also one ml. In standard formulations (U-100). . So the 10 unit mark on the syringe will be 0.1 ml. 15 units would be 0.15 ml. Hope that is clarifying and not confusing. I used “Trimix II”, another standard preparation.

cesces profile image
cesces in reply to MateoBeach

What's the difference between trimix and trimix 2?

in reply to MateoBeach

So what formulation was used? You are making a comment on a public forum without any knowledge of my particular situation....TRIMIX comes in different formulations...so what formulation was I injected with? If you don't know then you shouldn't be making comments without first getting all of the information.

I am not a pharmacist but from my readings the nervous system does control blood pressure...so are you saying these vasodilatos do not impact the nerves at all?

MateoBeach profile image
MateoBeach in reply to

I will not reply to you anymore.

in reply to MateoBeach

That's your choice. I welcome individual experiences with treatments. I draw the line at uniformed opinions on people's treatments. Unless someone knows the specifics of a particular patient via medical examination or medical records, comments like the one you originally posted are reckless.

cesces profile image
cesces in reply to

I submit it's not that big a deal.

When you see info that needs correction, maybe best policy is to correct it and move on.

in reply to cesces

How about this...you report back from your visit regarding the ed injections and let us know what your urologist suggested. Better yet, tell your urologist that a patient advocate from Malecare said to do <fill in suggestion>. Let us know how it goes.

cesces profile image
cesces in reply to

I'm going to ask him to start low instead of high.

My philosophy is not to micromanage any type of professional, including docs. You take them whole as you find them, and let them operate in their own comfort zone.

If you don't like where they are going, replace them, but don't try to change their judgement.

My philosophy anyways.

If he starts high without my permission, I fire him and start over. LoL

cesces profile image
cesces in reply to MateoBeach

Let him cool off then forget about it.

After all we are a forum of cranky old men. Lol

MateoBeach profile image
MateoBeach in reply to cesces

Agree. Thanks. Seems there is different nomenclature for the various alternatives. Bimix , Trimix, Trimix II, Super Trimix and so on. I haven’t used it in the last two years so don’t have a vial that I can check the concentrations. That is just what they called it in my community in Oregon. Sorry.

cesces profile image
cesces in reply to MateoBeach

Good fodder for questions to ask the doc.

CAMPSOUPS profile image
CAMPSOUPS in reply to MateoBeach

In his posts you will find that he went off ADT recently.I think his testosterone is back in full force.

You don't see it on GoodRx because it has to be made up in a compounding pharmacy. I started with 0.15 ml (1.5 units on an insulin syringe), which is fine for me. Each vial holds 1.0 ml, so I get about 7 injections from each vial. 6 vials cost me $150.

cesces profile image
cesces in reply to Tall_Allen

Tall Allen

There seem to be a lot of options, bimix, trimix, etc.

Trimix sounds best because it has a bit of everything.

Are you familiar with the plausible reasons to consider the other options over trimix?

Tall_Allen profile image
Tall_Allen in reply to cesces

Some men can't tolerate any alprostadil (too painful). They have to choose bi-mix.

cesces profile image
cesces in reply to Tall_Allen

Do they use different mechanisms or receptors, or do they act similarly through the same receptor as Viagra and the other pills?

Tall_Allen profile image
Tall_Allen in reply to cesces

Entirely different from ED pills. It relaxes the blood vessels so blood flows in. It doesn't require libido to work.

Bubasurf6 profile image
Bubasurf6 in reply to Tall_Allen

I’ve got a Trimex only mix It doesn’t work very well. What other medications could my ED DOC HAVE THEM add to that mix Viagra, cialis , Levite or others Thanks

in reply to Bubasurf6

If TRIMIX does work for you, you have blood flow issues...ie. blockade in the penis. Therefore it's extremely unlikely the ED pills will work. Your next option is a penile implant.I'm sure you ED doc mentioned this.

,NO?

cesces profile image
cesces in reply to

There is no other less invasive option than a penile implant?

in reply to cesces

If you think about the root cause of ED and what all these ED meds do, what conclusion do you come to if the med treatments do not work?My Uro said if TRIMIX fails then the implant is the next option before celibacy. But give that opinion a a big caveat. Apparently the implant surgeon in the same practice is supposed to be the best on the East coast, so there might be a little preference for the implant.

Cancer2x profile image
Cancer2x in reply to

Which implant surgeon is supposed to be the best on the East Coast?

cesces profile image
cesces in reply to Cancer2x

I would address that question to Tall_Allen.

Though I wouldn't limit it geographically.

Unless you are willing to make tradeoffs... Lol

in reply to cesces

Why..is TA the Library of Congress of doctors? He has his opinion on the best doctors and others have theirs.

Lulu700 profile image
Lulu700 in reply to

😂😂👏🏼👏🏼👏🏼

cesces profile image
cesces in reply to

He is a support group leader. He has direct and indirect interaction with lots of specialists around the country. He diligently reads their papers.

So he has the situational awareness on the subject of anyone I'm aware of.

in reply to cesces

My reference is a surgeon who reads papers and attends conferences with specialist around the country. EtcWhy is his opinion less than TA...im just trying to understand why you're so quick to dismiss an actual practicing medical professional?

in reply to Cancer2x

I'll get the name for you. "The Best" at anything is always subjective.

in reply to Cancer2x

Dr. Jay Simhan

providers.einstein.edu/prov...

I'm sure you'll seek a 2nd opinion.

I met him once and he was very nice.

Good luck with your decision.

in reply to cesces

Why the interest in TRIMIX? Are you considering it?

cesces profile image
cesces in reply to

I have an appointment to discuss the general topic.

Dr. Myers put me on low dose daily Viagra. It was off label for prostate cancer purposes.

When used full dose it no longer works for erectile purposes.

Maybe I wore out that pathway / receptor?

Tall_Allen profile image
Tall_Allen in reply to Bubasurf6

It's called "venous leak." the only solution I know of is an implant. Implants work well. Everyone I've known with one really likes it.

cesces profile image
cesces in reply to Tall_Allen

Tall_AllenSomeone said the trimix stops working after a while.Do you know if that is from damage or wearing out of the applicable receptors, or is it some kind of mechanical wear and tear?

Tall_Allen profile image
Tall_Allen in reply to cesces

I haven't heard it stops working, unless there is venous leak. It does form scar tissue at the injection site, so Peyronie's can happen.

JPnSD profile image
JPnSD in reply to Tall_Allen

How do you store 6 vials? Freezer? Otherwise the shelf life under good refrigeration is 30 days. I get 2 vials for $110. You get a great price. Low dose trimix?

Tall_Allen profile image
Tall_Allen in reply to JPnSD

Yes, in the freezer for unopened bottles, refrigerator for opened ones. Not low dose. 1 ml vials. Maybe your vials hold > 1 ml? The compounding pharmacy is Rx Unlimited in North Hills, CA

Not an enlargement. .just an erection...I highly recommend the injection...my wife is a nurse..she'll do the injection..how kinky is that!!

Lulu700 profile image
Lulu700 in reply to

I was kidding about the enlargement . Good luck Tom .I hope that you’re feeling ok! ✌️

in reply to Lulu700

Feeling pretty good since stopping adt and zytiga. Energy coming back in spite of <3 ng/dl. Go figure.

I have no idea of the implant cost. I only need a little assistance in the erections. I'm 60% now..im holding out hope that this won't be permanent but if it is, its not the end of the world. Much much worse things in life.

My initial dose in the doctor's office was 0.15 cc ( 0.15 ml also 15 units) resulted in a 6 hour erection. I took FOUR 30 mg generic sudafed tablets at the 4 hour mark and emailed my urologist. He called and had me update him in an hour. He had me use ice pack which really did not help me, but helps most.

I am in Houston, TX (large city - more options). Any place with 50k population probably has a compounding pharmacy.

I take 10 mg daily tadalafil (generic cialis) using GoodRx I purchase 90 pills for $40.

When I take trimix, I use 0.04 ml ( cc - units ). I purchase Trimix at My Compounding Shop (mycompoundingshop.com/ compounding pharmacy) for $90 for a 5 ml vial and 20 syringes. I always ask for 20 additional syringes since I take a low dose. I have changed to the 0.5 ml syringes because it is easier to see the different individual unit marks. You can get more syringes at a drug store (CVS, Walgreens, etc).

You will find that a local compounding pharmacy will be cheaper because the shipping charge for Trimix is around $50 due to the temperature requirement. If you pick it up at a compounding pharmacy - take a small ice chest with ice to store it until you get home.

I pump for 15 minutes (3 minutes pump, 2 minutes massage, repeat twice for 15 minutes) so I can see the blood vessels in my penis as well as to have a larger target. I use the Bathmate Extreme (as a hand pump (bathmatedirect.com/ sign up for emails and in a couple days you will get a code to get 20 to 30 percent discount). The Bathmate uses water. I sit on the corner of the tub with cups of warm water to fill the pump. The Bathmate has helped restore my length and girth since my RP.

Even the 0.04 cc dose gives me a 3 to 4 hour erection. I take it on an empty stomach. After I have an erection, I take FOUR 30 mg generic sudafed tablets. Having an empty stomach allows the sudafed to be absorb and distributed quicker. This gives me an hour of fun.

Note - My insurance did not cover the initial dose in the doctors office. The initial dose costed $185.

Being about three years in with Lupron, I am used to having zero libido, but within the past few months, I'm more concerned about genital shrinkage. Cialis is of no help. The vacuum pump helps a little, but not with length. Now I'm doing Trimix injections which work fairly well, at least assuring me that I still have a penis. When I get the vial on ice, the papers say to discard it after 28 days. The label says it was filled 10/4/2021, and that it should be used by 1/8/2022. I don't use the Trimix every day, and I don't want to waste it. Ideas?

cesces profile image
cesces in reply to Okay4now

Tall Allen said something about freezing it.

MateoBeach profile image
MateoBeach in reply to Okay4now

If you are very careful not to contaminate the contents when you draw it up (alcohol wipe and new syringes) it can last three months in the fridge and still be effective. Discard if it becomes cloudy at all.

Okay4now profile image
Okay4now in reply to MateoBeach

Good to know - thank you !

That makes sense. Until reading this post, I didn't know Trimix was freezable. Thanks

There was a medical school entrance exam where the students were asked to re-arrange the letters "pneis" to form the name of an important body part which is most useful when erect. Those that answered spine are now doctors...

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/01/2021 7:50 PM DST

timotur profile image
timotur in reply to j-o-h-n

Haha, got a chuckle out of that one!

cesces profile image
cesces in reply to timotur

Personally I think it's off topic spam that interferes with the serious purpose of this forum.

But some people seem to like that kind of filler

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