Physicians Information


Currently phosphodiesterese Type 5 Inhibitors (PDE5 Inhibitor) are your most popular treatment for ED. PDE5 inhibitor side effects have been seen to increase disproportionately when dosage is increased.  At the point PDE5 inhibitors are eliminated as a viable option, of the remaining options, penile injections with vasodilators prevail as the most effective non surgical alternative.

Most Primary Care Physicians are not equipped or comfortable enough to encourage or train patients on injection therapy. And of course, many patients are not receptive to this alternative because they cannot self-inject the penis.

Trimix for Injection is Top ED Treatment

The fact remains, the most effective non-surgical treatment is penile injection where a compound of vasoactive dilators is injected directly into the corpora cavernosa.  “Injection therapy remains on the forefront of treatment options” (Nehra, A. Curr Urol Prp. 2001 Dec;2(6):468-72).

But Men With ED Still Don’t Want to Self-Inject

A typical injection can result in an erection sufficient for penetration in sexual intercourse of a duration commensurate with the size of the dose, usually between 30 minutes to one and one half hours, but not to exceed four hours. A common objection to penile injection from the patient is the fact the patient must inject a needle into his penis.

Combination Therapy

PDE5 inhibitors and vasodilators such as prostaglandin, the main ingredient in TriMix-gel, have also been used in what is termed combination therapy. That is, a patient uses PDE5s at the same time with urethral alprostadil. It is thought both treatments use separate medical actions or medical pathways.

Men With ED Can Still Avoid Self-Injection

Results have been reported in the medical literature. There are several references in the medical literature suggesting combination therapy may be appropriate when each treatment has failed individually.[i] The patient can still avoid self-injection.

Prostaglandin E/alprostadil, a principle active ingredient in TriMix-gel, uses the energy pathway known as cyclic adenosine monophosphate (cAMP).  PDE5 inhibitors such as Viagra®, Cialis® and Levitra® use the energy pathway known as cyclic guanosine monophosphate (cGMP). “Combination oral and non-oral (intracavernosal injection and intraurethral application) thereapies have been shown to salvage monotherapy” (Nehra A. Rev Urol. 2007 Summer;9(3):99-105).

For patients who have failed both of these therapies individually in monotherapy, it has been observed that this combination of PGE1 (intracavernosal injection or intraurethral application) and oral PDE5 inhibitors such as Viagra®, Cialis® or Levitra® may be a viable alternative.

Urethrally applied prostaglandin, when used in combination with PDE5 inhibitors, has been studied and reported to the medical literature, including but not limited to The Journal of Urology.

For the patients who don’t find Viagra type pills helpful, and wish to avoid penile injections, TriMix-gel is a good example of the value found in compounding pharmacy.

What’s New ?

TriMix-gel is planning to investigate TriMix-gel as a penile tissue rehabilitation agent. New trials will study repeated daily use of TriMix-gel to determine if use can raise the oxygen tension level of penile tissue.

A large percentage of patients suffering from co-morbidities such as diabetes, post radical prostatectomy, hypercholesterolemia/atherosclerosis or heart disease, demonstrate subnormal levels of oxygen in the penile tissue.[ii]

For instance, a post-radical prostatectomy patient often will lose the ability for nocturnal erections. Nocturnal erections are important to the health of penile tissue because erections occurring during sleep supply needed oxygen to the penile tissues[iii].  Nocturnal erections are thought to be a significant factor in overall penile health and therefore the ability to achieve and maintain an erection for sexual activity.

The trial will be targeted to confirm the rise of oxygen level in penile tissue and to determine if there is a rehabilitative effect on penile tissue for patients who may suffer from hyperglycemia, atherosclerosis, post radical prostatectomy, smoking history, hypertension, hypercholesterolemia, poor blood flow, and so forth.

[i] Sommer F, Engelmann U. Drugs Aging. 2004;21(9):555-64.

[ii] Padmanabhan P, McCullough A, J Androl. 2007 Mar-Apr;28(2):223-8. Epub 2006 Oct 4 at