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.

Many Physicians and Patients Have Found this Helpful

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. https://www.ncbi.nlm.nih.gov/pubmed/12084233

Combination Therapy

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. https://www.ncbi.nlm.nih.gov/pubmed/11850734

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.

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. The patient can still avoid self-injection.

Physician Alternative for Viagra Failure

Currently phosphodiesterase Type 5 Inhibitors (PDE5 Inhibitor) are your most popular first line treatment for ED. PDE5 inhibitor side effects have been seen to increase disproportionately when dosage is increased. The truth persists, “Injection therapy remains on the forefront of treatment options” (Nehra, A. Curr Urol Prp. 2001 Dec;2(6):468-72).

Titration with trimix for injection can be challenging. Without making a recommendation, it has been noted most urologists experienced with TriMix-gel start patients on the higher doses if the patient is either an existing trimix injection patient or the patient failed on PDE5 inhibitors.

TriMix-gel gives the patient and physician one more alternative before facing the reality of self-injection. Dosage of course, is up to you. You can call 888-818-9770 for your questions. Select #2 for Physician’s Line.”





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.

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.  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.

Oral and non-oral combination therapy for erectile dysfunction 


Combination therapy for erectile dysfunction: where we are and what’s in the future


Extending the rationale of combination therapy to unresponsive erectile dysfunction https://www.ncbi.nlm.nih.gov/pubmed/18231616


Future options for combination therapy in the management of erectile dysfunction in older men.

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


Penile oxygen saturation in the flaccid and erect penis in men with and without erectile dysfunction

Padmanabhan P, McCullough A, J Androl. 2007 Mar-Apr;28(2):223-8. Epub 2006 Oct 4 at http://www.ncbi.nlm.nih.gov/pubmed/17021333?ordinalpos=16&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum