Trimix (drug)

Trimix is a prescription combination drug containing alprostadil, papaverine, and phentolamine. It is used to treat erectile dysfunction.[1][2][3]

This article is about the erectile dysfunction drug. For the oxygen-nitrogen-helium gas mixture, see Trimix (breathing gas).
Trimix
Combination of
Alprostadilprostaglandin
Papaverinevasodilator
Phentolaminealpha blocker
Clinical data
Routes of
administration		injection, intraurethral, topical
Legal status
Legal status
Identifiers
ChemSpider
  • none
  (verify)

Medical use

Available forms

Trimix is available in several different formulations, including a gel that can be used topically, a gel that can be administered into the urethra, and an injectable form that is administered via intracavernosal injection (an injection at either side, not the base, of the penis).[2][4][5][6]

Adverse effects

Adverse effects from injecting Trimix may include pain, fibrosis, hematoma, and priapism (a prolonged erection of the penis).[3]

Pharmacology

Trimix is a combination of three drugs: alprostadil, papaverine, and phentolamine. These medications work in combination to increase blood flow to the penis, resulting in an erection.[1][2][3] Alprostadil is a prostaglandin vasodilator that allows more blood to flow into the area by relaxing the smooth muscle in the blood vessels of the penis.[3][7] Papaverine is a smooth muscle relaxant that acts by increasing blood flow to the penis.[3][8] Phentolamine is an alpha blocker that relaxes blood vessel muscles, allowing more blood to flow to the penis.[3][9]

Society and culture

Availability

While the active drugs in Trimix have all been individually approved by the U.S. Food and Drug Administration (FDA), Trimix as a combination drug has not been approved by the FDA and is only available from compounding pharmacies.[1][3][10] Trimix is typically prepared by the compounding pharmacy in a sterile environment and then frozen.[11] The compound is stable for up to six months while stored frozen and for one month if stored refrigerated beginning at the time of manufacture.[12]

References
  1. Elena BW, Zachary M, Haritha P, Graham BA, Hellstorm J (April 2023). "Current status of intracavernosal injection therapy in erectile dysfunction". Expert Opinion on Pharmacotherapy: 1–9. doi:10.1080/14656566.2023.2204189. PMID 37078428.
  2. Marmar JL, Harkins TJ, Riordan J (May 2008). "Studies with Trimix gel in men who failed phosphodiesterase inhibitors". Journal of Urology. 179 (4S): 431. doi:10.1016/s0022-5347(08)61264-1. ISSN 0022-5347.
  3. Duncan C, Omran GJ, Teh J, Davis NF, Bolton DM, Lawrentschuk N (June 2019). "Erectile dysfunction: a global review of intracavernosal injectables". World Journal of Urology. 37 (6): 1007–1014. doi:10.1007/s00345-019-02727-5. PMID 30895359.
  4. Seyam R, Mohamed K, Akhras AA, Rashwan H (2005). "A prospective randomized study to optimize the dosage of trimix ingredients and compare its efficacy and safety with prostaglandin E1". International Journal of Impotence Research. 17 (4): 346–53. doi:10.1038/sj.ijir.3901313. PMID 15772683.
  5. Kim SC, Chang IH, Jeon HJ (August 2003). "Preference for oral sildenafil or intracavernosal injection in patients with erectile dysfunction already using intracavernosal injection for > 1 year". BJU International. 92 (3): 277–80. doi:10.1046/j.1464-410X.2003.04324.x. PMID 12887483. S2CID 41078747.
  6. Israilov S, Baniel J, Shmueli J, Niv E, Engelstein D, Segenreich E, Livne PM (March 2004). "Treatment program for erectile dysfunction in patients with cardiovascular diseases". The American Journal of Cardiology. 93 (6): 689–93. doi:10.1016/j.amjcard.2003.11.049. PMID 15019870.
  7. Jain, Ashish; Iqbal, Omar (18 July 2022). "Alprostadil". StatPearls Publishing. PMID 31194374. Retrieved 24 April 2023.
  8. Kim ED, el-Rashidy R, McVary KT (February 1995). "Papaverine topical gel for treatment of erectile dysfunction". The Journal of Urology. 153 (2): 361–5. doi:10.1097/00005392-199502000-00019. PMID 7815584.
  9. Bella AJ, Brock GB (2004). "Intracavernous pharmacotherapy for erectile dysfunction". Endocrine. 23 (2–3): 149–55. doi:10.1385/ENDO:23:2-3:149. PMID 15146094. The vasoactive potential of phentolamine was discovered in 1978, with early animal studies suggesting effective blockade of the epinephrine pressor response and a smaller sympatholytic effect (63). An alpha-adrenergic antagonist with equal affinity for α1 and α2 receptors, monotherapy with phentolamine has been disappointing. It is hypothesized that although intracavernous injection of phentolamine increases corporal blood flow, a concurrent increase in norepinephrine prevent sinusoidal relaxation.
  10. Billingsley, Alyssa (28 January 2022). "What to Know About Trimix Injections for Erectile Dysfunction". GoodRx Health. Retrieved 26 April 2023.
  11. "Alprostadil / Papaverine / Phentolamine 20mcg-30mg-1mg/ml Injection Solution (Tri-Mix) | Formulas | My Dashboard | Bayview Pharmacy". www.bayviewrx.com. Retrieved 2023-01-11.
  12. Trissel LA, Zhang Y (2004). "Long-term stability of trimix: a three-drug injection used to treat erectile dysfunction". International Journal of Pharmaceutical Compounding. 8 (3): 231–5. PMID 23924676.
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