Hi Masterstern, Your experience is very familiar to me. I was using Caverject (PGE1), but it hurt so I got a prescription for Bimix, which is the same as Trimix without the PGE1. It worked fantastically well and did not hurt. After a couple of months I found that 1 cc per injection wasn't working as well as at the beginning, so I started bit by bit to increase the dose. After 3 months I couldn't really get a full erection even with 2 cc of Bimix. Even more upsetting, when I went back to Caverject, it didn't give me a full erection either. I was terrified my penis had been permanently injured. My urologist could not give me any explanation for the loss of effectiveness of Bimix/Trimix. He is exasperating.
Whenever he doesn't know how to advise me, he just tells me it must be psychological. It feels like he is telling me I have a demon. His nurse, a great guy, suggested I try Actis, an elastic band, about $20, lasts for years, (http://www.phoenix5.org/sexaids/other/actis.html). Once I found I was not able to use Bimix reliably, I also discovered that Caverject though less effective, didn't hurt so much anymore either—unexpected but very good for me. By using the Actis band along with Caverject, I would get a full erection. It helped to put the band on right away after injection, I felt that the medication was leaking out too fast and did not have a chance to work. I imagined that the band held it in. This may be just a bogus explanation, but seemed to be what was happening. I came to this conclusion because I am less likely to ultimately get a full erection if I have a partial erection when I inject and the erection goes away immediately after injection. But if I inject into a completely flaccid penis I am more likely to get a good erection in the end. I would appreciate hearing other men's interpretations if they have experienced something like this too.
After I got an erection using the Actis band, I would generally take if off to have sexual intercourse. Also I tried putting the band on and then injecting. This was not as successful; several times I got bad hematomas under the skin. So I would not recommend injecting with Actis on. I don't usually need the band now, and I am using less Caverject too. But if for any reason I don't get an erection from an injection of Caverject, I can use the band to get things going and can even use the band during intercourse to guarantee success. Actis is a very simple device, just a thin rubber hose held in a loop. Pull one end to tighten, pull the other to release. By your description, I think your experience is practically identical to mine, so I will guess you only need a little constriction. Under such circumstances, this device is perfect, easy to use, not at all like the rings used with vacuum pumps. The failure of Bimix/Trimix appears to be due to venous leak (veno-occlusive disease) induced by the phentolamine/papaverine which is in both of these medications.
Of course a change in the sensitivity of the smooth muscle in the penis to the medication is possible too. But these drugs are reported in the medical literature to be several times more likely to injure smooth muscle cells and cause fibrosis than PGE1 (Caverject, Edex, Muse). Many researchers suggested that PGE1 may actually protect from fibrosis and may even reverse fibrosis. So I thought Trimix would be safer than Bimix. Trimix is in fact more effective then Bimix so ordinarily you can use less, which should also help. Your experience suggests that PGE1 may not be protective enough for some of us. Other researchers suggest that PGE1 can also cause fibrosis, but when I looked at the studies, they merely showed correlations without good controls. The causal relationship could not be proved in any of the studies that I read. ED can of course be progressive, but the rapidity of failure (3 months) after starting injection with Bimix/Trimix that we both experienced suggests a more direct link to the medication. This is my theory. If you are interested I can give you references to the medical literature. Please write back and give me your thoughts. Especially write if you disagree. I am open to all the help and advice I can get.
Best of luck
Mark

Thanks Daniel and Ernest both, Currently I am using a trimix (papervine=300 mg, regitine=5 mg, alporostadil=40 mg). Ernest mentioned in his email that he uses trimix forlmula#5. I didnt even know there were different formulae for trimix.
Maybe one is more effectiv ethan the other. Reading Daniel's email it looks like caverject or edex works better if u can bear the pain/discomfort. Daniel l confirm if I interpreted it right. I have cpl of edex packages in house, which I may try. U think I can use the same amount as trimix injection or less? Also whats this band, is it different than a cock ring (which I got fr a website, and it didnt work very well. Tell me exactly how u use this band? U put it on, after u have injected the trimix or caverject, before u stimulate urself for an erection or after u have achieved an erection? And how do u know when is it tight enough (the band)?
One more question, my pharmacist (kaiser permanente) told me that trimix needs to be refrigerated and they can guarantee its effectiveness only for abt 9 days after it has been prepred? Whats ur experience as long as how long it stays effective after it was initially prepared?
Btw have u guys ever travelled with it, u know for vacations to another city or ona cruise? How did u carry it? In a termos bottle?
Thanks,
Masterstern

Hi MStern,

You are right, Trimix is unstable. Trimix is a mixture of papaverine, regitine and alprostadil (also called PGE1, short for prostaglandin E1). Alprostadil is the active ingredient in Caverject, Edex, and Muse. It is not stable in solution, so you must refrigerate it. Your medication may be getting too old. Or, as Ernest suggested, try a different formulation of Trimix. If fresh solution doesn’t fix the problem, try the Actis with either Trimix or Edex. Look at the web link I sent you; it shows a picture of the Actis band. Phoenix5 is not a commercial web site. It is a prostate cancer site that also gives good advice for ED.

To use the band, just slip the loop down to the base of your penis below where you injected and pull the end to draw it tight. For me, I just need it to be snug, not really very tight at all, but you will have to experiment. The Actis band is easy to adjust and for that reason it is ideal for this purpose. The "cock rings" on the other hand (I have never tried one) could be a pain in more ways than one. Draw the Actis pretty tight if you want; it won’t hurt. As your erection develops, loosen it as necessary until it is comfortable. What I hope will work for you too, is that once I get an erection, I can take it off completely. But I can also leave it on or easily put it back on if necessary. I got a free sample from my urologist’s nurse. Anyway, they are cheap so you are not out much money if you don’t like it. Seriously, for me even when I could not get a good erection with the maximum dose of Caverject (same stuff as Edex), just a little pressure from the band gave me a good
erection. If I leave it on too tight, the head of my penis becomes too engorged and it hurts, so I just back off a little.

If you decide to try Edex, the amount to use is dependent on the concentration. You said your Trimix contains 40 mg (milligrams) alprostadil. Based on the other ingredients, I think your Trimix is in 10 cc total volume. Please look again at the amount of alprostadil. 40 mg of alprostadil in a total of 10 cc (that is 4 mg in each cc) sounds way too high. Generally the highest dosage recommended for Caverject and for Edex is only about 20ug (micrograms) per injection. That is 200 times less. It should say 40ug (micrograms), then that would be a total of 4ug in each cc. If that is true, you could safely inject 5 ug of Edex. I have never used Edex. Does it come already disolved or as a dry powder? If it is a liquid it will become inactive like the Trimix does. The powders are pretty stable so you can freely travel with them. I use about 10 ug of Caverject (same stuff as Edex). 20 ug hurts more but does not cause problems. Be careful if you want to inject more than 10 ug at first if you
haven’t had a shot of Edex in the urologist’s office. If my conjecture above is correct, you have been injecting almost that much already. Then you can try more if it does not work well. Just increase the dosage a little and wait to see what happens before injecting more. There is perhaps a temptation to inject more without waiting. After all, she is waiting too. But that is not wise. In any case I believe you can safely inject 5 ug, but I am a molecular biologist, not a physician.
Mark

I don't know what formula Trimix I am on. The urologist just wrote down the three ingredients with no specific ratio for the quantities.

The band is called the Actis Venous flow controller device. The common term for it is a cock ring. You can read about it at phoenix5.org/sexaids/other/actis.html and there is also an web address there for the manufacturer where you can order it by mail.

I don't know about shelf life of Trimix. I've only had one prescription and that had an expiration date on the label which was two months from the prescription date. Maybe that's why it worked the third time I tried it but did not work the fourth time even with a larger dose. The fourth time (last time I tried) was a little less than 2 months after the compounding date.