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Tri‑Mix is a compounded medication for erectile dysfunction (ED), combining three active ingredients: alprostadil, papaverine, and phentolamine. It is administered via intracavernosal injection (into the penis) and typically prepared by compounding pharmacies to tailor dosage per patient.

How it works & benefits:

• The components act together to increase blood flow to the penis, producing an erection within around 5–15 minutes, lasting up to an hour—though should not exceed 3 hours; persistent erection (priapism) is a medical emergency

Important:
Always consult a qualified healthcare professional before considering Tri‑Mix, especially in Pakistan—the pharmacy must follow sterile compounding standards, and dosing must be personalized under medical supervision.

What Are Penile Injections?

Men who do not get the expected results from oral ED medications may be candidates for penile injections. After being trained, men can draw up the medication in a syringe attached to a tiny insulin needle. Men inject the medication into the side of the penis, and they hold pressure for up to five minutes to prevent a bruise from forming. An erection usually results within a few minutes. There are several forms of penile injectables:

• Alprostadil (Caverject, Edex): Insurance sometimes covers alprostadil, but it is expensive. Approximately 15 to 50 percent of men complain of pain with injections. Approved and comes in a kit.
• Trimix (alprostadil, papaverine, and phentolamine combination): Trimix injections are stronger and there are fewer reports of pain compared with alprostadil alone. The efficacy and side-effects of Trimix vary depending on the dosage of each of the three ingredients.
• Bimix (papaverine and phentolamine): Bimix is very effective but has a higher incidence of priapism and fibrosis than alprostadil alone.
• Quadmix: (alprostadil, papaverine, phentolamine, atropine): Rarely used (Köhler, 2020)

Trimix, Bimix, and Quadmix are not F.D.A approved. The benefit is that they are cheaper than alprostadil, but they require a compounding pharmacy to prepare the prescription. Because of the higher incidence of side effects from Bimix and Quadmix, alprostadil alone and Trimix are usually the initial treatment choices. Alprostadil has a lower risk for priapism and fibrosis, while Trimix is lower cost and less likely to cause pain with injection (Bennarchik et al., 2010).