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Hello, I’m 66, married for 30 years next September. I have been dealing with my ED for at least the last 10 years, but it may have been longer. Married with children will do that to you I guess. My issues have been elections with my wife, but I have been okay with maintain an erection thru masturbation, so it could be worse. I have gone thru medical assessment with an MD, who is not a specialist in dealing with ED. I have been getting Tpelleting for the past several years. My regular MD wrote me a scrip for viagra, but I’m going with generic viagra trokes, which are a lot easier to manage. I did get a script for quad mix, which has been in the fridge for about 18 months. My wife is not too cool to the idea of having to take me to the ER even though I have the down Med to go with it. I have figured out the dosing, but she is so difficult to read for just when the moment is going to be right, I can’t really incorporate it. How long is that medications shelf life if it has been properly stored in the fridge?

Welcome to the forum.
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I'm not a medical professional of any kind. Anything I post is based on my own experiences, at best and hallucinations or delusions, at worst. Internet forum advice is likely worth what you paid for it, or worse. Always ask your doctor and follow his/her advice.
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I would get an new batch of mix. At 18 months refrigerated your mix has likely lost it's alprostadil (prostaglandin, PGE-1, same thing) potency, which is generally considered the most effective ingredient of the mix. However, I've used frozen alprostadil (mono-mix) that was over a year old and it seemed to have lost little potency. If you try to titrate (discover your correct dose) using the old mix it will have little value when getting a new batch, even if it proves safe and has some effectiveness. I say don't use it.

When you get a new mix you can be very conservative and try starting with a very low dose. If your doctor says to use 20 units, try 5 or 10. The only risk of using too low of a dose is no lift off. So experiment solo! Of course it depends on your wife and the relationship the two of you have. I did several solo injections (I don't recall the number now) before introducing my wife to the mix. That way there was no expectations, no pressure and no disappointment with failure. You will likely both be very happy with the results once you have your mix and dose figured out.

So, what is the mix the doctor wants to start you at? Ingredients and amounts of each? Why start with quad-mix? That seems unusual. I started on straight alprostadil. Since it works well for me I've stayed with it. Why complicate things with more drugs if not necessary. If it becomes necessary I won't hesitate to move to whatever mix is needed.

Most doctors start their patients on either tri-mix or mono-mix. If mono-mix it's usually in the form of Edex or Caverject which are proprietary versions of mono-mix in special cartridges. The proprietary versions tend to be expensive. I use a locally compounded version that is cheap and works for me. I think in the U.S., at least what I gather from posts to this forum, a weak tri-mix is the most common starting point.

Again, welcome to the forum and good luck.

Welcome to the forum i second the advice of getting new meds.

Get with your doctor be active in your treatment

Welcome to FrankTalk. I found a lot of information and support here. I expect you will too.

I’d recommend that you find a urologist with experience in treating ED. One who prescribes injectable meds for ED on a regular basis.

Starting with quadmix is very unusual. Quadmix is REALLY potent stuff and isn’t usually where you start. It would be a bit like starting hunting with an elephant rifle.

My urologist gave me a trial injection in his office. It was a smallish dose of Trimix and then we waited for a bit (10-15 mins or so) and he assessed how well it had worked. Then he gave me recommendations about how to adjust my dose going forward. My experience is pretty typical of what I have read here.

Let us know how you do as you go along.

Thank you all. I did get rid of the quad. I had a feeling it was too old. My issue is getting my wife to cooperate. Since we went thru a long dry spell in our marriage, my epiphany that brought us back together some 34 months ago has come with a price. She just has a lot of no go areas, because I guess she has a right to be set in her ways. However, she is willing to have intercourses with me provided I can get it up for a length of time to do it. The Cialis works great for solo, but won’t last long enough between the 2 of us. The doc who prescribed the quad is no longer practicing, but I still get my Tpellets from the practice. They just don’t have another practitioner to take his place. He was not urologist, to be honest, but was a PA that worked with one of the men’s health scams, New Male, that he felt was ripping off men with ED. I did try the blood plasma inject, which the head Doc (not a urologist) offered you my at cost. It was more uncomfortable then I was told to expect and I felt no benefit other then a few days worth of heavy flu systems. I wanted to ask of the injectable medications you have tried, is it possible to get one that wears off without the antidote injection. That would work perfect for me.

Thanks for sharing all of that. There is a lot to unpack for you and your wife as you move towards being more physically intimate and sexually active with one another.

The antidote shot that is sometimes prescribed with injectable ED medication is just a safety feature. It’s only to be used in case of an emergency, an erection lasting more than 4 hours which could cause damage to the penis. It’s not intended to be used each time, or even regularly. It’s like an airbag in a car. You have it because it’s the safe thing to have, not because you intend to use it.

You REALLY need to find a urologist in your area that has experience in ED and injectable medications to guide you. I’m happy to share my experience but I’m just a layman.

My experience with injectable ED medication is similar to many of the men here. When I want to have a firm erection that will last a while (an hour to an hour and a half in my case) I draw up the medication and inject it into the side of the shaft of my penis. Within 3 or 4 minutes I have an erection. Within 10 mins it’s at its maximum firmness and I’m able to function well for penetrating sex without worrying about my erection going away for the next hour+. Then as the medication wears off I’m at about half mast for another hour and have a chubby full flaccid cock for another hour or two after that.

I’ve been injecting for 5 or 6 years now and have NEVER had to use an antidote shot or take pseudoephedrine (over the counter cold medicine oral pills which can help reverse the effect).

I started on a medium sized dose of a weak formula of TriMix and my dose requirements have increased over the years. That is true for many of us here but not all. Some men have been on a very stable low dose for a long time. Every time I increased my dose it was as my doctor has taught me. Every time I needed a new formula strength it was written by my urologist.

There is a physician finder search function on this site. That might help turn up some names of MDs in your area. You could also search the posts for names of cities near you. That might turn up another member in your area that will have some ideas for MDs.

I’m going to hammer on this point one more time: you need to find a urologist who will help guide you to get the erections you want to be sexual with your wife again. There is a solution but you’ll need a good urologist to help you find it.

Thank you, GW. It is pretty obvious that I do need a referral to an experienced ED urologist. None showed up in the referral window that is near me, but I will pursue that for sure. I’m realizing I was not getting the proper medical advice, because the PA that I was seeing, was also using the quad mix and had to use the antidote every time that he used it. I far preferring not to have to do that and now I have a reason to seek proper medical treatment, because I don’t have to each time. The quad was clearly overkill, and what you shared is encouraging to me. I just want to share what time I have with my wife, I am a type 2 diabetic and have hypertension, but they are controlled.

Kahits wrote:.....I did get rid of the quad. I had a feeling it was too old.

That's good. Most guys freeze their mix but even frozen that was pretty old.

Kahits wrote: ....... However, she is willing to have intercourses with me provided I can get it up for a length of time to do it.

It sounds like you need to practice your injections solo until you get adept.

Kahits wrote:.. They just don’t have another practitioner to take his place.

Find a good Urologist that deals with injections if you can. Alternatively study up and become your own expert and get your General Practitioner/Primary Care Provider to write your scripts. That's what I do. You need to know what you're talking about though. See what are common starter mixes and doses and go from there. Always error to the conservative side. My first Uro gave me a script for Edex and told me to read the instructions in the package. There was some trial and error involved but I never had to go to the ER although I did think about it a couple of times.

Kahits wrote:. I wanted to ask of the injectable medications you have tried, is it possible to get one that wears off without the antidote injection. That would work perfect for me.

If you have the proper mix and dose, the meds should wear off without any use of antidote. I've never used one other than some oral Sudafed. For injections I've only used Edex and mono-mix alprostadil.

Here's a PDF from Wedgewood Pharmacy I think is fairly informative you might want to take a look at. I have no actual experience with the pharmacy:
http://www.wedgewoodpharmacy.com/uploads/ED%20Switching%20Guide.pdf

Edit to add: Look on the internet for compounding pharmacies near you or in the nearest metropolitan area. Call them and ask if they compound injection meds for ED. If they don't, ask them for the names of some that do. (Not all compounding pharmacies are licensed to compound injection meds.) When you find some that compound the meds ask them for a list of doctors (preferably urologists) that prescribe it. Then take that list and search for reviews on those doctors that are reasonably close to you.

Edit to add: Look on the internet for compounding pharmacies near you or in the nearest metropolitan area. Call them and ask if they compound injection meds for ED. If they don't, ask them for the names of some that do. (Not all compounding pharmacies are licensed to compound injection meds.) When you find some that compound the meds ask them for a list of doctors (preferably urologists) that prescribe it. Then take that list and search for reviews on those doctors that are reasonably close to you.

bldoink, Thank you for that. I was going to contact my regular doctor to get a referral for a local Uro who specializes in ED. My wife, who is an MD, commented all he will do is prescribe drugs. Works for me. I can get my other MD who does my Tpelleting to write anything, and I do have a local compounding pharmacy who did the quad and does my generic Cialis trokes. I’m sure they can do any of the mono meds. Just the idea of taking something that I can sleep on with or without sex, is all I ever wanted. The Tadalafil trokes are 40mg that I’m supposed to half before using, I am actually using without splitting. The compounding pharmacy said he could not make them any stronger then that. Anybody using a higher dosage then that?

Kahits wrote:.....I can get my other MD who does my Tpelleting to write anything, and I do have a local compounding pharmacy who did the quad and does my generic Cialis trokes. I’m sure they can do any of the mono meds. .... The Tadalafil trokes are 40mg that I’m supposed to half before using, I am actually using without splitting. The compounding pharmacy said he could not make them any stronger then that. Anybody using a higher dosage then that?

I'm a cancer survivor that was treated by having a radical robotic prostatectomy. I did not have ED prior to that surgery. So my ED history is different from yours and my experiences are not likely to mirror yours.

I have used Viagra and occasionally still do as a supplement. I use the 100mg pills with very minimal results erection wise. I've never used "trokes".

Edex, the proprietary mono-mix I used first comes in 10mcg, 20mcg and 40mcg cartridges. I think if I had Ed from other than a radical prostatectomy I'd start with a 10mcg cartridge and use half of one, as in 5mcg. You can translate that into a compounded mono-mix, which I've been using for years, in which case I'd get a mix at 40mcg per ml and use maybe 8 U-100 units on a a U-100 insulin syringe. I think that works out to 5mcg of alprostadil. Have your doctor wife check my math. Whatever the case, start out with a very small dose of alprostadil. You can always increase the dose and mix stringth. I use 8 (solo) to 14 (wife) units of a mono-mix of 80mcg pre ml of alprostadil but my ED is from a different cause than yours and without the meds I get nothing. You can start at whatever mix strength you want just make sure your starting dose of alprostadil is very low.

A few points to consider in no particular order of importance:

#1) Not all compounding pharmacies that sell or make tri-mix will do a mono-mix. I think many get their mixes partially pre-made so it would be difficult for them. Some just have preset mixes they offer and the docter has that list to choose from. Otherwise, I don't really know why but it is an issue with some. My mono-mix is just (bacteriostatic) saline and the alprostadil or PGE-1. My pharmacy makes whatever is prescribed. They only sell within Florida.

#2) Generally the more potent the mix concentration the cheaper the cost per dose. Most of the cost of the mix is in the labor, not the drugs.

#3) Alprostadil injections cause pain for some men. For some it's a deal breaker. For many others they initially have pain or soreness but it totally goes away or greatly diminishes with continued use. I initially had the soreness or pain but no longer, assuming I inject correctly. It can also be an issue with tri-mix that contains alprostadil.

#4) The strength of the alprostadil mix can affect the likelihood of pain. That's probably why Edex dilutes their cartridges in a full ml of saline. It's one of the reasons why I inject the meds very slowly over a minute or two. I depress the plunger is many short pulses. That seems to solve the pain issue.

#5) It probably goes without saying but the finer the needle the better, pain wise. I use 31 gauge 5/16 30 unit syringes. I find that the smaller syringe plunger makes it easier to determine plunger resistance. I determine if the needle is in the correct spot by plunger resistance. And the smaller the syringe volume the smaller the plunger. I use 5/16" syringes fully inserted + although many guys use 1/2".

#6)If it's painful or plunger resistance is hard your needle placement is wrong. You're either too shallow or too deep. Adjust your depth and try again. Sometimes I find I need to push the needle in too deep and then ease it back out a bit.

As I think you asked about my mono-mix that's how I wrote my response. However, I think pretty much everything I wrote would apply to tri-mix.

Don't forget my original disclaimer about not being a medical professional of any kind. Ask your doctor.