Prostaglandin E1 alone vs trimix?

[Hero123]

What is the general idea behind trimix vs Prostaglandin E1 alone? In other words, what are advantages of Trimix vs Prostaglandin E1 ?
Was trimix introduced because Prostaglandin E1 alone lacks efficiency? Or because trimix requires lower volume to be injected? If so, what's the problem with higher volume?

[GoodWood]

Gross simplification below.

Generally monomix < BiMix < Trimix < Quadmix (concerning strength/power).

Start with the lowest power mix that gets you the results you need. Then go up if needed.

[bldoink]

I think what GoodWood said was fairly accurate. I will try to expand a bit. However, I'm not really sure how accurate I'll be so bear that in mind.

I don't actually know which individual drug came first but I don't think it was the alprostadil. I believe Prostaglandin E1 (PGE-1, Alprostadil) was the first drug approved (only?) for that use by the FDA. That approval was for the proprietary alprostadil mono-mix preparations of Edex and Caverject. I don't think any of the compounded mixes ever got specific approval, including the compounded mono-mix Edex substitute I use.

The alprostadil is generally considered the heavy hitter ingredient of tri-mix or quad-mix and is usually considered to be the least likely to cause damage although some later research indicates alprostadil may not be as benign as originally thought. Unfortunately, as it happens, while possibly the least likely to cause damage, alprostadil is the most likely to cause pain or soreness. Although that's not an issue with many men and the pain diminishes or goes away in other men with continued use (I'm one of those).

All of the drugs work a bit differently and there are several reasons for using bi-mix, tri-mix or quad-mix. Some men can't tolerate alprostadil at all. The bi-mix eliminates that ingredient. Some men find that by adding the other ingredients of tri-mix they can reduce the alprostadil to a level they can tolerate. Some men don't get satisfactory results when using alprostadil alone and find that adding the other ingredients gives them the desired results.

The ratios of a mix can be played with to fine tune the results for the individual. Quad mix can be an even stronger concoction for those that are no longer getting satisfaction with the other mixes. I believe the combination of the drugs in the combination mixes are thought to work synergistically making the combination more potent than just the added effects of the three. I believe the quad-mix can also be a concoction that adds a pain killer that allows the use of alpostadil for those that can't otherwise tolerate it.

It seems that many of the compounding pharmacies that sell injection drugs for ED don't offer a mono-mix and only sell a bi-mix, tri-mix or quad-mix, or possibly only a tri-mix. It also appears that some, possibly many, only sell certain pre-set mixes and don't do custom mixes to the doctors order. The prescribing doctor has to pick a mix from a list. I believe some pharmacies get pre-mixes that they just add saline or bacteriostatic water to. I don't really understand the reasons for all of that.

I'm still using an alprostadil mono-mix as I've learned to work around and tolerate any pain or discomfort of alprostadil, it may be the least likely to cause damage, it works well for me, and I figure why add more drugs than necessary. If it didn't work for me I'd use whatever worked. If my situation changes I'll try something else.

Wedgewood Pharmacy, a pharmacy I have no experience with, has a pamphlet as a PDF document that explains the mix ingredients fairly well which can be found here:

http://www.wedgewoodpharmacy.com/uploads/ED%20Switching%20Guide.pdf

Bear in mind that I suspect I've presented some inaccurate information. So salt is in order. If someone would be so kind to correct any inaccuracies I'll correct this post.

[frwmw1]

The alprostadil is generally considered the heavy hitter ingredient of tri-mix or quad-mix and is usually considered to be the least likely to cause damage although some later research indicates alprostadil may not be as benign as originally thought.

Where can I find more info on the effects of each ingredient? My mix doesn't contain alprostadil, but it contains papaverine, which I understand is the worst ingredient.

[Hero123]

I think what GoodWood said was fairly accurate. I will try to expand a bit. However, I'm not really sure how accurate I'll be so bear that in mind.

I don't actually know which individual drug came first but I don't think it was the alprostadil. I believe Prostaglandin E1 (PGE-1, Alprostadil) was the first drug approved (only?) for that use by the FDA. That approval was for the proprietary alprostadil mono-mix preparations of Edex and Caverject. I don't think any of the compounded mixes ever got specific approval, including the compounded mono-mix Edex substitute I use.

The alprostadil is generally considered the heavy hitter ingredient of tri-mix or quad-mix and is usually considered to be the least likely to cause damage although some later research indicates alprostadil may not be as benign as originally thought. Unfortunately, as it happens, while possibly the least likely to cause damage, alprostadil is the most likely to cause pain or soreness. Although that's not an issue with many men and the pain diminishes or goes away in other men with continued use (I'm one of those).

All of the drugs work a bit differently and there are several reasons for using bi-mix, tri-mix or quad-mix. Some men can't tolerate alprostadil at all. The bi-mix eliminates that ingredient. Some men find that by adding the other ingredients of tri-mix they can reduce the alprostadil to a level they can tolerate. Some men don't get satisfactory results when using alprostadil alone and find that adding the other ingredients gives them the desired results.

The ratios of a mix can be played with to fine tune the results for the individual. Quad mix can be an even stronger concoction for those that are no longer getting satisfaction with the other mixes. I believe the combination of the drugs in the combination mixes are thought to work synergistically making the combination more potent than just the added effects of the three. I believe the quad-mix can also be a concoction that adds a pain killer that allows the use of alpostadil for those that can't otherwise tolerate it.

It seems that many of the compounding pharmacies that sell injection drugs for ED don't offer a mono-mix and only sell a bi-mix, tri-mix or quad-mix, or possibly only a tri-mix. It also appears that some, possibly many, only sell certain pre-set mixes and don't do custom mixes to the doctors order. The prescribing doctor has to pick a mix from a list. I believe some pharmacies get pre-mixes that they just add saline or bacteriostatic water to. I don't really understand the reasons for all of that.

I'm still using an alprostadil mono-mix as I've learned to work around and tolerate any pain or discomfort of alprostadil, it may be the least likely to cause damage, it works well for me, and I figure why add more drugs than necessary. If it didn't work for me I'd use whatever worked. If my situation changes I'll try something else.

Wedgewood Pharmacy, a pharmacy I have no experience with, has a pamphlet as a PDF document that explains the mix ingredients fairly well which can be found here:

http://www.wedgewoodpharmacy.com/uploads/ED%20Switching%20Guide.pdf

Bear in mind that I suspect I've presented some inaccurate information. So salt is in order. If someone would be so kind to correct any inaccuracies I'll correct this post.

Thank you for a detailed explanation. So it's was pain from PDE1 that prompted them to come up with Trimix and quadmix.

[bldoink]

Where can I find more info on the effects of each ingredient? My mix doesn't contain alprostadil, but it contains papaverine, which I understand is the worst ingredient.

I've been a bit busy of late or I would have dug some stuff up for you. Unfortunately, I did not save bookmarks when I was doing my "internet" research. It was mainly just doing Google searches and following links. Often times if you find a link on a study you will be able to follow links to other research.

Here's a copy of stuff from the Documents Worth Reading List found in the "General" sub-forum on this site to help you get started:

• Priapism - See Priapism listed under the Disease section
  ==============================================================================================
  
• Long-term stability of trimix: a three-drug injection used to treat erectile dysfunction.
  Trissel LA1, Zhang Y. An abstract: https://www.ncbi.nlm.nih.gov/pubmed/23924676
  ==============================================================================================
  
• Relation between Intracavernosal Dose of Prostaglandin Pge 1 and Mean Duration of Erection in Men with Different Underlying Causes of Erectile Dysfunction: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080498/
  ==============================================================================================
  
• Use of a visual analog scale to assess pain of injection with intracavernous injection therapy - An Abstract: https://www.ncbi.nlm.nih.gov/pubmed/16422875
  ==============================================================================================
  
• Penile fibrosis in intracavernosal prostaglandin E1 injection therapy for erectile dysfunction
  Chew, Stuckey, Earle, Dhaliwal and Keogh: https://www.nature.com/articles/3900296.pdf?origin=publication_detail
  ==============================================================================================
  
• INTRACAVERNOSAL INJECTIONS AND FIBROSIS: MYTH OR REALITY?
  Raanan Tal and John P. Mulhall: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1464-410X.2008.07738.x
  ==============================================================================================
  
• Clinical and sonographic assessment of the side effects of intracavernous injection of vasoactive substances
  Moemen MN, Hamed HA, Kamel II, Shamloul RM, Ghanem HM: https://www.nature.com/articles/3901194
  ==============================================================================================
  
• The substitution of Phentolamine with an equal
  amount of Chlopromazine as an alpha-blocker
  in vasoactive cocktails used for intracavernous
  injection therapy for the treatment of erectile
  dysfunction - An abstract -
  RA Uebel & AC Schmidt: https://www.tandfonline.com/doi/pdf/10.1080/20786204.2007.10873496
  ==============================================================================================

[bldoink]

Thank you for a detailed explanation. So it's was pain from PDE1 that prompted them to come up with Trimix and quadmix.

I don't really know but you may find this link entertaining and maybe even slightly informative. It's to a post on the site Life In The Fast Lane (litfl.com). I'm not endorsing the site and know little about it other than the linked text:

https://litfl.com/how-to-give-an-unforgettable-talk/

[Hero123]

Is the pain from PDE1 mostly during the PDE1-induced erection? Or does the pain usually last till after erection is over? For how long after?

My local doctor is convinced that PDE1 does not cause scaring, he insists that it's a very well studied and safe drug, while Papaverine alone does cause scarring. He says "that's why FDA doesn't approve it for penile injection". Is he right stating that PDE1 does not cause scaring?

If I understood this study correctly, it does cause scaring but chances of it much lower comparing to Papaverine. Please correct me if I'm wrong:

Penile fibrosis in intracavernosal prostaglandin E1 injection therapy for erectile dysfunction
Chew, Stuckey, Earle, Dhaliwal and Keogh: https://www.nature.com/articles/3900296.pdf?origin=publication_detail

[bldoink]

I can't correct you if you're wrong because my knowledge if based on the same type of studies you are now reading. It is my belief that PGE-1 is the least likely to cause scaring or fibrosis, based on those studies. However one of the last studies I read indicated PGE-1 may not be as benign as originally thought. That was one study. Even if there is risk with PGE-1 I believe it's less than the others. Your local doctor could well be 100% correct.

[Hero123]

Thank you.
Is the pain from PDE1 mostly during the PDE1-induced erection? Or does the pain usually last till after erection is over? For how long after?