Injection Prescription Questions

[LuisFernandez]

Hi,

Dr. Eid has prescribed me injections to help me with my erectile dysfunction. He prescribed me just PGE-1 (Edex, Caverject.)
Unfortunately, it seems that my insurance does not cover that medication (there's an exclusion.)

So i'm thinking of buying them out of my own pocket. First, it seems that each package contains 2 cartridges, which is about 200 dollars.

My starting dosage is 0.5mcg. I plan on having sex 2-3 times a week.

How many times can i use a single cartridge of edex? Do i have to buy the needles separately. I believe my doctor said very sternly to use .30 gauge needle. Do i re-use needles?

I tried asking my pharmacist about this, but they really had no idea. They said i can only use one cartridge one time. They said i can only use one needle one time.

Do i have to 'reconstitute' the medication? I'm just very confused. If i can only use the cartridge one time and two cartridge is $200 then that's way too expensive.

Additionally, I have Peyronie's. Has anyone injected after being diagnosed with Peyronie's? Did it help improve/restore their girth?

Thanks!

[flyingduck2019]

The first thing I would do is go back to your URO and explain that your insurance won't help with your RX. Ask if there is an alternative RX that you can use.

[notaes]

Injection Prescription Questions

I used Trimix for several years before getting my implant. My insurance did NOT cover any of my prescription medicine. It was expensive sex but worth it. I do not know of anyone whose insurance covered the trimix injections. This is strictly out of pocket medication.

[LuisFernandez]

Thanks. I'm still going to double check with my insurance and doctor. Let's assume i'll have to pay for it for now.

However, my main question is how many doses per box can i use? If i can only use it twice for 200$ then i think it's strictly out of the question.

It seems i should be able to use it more than twice based on my dosage - but I'm not sure.

[LuisFernandez]

So one thing that Dr. Eid mentioned is to find a compounding pharmacy in which i can buy alprostadil (PGE1) by itself.
I live in California. I called a couple compounding pharmacies but none seem to offer just caverject/edex by itself because "it's commercially available."

I've been doing some research here on old Franktalk threads.

search.php?keywords=alprostadil+pharmacy+mono

It seems that there are pharmacies that offer PGE1 as a mono-mix at the fraction of the price. I'm still trying to wrap my head around dosage. The document Dr. Eid gave me is a little hard to read. The only pharmacy i found recently on Franktalk is in Florida and does not seem to ship outside of Florida.

Here's a picture of the dosage information from the paper the Dr. gave me: https://imgur.com/4x7PXPI

Would really love some help from someone more experienced in getting a mono-mix prescription filled, specially in California. Will keep digging and will be calling a ton of compounding pharmacies until i find one that can help me.

Worse case scenario, looks like i'll be shelling out ~1k / month just to have a good sex life with EDEX

[bldoink]

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. Any advice found on an internet forum is likely worth what you paid for it, or worse. Always ask your doctor and follow his/her instructions.
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I use the FL pharmacy that only ships within the State for my mono-mix. It works out to be very cheap per dose. I have talked to a couple of the national shippers that ship mono-mix nationwide but I don't recall which ones they were. They weren't as cheap as my pharmacy so I didn't look into it any further at the time. I believe one of them was in Florida and their mix was also marketed by one the the internet men's clinics. So they are out there but definitely not as common as those doing tri-mix, etc. Keep calling around.

You don't ask for compounded Edex or Caverject at the pharmacy. You ask for alprostadil Mono-mix. I had my doctor write a script based on Edex but much stronger so I could get more doses per script order. I keep it frozen. The Edex in it's original form should probably be refrigerated but it does seem to have a long shelf life in it's un-reconstituted form. The compounded mono-mix will need to be kept frozen.

The Edex has to be reconstituted but it's all together in a cartridge you just mix by pushing a plunger. It's foolproof and it's their own proprietary system, as is the Caverject brand. Justifies the crazy price I guess. The compounded mono-mix will come already mixed which is why freezing it is necessary. reconstituted alprostadil has a very short shelf life when not frozen. It seems many of the compounding pharmacies use some sort pre-set of pre-mixed tri-mix concoctions which limits their ability to make custom mixes such as a mono-mix.

If I'm correctly reading the image you linked, the doctor prescribed you an Edex 20 (or compounded equivalent) and directed you to start with half of it, disposing of the unused remainder of the cartridge. That would indicate he is starting you at 10mcg of alprostadil.

The Edex cartridges come with 29 gauge 1/2" non-reusable needles that are proprietary to the cartridge type. I use more conventional U-100 insulin syringes that are 31G X 5/16. You'll have to figure out what size works best for you. I think the most commonly used sizes are the U-100 31G X 5/16" and the 30G X 1/2". Depending on your State of residence you may or may not need a script to buy syringes. They are cheap.

You are to only use the Edex cartridge one time. Yeah, disposing of the unused portion of the cartridge seems wasteful but you're not supposed to reuse the cartridge or save it. This topic has has been discussed previously and I've been known to violate the strict prohibition against saving part of a cartridge but with great caution and care and I won't recommend the practice. If you search the forum you should be able to find the relevant threads. If you were to violate the instructions on the Edex insert and ignore both the pharmacist and your doctors orders, you would need to purchase some of the small insulin U-100 syringes previously described. You could theoretically mix the Edex cartridge as directed and then carefully, to maintain sterility, decant the Edex vial into your previously purchased U-100 insulin syringes, freezing the remainder if not immediately used. You do not reuse the Edex cartridges or needles. I can pretty easily get 2 doses out of an Edex 40. You'll have to figure out your dose first.

PS: I wrote this sometime yesterday evening but I fell asleep on the couch before I could post it. We just got back yesterday afternoon from a funeral in Arlington and my tiredness snuck up and hit me like a hammer. I'm not proofing this now as I can't see clearly yet.

Oh yeah, as it's now Christmas, A Ho, Ho, Ho and Merry Christmas. May God grant you success in your journey to a great resolution for your ED.

[LuisFernandez]

Hi bldoink,

Thanks so much for his this very helpful information. I think my mistake was in asking for edex and caverject specifically. I will call around and ask for alpostradil monomix instead. I’ll start my search when things open back up after Christmas. I’ll post my findings here. Thanks again. Sorry for your loss. And have a good Christmas!

[Stew52]

I had to switch to TriMix and MonoMix (PGE) after Caverject (20mcg) when I went to Medicare in the US as no boner treatments were covered. Under my previous private insurance Caverject was reasonable but went sky high after (as you found) I had to switch. SO I went to TriMix/MonoMix via a compounding lab which is quite reasonable. Last batch was 10ml of 60mcg/ml PGE for $195. At ~0.25/dose(15mcg) that is 40 doses which is about $5/dose. Plus the syringe. Cheaper than pills.

Caverject has dry crystalline PGE inside the tube and when manipulated per instructions brings that together with contained bacteriostatic water to make the mix which you gently shake and then use. You do not need to use the whole 20mcg. It feels like a 30 gauge needle but I could never find out for sure. If you have a tough spot, a 30 ga may bend. I still have some leftover Caverjects and they are great for traveling as you do not need to keep it cold.

I would NOT reuse a partially used tube/syringe. The needle can be contaminated and introduce contamination directly into your bloodstream. You just have to find a cheaper source.

Add PS: there are two types of compounding pharmacies - sterile and non-sterile. Since this shot goes inside you, especially your bloodstream, you need a sterile lab.

[LuisFernandez]

Thanks to everyone for the help. I have a bit of an update.

So, i was able to find a pharmacy that supplies PGE1 as a mono-mix. They're called empower pharmacy in Texas: https://www.empowerpharmacy.com/drugs/p ... -injection

I am very happy with them so far. My doctor sent over the prescription and a few days later they gave me a call to say that it was ready. They even communicated behind the scenes with the doctor to verify dosage and syringe gauge.

So, I will be receiving powder, a bacterium? solution, and syringes along with all the instructions. One vial of powder would create 100ml @ 10mcg/ml. The package only has one vial of powder. I'm getting a big needle to mix the solutions. After mixing i have to put in the fridge. I'm getting 31 gauge needles for injecting.

My dosage is 5mcg/ml, which means i get 20 doses per vial.

The cost per vial is $75, plus $10 shipping. VERY cost effective and *much* cheaper than Caverject/EDEX.

I'm now waiting for the package so i will probably have more questions and comments once i receive it.

[bldoink]

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 pay for it, or worse. Always ask your doctor and follow his/her advice.
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It sounds like progress. That's great!

I don't think you have to dilute the mix to the 10mcg per ml if you don't want to inject as much volume. If your dose is 5mcg, requiring 50 units at that concentration, then diluting it half as much would allow you to inject just 25 units, etc. My mix is at 80mcg per ml and I usually inject 14 units which I think works out to 11.2mcg, assuming my math is correct. Supplementing with a novelty cock ring allows me to use a bit less than I would have to use otherwise. I like being able to use smaller syringes, those of 3cc volume. They allow better plunger sensitivity which helps with determining correct needle placement.

I keep my mix frozen between uses. It lasts a long time kept frozen.

Good luck.