first time Trimix user

[1969CevyC10]

Gentlemen, I am a first time Trimix user, I have previously been taking Edex 40 in pre-loaded syringes so there
was no question about mixing or loading a syringe. In the mail came 4 small bottles of Trimix which are marked
20MCG/2MG/30MG/ML. The script I have reads 20MCG/Phent2/Papav30MG 1ML. There were no syringes sent with
these so I assumed you are suppose to use a diabetic syringe and fill the syringe to the 20 mark. I did this but there
is over half the bottle still left after loading the syringe so I am assuming I am not doing this correctly. If I look on
the old Edex syringe that 2.0 mark is much much greater than the 20 mark on the diabetic syringe so can anyone
please tell me what I am not understanding and what I am doing wrong? I would really like to try the Trimix but
when I gave myself an injection of Trimix with what I loaded in the syringe last night it wanted to work but I could tell it just was not strong enough. Please help me understand this,,,,,,,,thank you so very much Gentlemen

[bldoink]

Gentlemen, I am a first time Trimix user, I have previously been taking Edex 40 in pre-loaded syringes so there was no question about mixing or loading a syringe. In the mail came 4 small bottles of Trimix which are marked 20MCG/2MG/30MG/ML. The script I have reads 20MCG/Phent2/Papav30MG 1ML. There were no syringes sent with these so I assumed you are suppose to use a diabetic syringe and fill the syringe to the 20 mark. I did this but there is over half the bottle still left after loading the syringe so I am assuming I am not doing this correctly. If I look on the old Edex syringe that 2.0 mark is much much greater than the 20 mark on the diabetic syringe so can anyone please tell me what I am not understanding and what I am doing wrong? I would really like to try the Trimix but when I gave myself an injection of Trimix with what I loaded in the syringe last night it wanted to work but I could tell it just was not strong enough. Please help me understand this,,,,,,,,thank you so very much Gentlemen

The Edex cartridges are 1ml of saline you mix in the cartridge with the dry alprostadil. It's intended as a one use cartridge with the potency of the cartridge roughly matched to your need. You are intended to use most of the cartridge and up to the full cartridge. I think they come in 10, 20 and 40 mcg of alprostadil per/ml cartridges, but all are still all 1ml. On the Edex cartridge I see 0.25, 0.50, 0.75 and 1.0. In U-100 insulin units that would equate to 25, 50, 75 and 100 units at 40mcg/ml.

I've never heard of tri-mix being dispensed in single dose bottles. I doubt it is intended as single doses. The 20 unit suggested dose will not be the whole bottle/vial. If they are 1ml bottles it would be 1/5 of the bottle or 5 doses per vial. If 2.5ml vials it would be 12.5 doses per vial. Of course that's at the 20 units per dose which appears to be insufficient. If you were getting unsatisfactory results with Edex 40 I'm surprised they gave you a tri-mix script with only 20mcg alprostdil/ml. I would have thought starting at a 40/2/30 mix would have been more appropriate. But then I'm no doctor.

If you haven't tried adding novelty/sex shop cock rings to the mix you should certainly give them a try. See the "Cock Ring" thread in the "Members Only" sub-forum.

With the tri-mix, you are not intended to use the full vial. You are intended to use the amount (dose) as directed by your doctor. You can often get several, or even more, doses per vial.

Most often you are given your dose instructions in units. These will be U-100 insulin units. These are to be measured in U-100 insulin syringes. There are also U-40 insulin syringes that are for veterinary use. Do not use U-40 veterinary syringes. There are 100 U-100 insulin units per milliliter. If you are intended to measure your dose in U-100 insulin syringes then your 20 units should get you 5 doses per ml. Not knowing the size of your vials I couldn't guess how many doses per vial. I get my mono-mix in ten 1ml vials. I very much like it in 1ml vials but I haven't heard of anyone else getting theirs that way. It seems to usually be in 5ml vials, but could be in 10ml vials or even 2.5ml vials. I'm wildly guessing your vials are the 0.25ml size.

I've heard of a few doctors that describe doses in milliliters rather than U-100 insulin units. I guess you can then use syringes marked in ml or just convert remembering that there are 100 U-100 insulin units per milliliter. In other words each numbered mark on the U-100 insulin syringe is that many hundreths of a ml. That was probably as clear as mud.


Tri-mix is a combination of 3 drugs including the alprostadil you're used to in Edex. The 3 drug combination is supposed to be synergistic, possibly allowing a smaller dose to achieve the desired result. (Synergistic: Two or more drugs produce a combined effect greater than the sum of their individual effects.)

Please note that I really suck at math. My computations are more likely wrong than correct. Base no decisions on my math. Have it double or triple checked by someone with a brain. That said, with your Edex 40 cartridges, assuming you were using the whole cartridge, you were getting the 40mcg of alprostadil or as your tri-mix is labled PGE or PGE1. (100 X .4 = 40mcg)

Your new tri-mix contains 20mcg/ml of alprostadil (PGE1). At 20 units of your tri-mix (at 20mcg/ml) I think that gives you (.2 X .2 = 4mcg). As for the alprostadil, at the recommended 20 unit dose with the tri-mix, you're taking 1/5 of the dose volume at 1/2 the strength. That's a lot less alprostadil. With the drastically reduced alprostadil but with the synergistic 3 drug combination all bets are off. You'll have to start titration all over again.

Do not expect to use a full vial of tri-mix as one dose!

You didn't mention what size your vials are. It should say somewhere.

Good luck.

[1969CevyC10]

Thank You for all your information, the vials are 1ml. The VA allows four injections/month and they sent
4 1ml bottles. My script reads "4 injections/month for ED", so I can only assume they are saying you get
4 bottles of Trimix per month and you get 4 injections, unless I am reading this wrong..... I am just wanting
to know what mark to use on what kind of syringe. Last night I used the 20 mark on an insulin syringe but it
was very ineffective and there is a lot of liquid left in the bottle, I am very confused. On a 3 ml syringe the
20 mark is much larger in liquid but the needle is also much larger so I am not sure which I should be using.
I know this is not all the difficult to figure out but there were no instructions sent with the vials.

[1969CevyC10]

If the 20 dose was not enough and there is liquid left in the bottle, could I not fill a syringe to the 40 mark to
get a more satisfactory result???

[bldoink]

If the 20 dose was not enough and there is liquid left in the bottle, could I not fill a syringe to the 40 mark to
get a more satisfactory result???

You could but that would be too big of a bump although you may end up there. You're in titration mode and you should bump up gradually so as to avoid a priapism and an ER visit. I think bumping in 5 unit jumps would be more commonly recomended. The doctor should have given you some directions on titrating to the proper dose. I'm betting you'll need a stronger mix before you're done.

As for syringes, in your case I think I'd suggest starting with U-100 insulin syringes of 1ml by 1/2" length by 29 or 30 gauge.

You may want to consider getting a tri-mix script and pharmacy outside of the VA. It doesn't really sound like you have the best doctor for this. From the right pharmacy and when you've found the best strength mix and dose, tri-mix can be very affordable in the civilian market.

Good luck.