Chemistry:Trimix (drug)

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Short description: Treatment for erectile dysfunction
Trimix
Combination of
Alprostadilprostaglandin
Papaverinevasodilator
Phentolaminealpha blocker
Clinical data
Pregnancy
category
  • US: D (Evidence of risk)
Routes of
administration
injection, intraurethral, topical
Legal status
Legal status
Identifiers
ChemSpider
  • none
  (verify)

Trimix is a prescription combination drug containing alprostadil, papaverine, and phentolamine. It is used to treat erectile dysfunction.[1][2][3]

Medical use

Available forms

Trimix is available in several different formulations, including a gel that can be used topically, a gel that can be administered into the urethra, and an injectable form that is administered via intracavernosal injection (an injection at either side, not the base, of the penis).[2][4][5][6]

Adverse effects

Adverse effects from injecting Trimix may include pain, fibrosis, hematoma, and priapism (a prolonged erection of the penis).[3]

Pharmacology

Trimix is a combination of three drugs: alprostadil, papaverine, and phentolamine. These medications work in combination to increase blood flow to the penis, resulting in an erection.[1][2][3] Alprostadil is a prostaglandin vasodilator that allows more blood to flow into the area by relaxing the smooth muscle in the blood vessels of the penis.[3][7] Papaverine is a smooth muscle relaxant that acts by increasing blood flow to the penis.[3][8] Phentolamine is an alpha blocker that relaxes blood vessel muscles, allowing more blood to flow to the penis.[3][9]

Society and culture

Availability

While the active drugs in Trimix have all been individually approved by the U.S. Food and Drug Administration (FDA), Trimix as a combination drug has not been approved by the FDA and is only available from compounding pharmacies.[1][3][10] Trimix is typically prepared by the compounding pharmacy in a sterile environment and then frozen.[11] The compound is stable for up to six months while stored frozen and for one month if stored refrigerated beginning at the time of manufacture.[12]

References

  1. 1.0 1.1 1.2 "Current status of intracavernosal injection therapy in erectile dysfunction". Expert Opinion on Pharmacotherapy 24 (8): 925–933. June 2023. doi:10.1080/14656566.2023.2204189. PMID 37078428. 
  2. 2.0 2.1 2.2 "Studies with Trimix gel in men who failed phosphodiesterase inhibitors". Journal of Urology 179 (4S): 431. May 2008. doi:10.1016/s0022-5347(08)61264-1. ISSN 0022-5347. https://www.auajournals.org/doi/pdf/10.1016/S0022-5347%2808%2961264-1. 
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 "Erectile dysfunction: a global review of intracavernosal injectables". World Journal of Urology 37 (6): 1007–1014. June 2019. doi:10.1007/s00345-019-02727-5. PMID 30895359. 
  4. "A prospective randomized study to optimize the dosage of trimix ingredients and compare its efficacy and safety with prostaglandin E1". International Journal of Impotence Research 17 (4): 346–353. 2005. doi:10.1038/sj.ijir.3901313. PMID 15772683. 
  5. "Preference for oral sildenafil or intracavernosal injection in patients with erectile dysfunction already using intracavernosal injection for > 1 year". BJU International 92 (3): 277–280. August 2003. doi:10.1046/j.1464-410X.2003.04324.x. PMID 12887483. 
  6. "Treatment program for erectile dysfunction in patients with cardiovascular diseases". The American Journal of Cardiology 93 (6): 689–693. March 2004. doi:10.1016/j.amjcard.2003.11.049. PMID 15019870. 
  7. "Alprostadil". StatPearls. Treasure Island (FL): StatPearls Publishing. 18 July 2022. https://www.ncbi.nlm.nih.gov/books/NBK542217/. Retrieved 24 April 2023. 
  8. "Papaverine topical gel for treatment of erectile dysfunction". The Journal of Urology 153 (2): 361–365. February 1995. doi:10.1097/00005392-199502000-00019. PMID 7815584. 
  9. "Intracavernous pharmacotherapy for erectile dysfunction". Endocrine 23 (2–3): 149–155. 2004. doi:10.1385/ENDO:23:2-3:149. PMID 15146094. "The vasoactive potential of phentolamine was discovered in 1978, with early animal studies suggesting effective blockade of the epinephrine pressor response and a smaller sympatholytic effect (63). An alpha-adrenergic antagonist with equal affinity for α1 and α2 receptors, monotherapy with phentolamine has been disappointing. It is hypothesized that although intracavernous injection of phentolamine increases corporal blood flow, a concurrent increase in norepinephrine prevent sinusoidal relaxation.". 
  10. "What to Know About Trimix Injections for Erectile Dysfunction". 28 January 2022. https://www.goodrx.com/conditions/erectile-dysfunction/trimix-injections-erectile-dysfunction. 
  11. "Alprostadil / Papaverine / Phentolamine 20mcg-30mg-1mg/ml Injection Solution (Tri-Mix) | Formulas | My Dashboard". Bayview Pharmacy. https://www.bayviewrx.com/formulas/rec7COK9TaoQTRYU4. 
  12. "Long-term stability of trimix: a three-drug injection used to treat erectile dysfunction". International Journal of Pharmaceutical Compounding 8 (3): 231–235. 2004. PMID 23924676. 

External links