Caverject Impulse or other injection question

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RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 11/4/2008 5:45 PM (GMT -6)   
Just went to Doc for 6 month PSA and thankful to receive a non-dectable.  The reason I am writing is to see if anyone knows or can direct me to info on injections.  The Doc gave me a prescription for Caverject Impulse, which I have since found out is temporarily not available.  The druggest seem to look at me as if I was from outer space as though this stuff has never been prescribed before.  I keep hearing talk about bimix, trimix, edex, etc..  Where do you find these?  Do they come via prescription?  Do you get them through your local druggest, or order in a brown box from a 3rd world country.  What is best? 
 
I know this place is the best place to come for info....thanks in advance.
 
RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.01 10/30/2008
 
 

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 11/4/2008 6:08 PM (GMT -6)   
You need to find a compounding pharmacy for the bimix and trimix -- one who mixes them up from the two or three basic ingredients. Your local druggist should be able to direct you to somewhere local -- depending on where you live! I don't know about the Caverject. but I'm sure someone else will....
Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week and 7-month PSAs: 0
Bimix injections working well 


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 11/4/2008 7:47 PM (GMT -6)   
Piano,
Thanks - I have been reading up on compounding pharmacies - I learn something new every day. What two drugs are most mixing? Are they mixed 50/50? What is the life expectancy after they are mixed? How expensive is all of this? Do you use a syring like those used by diabetics? Thanks RB

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 11/4/2008 10:12 PM (GMT -6)   
The main drugs are Papaverine and Phentolamine, mixed in a ratio that varies from 30/1 to 30/5 depending on who does the prescribing and compounding. I'm on bimix at a 30/3 ratio -- that is 30 parts of Papaverine to 3 parts of Phentolamine.

Trimix is similar except that a small amount of a third drug is added (Prostaglandin -- the Caverject ingredient). This can cause serious aching in some people.

The shelf life of both is supposedly three months refrigerated, but you can go beyond that. I believe the bimix doesn't really need refrigeration but I do it anyway.

Cost is about $2 to $5 or more per shot, including syringe and alcohol wipe. It depends greatly on how much you need to get results. A diabetic syringe is commonly used.

You'll get a lot more info using the "Search Site" button at the top this page -- the Google Custom search. I have tried the search function just below that button, but found that to be useless.

I have written extensively about my injection experiences here:
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week and 7-month PSAs: 0
Bimix injections working well 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 11/4/2008 10:18 PM (GMT -6)   
Below is a list of threads dealing with the subject and which will give you all the info and answers you're needing, plus lots more....lol

http://www.healingwell.com/community/default.aspx?f=35&m=897291
http://www.healingwell.com/community/default.aspx?f=35&m=1062508
http://www.healingwell.com/community/default.aspx?f=35&m=1012934&p=1&ord=d
http://www.healingwell.com/community/default.aspx?f=35&m=1066477
http://www.healingwell.com/community/default.aspx?f=35&m=1072323
http://www.healingwell.com/community/default.aspx?f=35&m=992063
http://www.healingwell.com/community/default.aspx?f=35&m=1110785
http://www.healingwell.com/community/default.aspx?f=35&m=1115024
http://www.healingwell.com/community/default.aspx?f=35&m=1017774
http://www.infertility-male.com/erectdys/injxn1.htm
http://www.medrehab.com/ICI_Impotence.php
James C.
Co-Moderator- Prostate Cancer Forum
Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
Present- 1 year: ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's: 3 mts-0, 6 mts.-0, 9 mts.-0.


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 11/4/2008 10:55 PM (GMT -6)   
Thanks so much James C & Piano! That is why this forum is so valuable. RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.01 10/30/2008

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 11/4/2008 11:04 PM (GMT -6)   
Good advice on looking at the bi-mix.  I did a little research on Caverject and found that what is in short supply is the Caverject Impulse Kit.  That is the prefilled syringe kit that is very very expensive.  I was told that you can still get the vials of Caverject quite easily. That is the brand alprostadil also known as prostaglandin.
 
I just wonder why some of this has been taken off the market.  Is there a problem?  a recall?  No one will give me a straight answer.
 
I am currently having some plaque problems.  One source suggested that my problems might be related to the Caverject (recall? shortage?).
 
Does anyone have any information on this?
PSA up to 4.7 July 2006 , bump noted during DRE
Biopsy 10/16/06
stage T2A  -  Psa 4.7
Gleason  4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion found
No continence problems
PSA 90 day (-.01)  , (6 month -.01) , (9 month +.02) , (1 year +.02) ( 18 months +.02)
ED still a problem, minor succces with bi-mix
plaque buildup due to injections 
 
 
 


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 11/5/2008 9:52 AM (GMT -6)   

I am surprised your urologist did not offer to give you an injection himself in the office to see how you would react to the Caverjet.  Many men, including me, had adverse reaction of severe aching to Caverjet.  Did your urologist give you a starting dose?  I guess I come from the belief we pay the doc a lot of money to treat us right and it sounds to me your urologist is not doing a good job of handling you through the ED phase.

 

Tamu


Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06, 6/25/07, 1/8/08
No more pads as of 1/13/07
Began injections in April '07
 


hb2006
Regular Member


Date Joined Nov 2008
Total Posts : 299
   Posted 11/23/2008 9:41 PM (GMT -6)   
The Caverject Impulse was taken off the market due to the FDA asking that the Impulse product be reformulated. It is supposed to be back in July, 2009. The dry powder Caverject is still available but you have to obtain the sterile water and syringes on your own, unless your pharmacy will sell them at the same time.

Edex Refill can be easily obtained in place of the Impulse product and is virtually the same drug but not as fancy in terms of mixing it.

I get the aching pain from both but am not sure what dose works best for me. So it's still trial and error. Both of these medications have worked great for me, outside the pain, two to three hour erections every time.

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 11/23/2008 10:45 PM (GMT -6)   
hb2006, that was my experience with Caverject, both Impulse 20mcg and powder 40mcg. Results were a 10, pain scale also near 7 or 8 at higher doses, and ineffective but still uncomfortable at lower doses.
James C.
Co-Moderator- Prostate Cancer Forum
Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
Present- 1 year: ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.


j one
New Member


Date Joined May 2010
Total Posts : 1
   Posted 5/12/2010 11:18 AM (GMT -6)   
I am new to the forum and have read numerous posts regarding BI and TRI mixes. Two questions: 1. I hear alot about PAIN, which I believe to be an individual experience. What is the main reason for the pain? 2. I also read that TRI and BI mixes are available through the VA, does anyone know for sure it is available through the Vets Admn?

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 5/12/2010 11:29 AM (GMT -6)   
Welcome to the Forum. Sorry you have to be here.

The reason why there is such a high report of pain and aching in the Trimix is the use of Alprostadil in it. That's the one that causes aching and pain in the reports. Bimix has none, so there's muc less problems with it reported. The brand name Caverject contains 100% alprostadil, which is why so many report problems with using the Caverject Impulse or the Caverject pwoder-water mixed- injectables. The usual scale of ache/pain is the most reports of it is from users of Caverject, then fewer reports of users of Trimix, as the alprostadil component is much stronger when used straight and weakened somewhat when used in the Trimix. Hope this makes sense. I can't answer any questions about VA procedures, sorry. As far as I know, there's only one guy here now who can tolerate Caverject (alprostadil) in straight single dose use. He, or others, may want to weigh in on this subject.
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 10 gms., margins clear
32 Months: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/12/2010 3:26 PM (GMT -6)   
Cajun Jeff, looks like your experitise and 1st hand experience is needed for this brother. Hope you spot it.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


male_sling_problems
Regular Member


Date Joined Nov 2009
Total Posts : 134
   Posted 5/12/2010 3:56 PM (GMT -6)   
Hello RB

I have used bimix very successfully. You will need good instructions from a urologist familiar with this special medicine or you can have big (sic) problems requiring a trip to the emergency room due to the 4 hour maximum thing. I suggest you start with low dosages and work up to the correct amount. Be certain to ask your doctor the procedures for using Sudafed and ice packs to reverse the erection if you use too much medicine.

My bimix is ordered from: Wedgewood Pharmacy
405 Heron Suite 200
Swedeboro, NJ 08085-1749
Phone: 800.331.8272

Wedgewood is a compounding pharmacy. You will need a doctor's prescription for this medicine.
The people at Wedgewood are very helpful and easy to order from.

Feel free to email me if I can be helpful.

Best regards,

John
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