Quick primer on injection drugs:
Caverject (Alprostadil) is a one drug injection drug. It is usually prescribed in either 20mcg. or 40mcg strengths. This is usually 20 or 40mcg of the drug in 1 ml of sterile water. Most of the time, it will come in powder form and you have to add the sterile water to each vial to mix it. Not a big problem. Jeff and I are both proficient at that. Most patients begin with a 31 guage insulin syringe, 5/16 inch needle, and using .05ml or 5 insulin units measurement on the syringe of the Caverject. From there, it will probably take some adding or subtracting to the dose to find an ideal tradeoff between firm erection and less than 4 hours erection. Note that the 40mcg Caverject is twice as strong as the 20mcg, hence it will take half as much as the 20mcg for the same effect--usually. It's better to start low and work up, and you can expect failures at times along the way. All part of the process. Most guys here report they are unable to tolerate the aching and pain of the drug, and move on to Trimix or Bimix.
Trimix is a 3 drug combination of papaverine, phentolamine and alprostadil, usually written as 30/1/20 or 30mg papaverine/1mg phentolamine/20mcg alprostadil. That's the information as it is written for the prescript
ion. As with the Caverject this 3 drug combo is mixed with 1ml of sterile water, but the difference is it has to be bought from a Compounding Pharmacy with a doctors prescript
ion. Cost is around $100 per 5ml vial, give or take ten bucks or so. Doseage usually begins at .10ml or 10 insulin units on the syringe for most first time trials. At 10 units per shot, you will get 50 shots from the 5ml. vial. So the cost is $2 per dose. From there, you add or subtract, again looking for the happy medium. There is a chance of a much reduced ache or pain from this mix, and it doesn't give as immediate and/or or strong erection in some cases, but it's advantage is the slight kick of the aplrostadil with the reduced ache. Refrigerated shelf life varies from 3 months to a year or more, depending on who you are listening to.
Bimix is a 2 drug combo, consisting of 30mg papaverine/1mg phentolamine per 1 ml of sterile water, again mixed by a Compounding Pharmacy. Cost is around $50 for a 5ml vial of it. The usual starting dosage is .10ml or 10 insulin units, and probably working up from that. The advantage of Bimix is the absence of Alprostadil, the tradeoff is it is less effective in a lot of cases, hence it takes more drug to produce the same results. I'd estimate most guys end up using on average a .2ml dose, as opposed to probably an average .05ml dose of Trimix. Like everything else, there's exceptions in both directions. I have to have .30ml/30 units of Bimix or .10ml/10units of Trimix for an equivilant response. Shelf life is the same 3 months to a year.
Injecting and the various techniques for best results is material for a post by itself, so if and when you ned to get further into it, let us know. Summerizing, Caverject is the strongest drug, with the best chance of successful erections, but with the cost of about
$10 to 20 per injection, increased chance of pain and aching enough to make you swear off it forever, and a chance for priaprisms lasting over 4 hours. Trimix is still strong, but you do have a chance of the same pain and aching, but probably at a reduced elvel, tolerable for most guys, considering they are geting a strong erection from it. Bimix is the least likely to produce pain, aching or priprisms, but it will probably take more and the erections may not be as firm as from the other 2. Again, it varies from man to man. In any of the 3 drugs, the first injections is made in the doctors office for instruction, usually after that you do them by yourself at home.
If you decide to push your doc for a prescript
ion, I've given you the info that is needed for the first prescript
ion , so he can write it,
Again it would be either 20mcg or 40mcg Alprostadil for CAverject per 1ml vial, common quantity is 5ml. Trimix would be 30mg Papaverine/1mg Phentlamine/20mcg Alprostadil per 1ml, quantity dispensed being 5ml. Bimix would be 30mg Papaverine/1mg Phentolamine, per 1 ml, dispensed in 5ml quantity. Some guys have different ratios of the drugs, but these are the 'standard' ratios that are recommended by most ed doctors. Hope this primer is helpful...
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing
open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
32 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN
Post Edited (James C.) : 2/16/2010 10:08:28 AM (GMT-7)