injection question

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Regular Member

Date Joined Dec 2009
Total Posts : 348
   Posted 1/17/2011 4:23 PM (GMT -6)   
I'm due to see my ed nurse on wednesday and will probably
have a first go at the injection (eek)

Some people on this site have mentioned that certain drugs give more pain than others
and some drugs are less sucsessful than others.
What should I be looking out for on the day, and is there any other advice people can give me?


Regular Member

Date Joined Dec 2008
Total Posts : 377
   Posted 1/17/2011 4:33 PM (GMT -6)   
trimix is very powerful and more painful than bimix. There is also caverject and edex injections, which I believe are less painful than trimix, but I don't know for sure, never used them because they are much more expensive than bimix or timix. Something like $25/ shot for caverject and edex versus a whole bottle of trimix for $90 that will give you multiple injections over a 3 month period, works out to about .75 a shot I believe depending on dosage. Others will comment shortly, that's the most I know.....
My age= 52 when this all happened.
PSA went from 1.9 to 2.85 in one year, biopsy ordered,
Second biopsy on 08/14/08 found 2/12 cores positive for CA on R side, 1 core=5%CA, other core=25% CA, Gleason score= 6 both cores,
Bilateral nerve sparing robotic surgery on 09/11/08, pathological stage T2A,
No signs of spread, organ confined,
5 0's in a row, still use trimix for ED

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 1/17/2011 4:45 PM (GMT -6)   
The drugs, in order of chance of painful side effects are:

1. Caverject or 100% Alprostadil

2. Trimix- a 3 part mixture of alprostadil, phentolamine and papaverine.

3. Bimix- a mixture of phentolamine and papaverine.

4. A category by itself is Muse, a pellet inserted into the mouth of the penis. Most guys who use it here report a noticed lack of successful erections, with a high dose cost.

Caverject is usually 20mcg or 40mcg strength dose. Thais is what most ED treatments want to start out with. It is very expensive (maybe in the $40 a shot range) and the most likely to produce pain and aching, usally described as severe. Also the most likely to produce erections over 4 hours.

Trimix contains (usually) alprostadil 20mcg/phentolamine 1mg/papaverine 30mg. Alprostadil in this formula is much reduced than when straight, and results in no or very little pain and/or aching when the dose is adjusted to the maximum effect to the least amount. There may still be some small amount of aching invloved, but nothing that can't be tolerated well, plus most guys report that it mostly goes away with repeated use. Trimix costs around $90 to $100 per 5ml vial, and depending one individual doseage, will give maybe 50 does. That's at .10 cc or ml, or 10 units on an insulin syringe. Cheap and effective.

Bimix contains the phentolamine and papaverine drug in the same strength, and usually is effective and well tolerated by most users. It may not be strong enough for satisfactory results with some guys who have severe damage to the veinous valves in the penis, but does eliminate the aching and/or pain. It is easy to adjust the strength to find a dose that is effective. Effective for all three types is a firm erection lasting an hour or so. Bimix costs around $55 a 5ml vial and usually the user will be using twice the amount (.2cc/ml or 20 units)as the trimix, so the cost is about equal.

As I said, most places want to start with the strongest and go down. I don't necessarily agreew ith that, as a bad first experience, with aching, pain or over 4 hour erection is a poor way to begin the injection process and will put lots of guys off. If it were me, I would try to get them to try the bimix first, then progress up from that, but that's something you and the doctors will need to discuss.

One thing to note, some insurance plans will pay for the CAverject, but won't pay for the bimix or trimix.

I hope this little primer is helpful. Good luck and let us know how it goes.

edited to correct type of Edex to Muse, thanks Jeff
James C. Age 63
Gonna Make Myself A Better Man
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 01/11-.09
ED-total-Bimix 30cc

Post Edited (James C.) : 1/19/2011 10:03:27 AM (GMT-7)

Regular Member

Date Joined Jan 2011
Total Posts : 126
   Posted 1/17/2011 6:28 PM (GMT -6)   
Hi Mike,
I am based in the UK and the common injection here is Caverject which is what i have been using for the last 3 years prior to my surgery for prostate removal and hope to start using it again soon. The injection here is a sealed unit with a dial to set the dosage, the maximum being 20 microgram and the minimum being 5.
When i started they injected me the first time in the hospital using 10 on the dial suggesting that if it worked we should go straight home and use it. In my case it was not enough so they suggested i experiment for myself and found using 15 or 20 both worked but it depended on mood, how horny we were and time available as well.
If our "enthusiasm" levels were high then it was 20 on the dial which suited our mood and needs and gave me a 3 hour erection but i got the typical ache that it gives you and i struggled to orgasm, but if i used 15 on the dial, the effect was not as long, an hour or so, but was more sensitive and i orgasmed earlier, so it comes down to what you want and need. A bonus for us was that very shortly after orgasm you can carry on again if you choose to as the erection does not go till the injection wears off,
Have fun experimenting, Bob.
Age 58
Prostate problems since early 40s
Ed since early 40s
April 2007 biopsy & all clear
July 2010 prostate swollen more, psa up to 5.6 August 6.7
September Biopsy again
October 7th diagnosed cancer, Gleason grade 6 at 10% mass
December 13th 2010 open radical proctatectomy
Pathology results came back Gleason grade 7 at 12% mass BUT clear margins
Catheter out Jan 5th 2011

Veteran Member

Date Joined Jul 2009
Total Posts : 504
   Posted 1/17/2011 6:28 PM (GMT -6)   
Hi Mike,

I have been using Trimix for about a yr now and I have never felt any pain so its on a case by case basis

The procedure you use is what will make it successful. Sounds simple but wash your hands and penis before you start, stay with your pre-shot plan and post shot plan, there are many posts here on why it is important to keep the medication from being flushed out by your bloodflow

See if the Dr has an auto-injector. It is important for a number of reasons. You do not see a needle enter your skin, much more accurate aim, adjustable depth, no jabbing, one hand operation, etc

Compound pharmacy prices vary greatly, I pay for a 5ml Trimix vial overnighted in ice package for $64. Needles are covered by my Ins co at my local pharmacy, $6 for 30 which lasts a few months, alcohol swabs are cheap at CVS I think $3 for 100

Once you get past the initial willies of injecting yourself you will be glad you did, its an amazing experience. I have my dosage dialing in for a 1.5 hr erection, hard as a plank of wood, works every single time.

Oh you may want to pick up this book, you will get some great ideas with this amazing erection on tap every time. 365 different positions

Regular Member

Date Joined Dec 2010
Total Posts : 99
   Posted 1/17/2011 9:37 PM (GMT -6)   

Hi Mike,

Don’t let the needles scare you off. I have used Trimix for about a year with very good results.

My only regret is that I didn’t start sooner.

Good Luck,


Age 53...51 when diagnosed.
February/09 PSA 11...GP discoverd during yearly physical...referred to Urologist
Biopsy found cancer, Gleason score of 6.
July 2009...Nerve-Sparing open radical prostatectomy.
Doing very well...only issue is ED and that is getting better.

Regular Member

Date Joined Dec 2009
Total Posts : 348
   Posted 1/18/2011 12:21 PM (GMT -6)   
Thanks everyone for the useful info.
I'll let you know how I get on...gulp

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 1/18/2011 2:03 PM (GMT -6)   
Here's some light reading for you, in the meantime... smilewinkgrin
James C. Age 63
Gonna Make Myself A Better Man
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 01/11-.09
ED-total-Bimix 30cc

Cajun Jeff
Veteran Member

Date Joined Mar 2009
Total Posts : 4119
   Posted 1/18/2011 9:49 PM (GMT -6)   
James C. I think you made an error in your first post.

" 4. A category by itself is Edex, a pellet inserted into the mouth of the penis. Most guys who use it here report a noticed lack of successful erections, with a high dose cost."

Muse should be in place of Edex.

Edex in fact is the same thing as Caverject. It comes in pre loaded syrenges. It is straight Alrpostadil, just like Caverject.

Just clarification.

Cajun jeff

Thanks, Jeff, I corrected my brain 'fade'

Post Edited By Moderator (James C.) : 1/19/2011 10:04:33 AM (GMT-7)

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2461
   Posted 1/18/2011 10:01 PM (GMT -6)   
I also have been using trimix for over a year. I started out with the .10 cc but that didn't do it. I increased the dosage to .20 and that was 80% successful. I have since settled on .25 which gives me an erection that lasts an hour to 1.5 hours.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18 months) undetectable
Latest PSA test (21 months) .005

Regular Member

Date Joined Nov 2009
Total Posts : 21
   Posted 1/18/2011 10:53 PM (GMT -6)   
Good evening,
I have been injecting off and on for about a 1 1/2 years now. Got scared off with too long an erection for a while but still going. I am using the caverject twin, forget the name and am down to .25 a dose for an erection that lasts long enough but not the 4 hour killer that has been mentioned. It's all trial and error. Just make sure you are injecting it into the right area---listen to your nurse--you will be fine. Relax, it happens never fail once you inject in the right place--the real issue is how long and if it hurts or not which is different for every person. Cheers, good luck and have fun--the most important part that sometimes get lost in all of this.
Initial PSA 4.7 retest 4.9
Biopsy January 2009, two cores 3+3=6 Gleason
Diagnosed Febuary 2009, age 47
open Surgery June 2009, radical, open, nerve sparing retropublic prostectomy
No positive margins and a favorable Gleason's grade of 3+3=6
PSA August 2009 .3
PSA November 2009 undetectable
PSA February 2010 undetectable
PSA June 2010 undetectable
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