For years, people have used medication to improve blood vessel circulation in the penis; Trimix and ED medications are the most widely recognized.


These medications include papaverine, phentolamine, and prostaglandin E1 — Trimix is a mixture of all three of these drugs. Scientists have found that these drugs can induce a penile erection when injected directly into the penis.

Since 1983, these erectile dysfunction injections have gained acceptance across the globe. The FDA approved Prostaglandin E1 for treatment in 1995.

Medications like Viagra, Cialis, or Levitra do not work for every man dealing with erectile dysfunction. However, penile injection therapy is another viable option. The thought of injecting a needle into your penis may sound intimidating, but about 70 percent of men are highly satisfied with this therapy.

Trimix Dosage

We do the first injection here in our office so we can show you how to do it yourself at home. It also helps us determine the correct dose for your needs.

We typically start you off at 15 units. You may increase your dose by five units each time until you get the effect you want. If you are using 50 units and not getting the erection that you need, call us and we will prescribe you a stronger dose.

We allow a maximum of three injections per week, but you must wait 24 hours before taking another dose. And make sure you alternate between the sides of the penis for each injection.

However, injection therapy is not always a good long-term option for some men and that is when they may want to consider the penile implant.

Trimix Injection Site

Below are step-by-step instructions detailing how to properly use your penile injection at home without a doctor.

1. Tear open an alcohol swab and wipe the rubber top of the bottle to sterilize it.

2. Open the syringe carefully and remove the protective cover from the needle. It is important that you do NOT contaminate the needle with anything but the rubber bottle cap.

3. Push the needle through the rubber stopper, then flip the ampule (the glass container of medication) upside down. Pull on the plunger until you withdraw 1.0 cc of the medicine.

4. As you continue to hold the ampule upside down, inject whatever air remains in the syringe into the ampule.

5. Withdraw the fluid until there are no more air bubbles in the syringe and the correct amount of medication is in the syringe.

6. Pull the needle out of the ampule and lay the syringe on the edge of a flat surface. Make sure the needle hangs over the edge to keep it from touching anything.

7. Grasp the head of the penis between the index finger and thumb and gently pull the penis away from your body until the skin is taut.

8. When choosing an injection site, avoid any area where a vein is clearly visible. We recommend changing injection sites from left to right as well as up and down the shaft and back again to ensure that you do not develop scar tissue at one specific site.

9. Wipe the skin with an alcohol swab.

10. Pick up the syringe with the other hand and position your hand like you’re about to throw a dart.

11. Touch the point of the needle to the place you want to inject. (Only inject your penis while you’re sitting or standing.

12. Hold the syringe at a 90-degree angle and push lightly to penetrate the skin near the base of your penis.

13. Once you’ve poked through the skin, you will feel some resistance. Push firmly forward until a distinct “give” is felt. The needle should now be in the right place (within erectile bodies). The whole length of the needle should also be up to the hub.

14. Hold the syringe between your index and middle fingers and place a thumb on the plunger to inject the entire contents of the syringe. Then take the needle out of your penis.

15. Immediately apply pressure to your penis with your thumb and index finger for two to three minutes using the alcohol swab. Wait until there is no bleeding.

16. Place the needle in the disposal box.

ED Medication

Erectile dysfunction (ED) is when you can’t get or keep an erection that’s firm enough for sexual intercourse. It’s often caused by an underlying health problem.

The Urology Care Foundation estimates that this condition affects 30 million men in the United States. For some people, treatment with drugs may resolve their ED.

If you’re looking for options to treat your ED, check out the list below. Information like how to take these drugs and what the side effects are like can help you discuss drug treatment options with a doctor.

A quick look at erectile dysfunction medications:

  • alprostadil
  • avanafil
  • sildenafil
  • tadalafil
  • testosterone
  • vardenafil
  • vitamins and supplements

What erectile dysfunction medications are there?

There are many types of drugs used to treat ED. Each drug works differently, but they all improve the sexual activity by stimulating blood flow to the penis.

The most common ED drugs belong to a group known as phosphodiesterase type 5 (PDE5) inhibitors. They block certain enzyme activity that leads to ED.

If you have certain health conditions, it may not be safe for you to take ED drugs. For instance, if you have heart disease, your heart may not be healthy enough for sex.

Make sure you tell a doctor about any underlying health issues you might have and the medications you’re taking. This information can help a doctor decide which drug is best for you.


Alprostadil (Caverject, Edex, MUSE) comes as an injectable solution and as a penile suppository.

You’ll inject the solution directly into your penis 5 to 20 minutes before having sex. You can use it as needed up to three times per week. You should let at least 24 hours lapse between injections.

With MUSE (or Medicated Urethral System for Erections), the suppository should be administered 5 to 10 minutes before sex. It should not be used more than twice in a 24-hour period.

The more common side effects of this drug include pain in the penis and testicles, as well as burning in the urethra.


Avanafil (Stendra) is an oral drug and a PDE5 inhibitor. You should take it about 15 minutes before having sex. Do not take it more than once per day.

You should not use any PDE5 inhibitors if you’re also taking nitrates to treat heart disease. Examples of nitrates include isosorbide mononitrate (Monoket) and nitroglycerin (Nitrostat). Taking nitrates with avanafil can cause severely low blood pressure and even death.

The more common side effects of this drug include:

  • headache
  • flushing, or the reddening and warming of your face
  • stuffy or runny nose
  • back pain
  • sore throat


Sildenafil (Viagra) is also a PDE5 inhibitor. Viagra is only available as an oral tablet. You should take it only once per day, about 30 minutes to an hour before sex.

The more common side effects of this drug include:

  • headache
  • flushing
  • stuffy or runny nose
  • back pain
  • upset stomach
  • muscle aches
  • vision changes, like blurry vision and changes in how certain colors look


Tadalafil (Cialis) is an oral drug that increases blood flow throughout your body. You take this PDE5 inhibitor about 30 minutes before sex, no more than once per day. It may work for up to 36 hours.

The more common side effects of this drug include:

  • headache
  • flushing
  • stuffy or runny nose
  • back pain
  • upset stomach
  • pain in the limbs


Testosterone is the primary sex hormone in the male body. It plays many roles in overall health.

Testosterone levels naturally drop with age. This change can lead to ED and other issues, like:

  • fatigue
  • low sex drive
  • reduced sperm count
  • weight gain

Doctors sometimes prescribe testosterone to treat ED. In fact, PDE5 inhibitors are most effective when used alongside testosterone therapy in people with a testosterone deficiency. But the drug does come with risks.

Testosterone can increase your chance of a heart attack or stroke. Because of these risks, the Food and Drug Administration (FDA)Trusted Source says that only people who have low testosterone due to certain health issues should use testosterone.

A doctor will watch you closely if they prescribe testosterone. They’ll test the levels of testosterone in your body before and during your treatment with this drug. If your testosterone levels are too high, a doctor will stop your treatment or lower your dosage.

Side effects of testosterone may include:

  • acne
  • male breasts
  • prostate growth
  • fluid retention that causes swelling
  • moodiness
  • sleep apnea, or interrupted breathing during your sleep

Testosterone for ED comes in many forms.


Vardenafil (Levitra, Staxyn) is an oral drug and a PDE5 inhibitor. You take it as needed 60 minutes before sex. You can take this drug up to once per day, a doctor’s recommendation.

The more common side effects of this drug include:

  • headache
  • flushing
  • stuffy or runny nose
  • back pain
  • upset stomach
  • dizziness

Vitamins and supplements for ED

There are many vitamins and supplements on the market that claim to help ED. Some promise better sexual function as well as increased energy and vitality. But these supplements usually do not work. They may also be unsafe.

Some supplements that are marketed as “natural” may even contain drugs. ED supplements can still interact with other medications you’re taking. They may also cause side effects.

Talk with a doctor before trying any vitamins or supplements for ED.

Before you take erectile dysfunction medications

Not everyone with ED needs to take medications. If you think you have ED, see your primary care doctor. They’ll do a physical exam and request certain lab tests, as well as a complete medical and psychosocial history.

They may also refer you to a mental health professional who can help you manage performance anxiety or relationship issues related to your ED.

ED caused by underlying conditions

Your ED may be caused by untreated diabetes, high blood pressure, or another issue. Treating that condition first may improve your ED symptoms.

ED caused by medications

Other medications you’re taking may cause ED. These may include drugs used to treat:

  • high blood pressure
  • heart disease
  • depression
  • seizures
  • cancer

A doctor can also review any medications you’re currently taking and make some changes that could improve your ED.

ED caused by lifestyle choices

Lifestyle can sometimes contribute to ED. Adopting habits that promote overall health and well-being may help improve your symptoms. Try limiting or avoiding smoking if you smoke, maintaining a moderate weight, getting regular exercise as often as possible, and consuming alcohol on a limited basis.

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