Troche
Apomorphine / Sildenafil / Tadalafil / Vardenafil Troches
Quad-mix troche combining three PDE5 inhibitors with apomorphine dopamine agonist for maximum potency and comprehensive mechanism.
4, 8 or 12 troches per month
Starting at $69/mo
Sexual healthErectile dysfunctionInjection
Tri-Mix Injection
RxPrescription onlyInjected at the base of the penis · As needed, 10–15 min before · 0.2 mL · Sexual health · Erectile dysfunction · Injection
Starting at $179/mo
Papaverine, phentolamine and alprostadil (PGE1) injected into the side of the penis with a tiny needle. For men whom pills did not help, with an erection in 5 to 15 minutes.
Choose your plan
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Works in most men when pills fail
- Starts in 5 to 15 minutes
- Several strengths, titrated by your physician
Every plan includes
- Personalized, physician-guided plan
- Monthly, 3-month and 6-month plans
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
- Physician-guided care
- Ongoing, expert support
- 100% online
- Free, discreet shipping
What is Tri-Mix?
(tri-mix)
Three drugs that relax the blood vessels and smooth muscle of the penis directly. Because it acts locally, it works even when nerve or blood-flow problems block pills.
- How it is taken
- Injected at the base of the penis
- How often
- As needed, 10–15 min before
- Dose range
- 0.2 mL
- Form
- Sexual health · Erectile dysfunction · Injection
~80%+
of men respond to intracavernosal combinations in clinical series
Response depends on the cause of ED and on correct dose and technique.
How it works,
week by week.
Day 1
A physician reviews your history, why oral medicines did not work, and bleeding and blood disorders. You get training on technique and a written priapism plan.
First dose
Start at a low dose. Inject into the side of the shaft, avoiding the top (vessels) and bottom (urethra); press for 5 minutes.
Weeks 1-4
The dose is raised in small steps until the erection is firm and lasts under an hour. Alternate sides each time.
Month 1
Check-in: dose, technique, any bruising, pain or nodules.
Beyond
Regular reviews to watch for scarring and adjust the dose.
What you may notice,
and when.
Fast response
an erection in 5 to 15 minutes
Reliable
works in most men who did not respond to pills
Titrated to you
dose adjusted in small steps
Safety plan
a written priapism rescue plan from day one
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
Safety first:
what to know before you start.
Important safety information and common side effects
Intracavernosal injections are highly effective but need training. The main risk is priapism: an erection lasting more than 4 hours is an emergency that can permanently damage the penis. If an erection lasts 2 hours, use your rescue plan (phenylephrine as directed, cold pack, climbing stairs); if it lasts 4 hours, go to the emergency room. Other risks are bruising, pain (more with alprostadil/PGE1), and scarring (fibrosis) with repeated use at the same spot. Do not use with sickle cell disease, multiple myeloma, leukemia, a penile implant, or on blood thinners without your physician's approval. Never use more than once in 24 hours or more than 3 times a week.
The research behind
trimix.
Trimix is an injection into the penis of alprostadil, papaverine and phentolamine. Alprostadil alone has the best trial evidence. The three-drug mix is used when alprostadil alone is not enough, and its evidence is small.
- Alprostadil94% of injections
In a six-month self-injection study of 683 men, alprostadil allowed sex after 94% of injections. In a dose-finding study of 201 men, the lowest effective dose was 2 mcg or less for 20% to 38% of men, depending on the cause of erectile dysfunction.
Alprostadil Study Group, Linet and Ogrinc, NEJM 1996 - Trimix vs alprostadil180 men
180 consecutive men were randomized to nine trimix dose groups, each also receiving alprostadil. At the smallest doses, rigidity, pain and satisfaction did not differ significantly from alprostadil, while alprostadil gave shorter erections and less priapism.
Seyam et al., International Journal of Impotence Research 2005 - Erections that last too longfirst-line options
The 2021 AUA/SMSNA guideline on acute ischemic priapism lists intracavernosal phenylephrine among several options, with aspiration, shunts and early prosthesis placement. It does not name a single first-line treatment.
Bivalacqua et al., Journal of Urology 2021
What the studies found
- Alprostadil alone allowed sex after 94% of injections in 683 men over six months (Alprostadil Study Group, NEJM 1996)
- All alprostadil doses beat placebo in 296 men, with higher response at higher doses (Alprostadil Study Group, NEJM 1996)
- At the smallest trimix doses, erection rigidity, pain and satisfaction matched alprostadil in 180 men (Seyam et al., International Journal of Impotence Research 2005)
Trial figures are for alprostadil and for men with erectile dysfunction, averaged across each group. Trimix as sold here is a compounded injection, and its three-drug mix has not been trialled as a single formula. Your physician sets your dose and teaches you the injection technique.
What this does not say
- No placebo-controlled randomized trial of the three-drug mix was found.
- A prolonged erection (priapism) is a medical emergency; the physician explains when to seek urgent care.
- Prolonged erections and penile fibrosis were recorded side effects in the alprostadil self-injection study.
The research
behind it.
Clinical series report high response rates with Tri-Mix, including after prostate surgery and in diabetes.
Priapism and scarring are the key risks; careful dose titration and technique keep them low.
Erections as a vital sign:
what the cohorts showWhy a change in erections is worth a heart check, what the numbers say, and what they do not.Read the researchPDE5 inhibitors:
what the trials showSildenafil, tadalafil and vardenafil compared, daily and as-needed use, and the rule on nitrates.Read the research
what the cohorts showWhy a change in erections is worth a heart check, what the numbers say, and what they do not.Read the researchPDE5 inhibitors:
what the trials showSildenafil, tadalafil and vardenafil compared, daily and as-needed use, and the rule on nitrates.Read the research
Getting started
takes a few minutes.
- 1
Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
- 2
Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
- 3
Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
Frequently asked questions
Contact supportHow do I use Tri-Mix Injection?
Injected at the base of the penis, as needed, 10–15 min before. The starting prescription is 20 units (0.2 mL) each time. Your physician sets your own dose and it is printed on your label.
What strengths does Tri-Mix Injection come in?
The pharmacy carries 4: 10 mcg / 30 mg / 0.5 mg/mL, 20 mcg / 30 mg / 1 mg/mL, 30 mcg / 30 mg / 2 mg/mL, 40 mcg / 30 mg / 2 mg/mL. Your physician chooses which one you get.
What exactly is in it?
Alprostadil, Papaverine, Phentolamine.
How much arrives in each shipment?
1 vial at the starting strength, shipped to your door from a licensed US pharmacy.
Who is Tri-Mix for?
Men with erectile dysfunction who did not respond to, or cannot take, PDE5 inhibitors, including after prostate cancer treatment.
Does the injection hurt?
The needle is the same tiny insulin needle used for diabetes; most men feel a brief pinch. Alprostadil (PGE1) can cause an ache afterwards, which is why Bi-Mix exists.
How fast does it work?
Usually within 5 to 15 minutes, and it does not require arousal to start, although arousal helps.
What do I do if the erection will not go down?
At 2 hours, follow your rescue plan. At 4 hours, go to the emergency room without waiting.
Tri-Mix educational content reviewed by our physician
Scott Nass, MD Doctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
More options
in this area.
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Combination of papaverine and phentolamine for intracavernosal injection. Vasodilator mix for erectile dysfunction. Priapism risk and rescue requirements.
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References
- 1.Intracavernosal injection therapy for erectile dysfunction: efficacy and safety of papaverine, phentolamine and prostaglandin E1 combinations. PubMed
- 2.AUA/SMSNA guideline on the diagnosis and management of priapism. J Urol, 2022
Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.