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Caverject and Cialis combo - Anyone got recent experience?

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Posted 12/27/2014 10:40 PM (GMT 0)
I live in UK.
Last week, 5 months after RP I finally got an appointment at my local ED Clinic. There I was given 4 options. Vacuum pump, a gel (rub into glans or squirt into penis? don't know), MUSE, or Caverject injections. Bi-mix, tri-mix etc not available here in UK even privately.

I already bought a pump months ago and don't find it much fun, agreed with the specialist that the gel didn't sound like it had a lot to offer and didn't like the idea of the MUSE for vague reasons, that left the Caverject which he thought we should try there and then before I found 20 reasons why I might have better things to do for the next 6 years!!

He showed me how to mix the powder and liquid in the phial and I did the injection under his supervision. Dosage for the trial was 2.5 mgm which certainly had an effect (probably 60% erection? that lasted a total of around 45 mins then reduced in fits and starts over next hour or so) albeit with some unpleasant aching.

I have been recommended to try Cialis daily as well as using the Caverject which he thinks will likely be effective at, and therefore suggests I start at, 5mgm, though might need gradual increase to a max of 10mgm (if I need a bigger dose than this I have to return to clinic first).

I am feeling leery about starting Cialis AND using a larger amount of Caverject on the first occasion that I self inject at home but after 5 months I don't want to waste ANY opportunity either!

My question is does anyone have any thoughts, experience knowledge about combining the two drugs even at low doses?
Posted 12/28/2014 7:27 PM (GMT 0)
Prevail – IMO, for your first injection at home start with the same (or lower) 2.5 mgm dose used in your trial – and do not start the Cialis until after you see what the results are. I saw Dr. Mulhall for ED rehab and he recommended a lower dose (of Trimix) for my first at-home injection, because reduced anxiety in the home environment can result in better results than in the clinic. His mantra is start with a low dose and gradually increase as you dial in the dose that is right for you. Btw, he also is strictly against mixing injections and pills…but your doc is telling you otherwise.

Best of luck, hope you have “hard” times ahead -- Tigerfan
Posted 12/28/2014 11:47 PM (GMT 0)
The Cialis daily is for rehab, right? I'm assuming you won't get anything from it.

My doc told me to go ahead with the daily Cialis AND injections as needed. Not that I do this as often as I should because of thr Cialis expense.

I am one who has not had very much success- or as I like to say "close but no cigar" with injections of Trimix and zero success with Bimix. (at least it didn't ache!) But when I have been taking the 5 mg Cialis daily- or on occasion 20 mg Revatio(Sildenafil) because I can get it much cheaper- I have never noticed any difference one way or the other when I inject. Maybe there is some difference but if so it is too slight for me to notice. And there is zero response with the pills by themselves, since my surgery.

I think I have read where some others got too much response using the 2 together. But then again, I have heard of too much response when people use injections by themselves. But a safe way to cover it either way is just to sacrifice a couple of tries by starting with 1/2 the recommended dose or 1/2 the office dose, and work up from there. You can always take a higher dose later, but you can not get it back when you give too much.
Posted 12/29/2014 1:00 AM (GMT 0)
My uro is absolutely against mixing pills & shots. Suggested that I not call him if I had issues that came from such an experiment.
Message was received.

Trimix works great for me by itself. I have not experimented with bimix or caverject at all.
Posted 12/29/2014 6:08 AM (GMT 0)
I'm also in the UK.
I've not combined the injections with the pills but have with pills/Muse.
The reason being neither Muse or the Caverject gives me more than an 80% erection.
(The shaft is rock hard but not the head)
The Cialis presumably is a 5mg tab so you shouldn't really have an issue combining
what is essentially a maintenance dose with the injections but obviously ask that question at the ED clinic.

Cheers,
Mike
Posted 12/30/2014 12:45 PM (GMT 0)
SV 10,

Read my recent experience at www.healingwell.com/community/default.aspx?f=35&m=3275097

Good luck!
.
Posted 12/30/2014 9:52 PM (GMT 0)
Thanks you all for your replies, I appreciate it.

PSA3 - it was reading your recent experience that made me wonder about what I was being advised!! Especially as other posts, some time ago, suggest that the risk is the opposite - hence my confusion.

Spottydog, Billybob, - The Cialis is 5mg daily "rehab" "maintenance" dose, "to promote blood supply" rather than create erection which of course it never can do for me being sans nerve bundles.

Tigerfan - what you say makes a lot of sense re being more relaxed at home therefore possibly more effective. As frustrating as it may be I think I will do as you suggest - the idea of a visit to A&E with priapism is more than I dare think about!

In fact since posting I have spoken to my GP who has to prescribe and she is already twitching at the Cialis suggestion because of cost and wondering if Viagra wouldn't be as good.

I have tried to explain the concept of "penile rehab" and why Cialis is the drug of choice for this because of its different properties to Viagra, as told to me, but I don't think she was listening too closely, cost being everything these days in the NHS!

I now have to wait till middle of next week after she has has had contact with the ED Clinic. Only then will I learn whether or not she will agree to prescribe it.

Thanks again for your helpful advice, if I get any Cialis I now have some clearer thoughts about how I will take the next steps!!
Posted 12/31/2014 3:00 AM (GMT 0)
Please note that daily 5 mg- and for some even 2.5 mg Cialis can indeed produce strong erections in the man who has functioning erectile nerves. In fact, for some men without severe ED, with adequately functioning nerves, even a single dose of 2.5 or 5 mg can result in adequate erection. Although without these nerves, most likely even the maximum 20 mg dose will do nothing.

Because of it's long half life, the blood levels of daily Cialis build day by day. A single 20 mg dose peaks at about 320 micro gms/L, a single 5 mg dose at ~95 and a 10 mg dose(recommended starting dose for most men, non-RP at least) at about 170. The steady state blood level with 5 mg daily reaches- and stays near- about 160 after 5 days.

You can see that the steady state blood level with 5 mg daily is very close to the peak level a few hours after taking a single 10 mg, which is adequate for many non-RP men.

Still, for most- or at least many- of us after RP, at least until healing has occurred long after surgery for the lucky ones with successful nerve sparing where it does occur, no amount of Cialis will do anything. Some say it will help healing by some means or another, hence the daily use for rehab.

As for using Cialis and injections together, my surgeon said to do it, the daily dose plus injections. What about Mulhall? Doesn't he say to take daily Viagra ( don't know about Cialis) plus injections?

But keep in mind that though daily Cialis or Viagra seems to make no difference with me, and no difference with injections, there was little or no attempt to spare my nerves. If you have- now or later- functioning nerves, I guess it could make a difference.

EDIT: I just looked it up in Mulhall's book, and he does not recommend daily Cialis and injections, due to the long lasting effect of Cialis. But my doc did and who knows that may be based on newer info than what is in the book. It would probably also help to at least skip the Cialis on the day of injection. Or better yet- skip it the day before and the day of, or maybe the day before and then take it the day of injection but several hours after the injection has worn off.

Post Edited (BillyBob@388) : 12/30/2014 8:25:42 PM (GMT-7)

Posted 1/1/2015 10:44 PM (GMT 0)
Thank you BillyBob useful detail indeed.

I have been told by surgeon and ED clinic that neither Cialis or Viagra will ever have any impact with regard to producing an erection for me but the ED clinic have suggested the daily dose would be a positive thing with regard to increasing blood flow in the same way that it is for those who have had nerve sparing op but have delay in recovering erectile function.

I am not sure I can see how that works unless it is in conjunction with the use of a vac. pump daily and / or the caverject (less than daily of course!) but keep realising that after every contact I have with professionals I end up with more questions than I had before and they are all notoriously difficult to get clarification from being largely unavailable outside of an appt session !!!!
Posted 1/2/2015 5:56 AM (GMT 0)

Prevail SV10 said...
Thank you BillyBob useful detail indeed.

I have been told by surgeon and ED clinic that neither Cialis or Viagra will ever have any impact with regard to producing an erection for me but the ED clinic have suggested the daily dose would be a positive thing with regard to increasing blood flow in the same way that it is for those who have had nerve sparing op but have delay in recovering erectile function.

I am not sure I can see how that works unless it is in conjunction with the use of a vac. pump daily and / or the caverject (less than daily of course!) but keep realising that after every contact I have with professionals I end up with more questions than I had before and they are all notoriously difficult to get clarification from being largely unavailable outside of an appt session !!!!

I am starting a new thread about combining PDE5 inhibitor pills and injections. I have found out some info that I did not know!
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