Question about Prostaglandin injection

Hello,

My urologist just prescribed me a prostaglandin injection -- he says
he does not prescribe Trimix because he finds prostaglandin safer. He
prescribed a 20ug or micrograms per mil (20ug/ml) in a 5ml bottle. The
prescription only said "as directed" and didn't indicate any dosage.
what would be an advisable starting point?

I have used Trimix before and liked it. Now, what should i expect
from prostaglandin alone, pain and effect-wise?

Also, where would be a good place to get an auto-injector?

Thanks very much ...

-- YoLisaMarie

Is your prostaglandin part of a Caverject system?  The Caverject is a self contained dry mix system.  Caverject is much more expensive than just straight prostaglandin (also called alprostadil).

My experience was significant discomfort using the prostaglandin, I used dosages of .10, .15 and .20 ml.  I finally went to the bi-mix that does not contain the prostaglandin. I had no discomfort, but the results were not as good.

I would be very interested to hear why your doctor considers the prostaglandin to be "safer" than the tri-mix.  Ask the question and get a substantive answer please.  He might be right, but I have never heard that before.

I expect you will get a faster, harder erection with straight prostaglandin.  If you do not have pain problems than it will be the right answer for you.

First, I'm surprised the doctor didn't do the first injection in the office, but maybe he felt you could handle it, as you were experienced with Trimix? Caverject is the commercial name of prostaglandin/alprostadil. I have used Caverject powdered that I had to reconstitute in bacteriostatic sterile water to make the solution. The powder I had was 20mcg strength. That is the amount of drug that was in 1ml of water. So that means that you actually have 5ml's of 20mcg strength prostaglandin/alprostadil. Most of the guys injecting prostaglandin/alprostadil here do so in much smaller amounts than users of Bimix or Trimix. A little goes a long way, as it is the strongest of the 3 types. For info purposes, Trimix is next strongest, as it contains prostagandlin/alprostadil. with the Bimix drugs. Bimix is weakest, containing no prostaglandin/alprostadil.

As to pain, it's almost a general experience with guys that the prostaglandin/alprostadil causes the most trouble with pain and aching. In my case, not necessarily pain as such, but a very painful aching, if you can understand what I mean. It really aches and spreads throughout the penis, testicles and abdomen while working just great to create a usually almost rock hard erection. The aching begins shortly after injection and increases as the time goes on. This is the drug that you are most likely to have the famous over 4 hour erections with.

You say you have used Trimix before. How did you react to it, as far as results of erection and aching? This will give you an idea of what the straight stuff may do for you. I used the 20mcg strength doses by drawing around .15cc/ml (that's the 15 mark on an insulin syringe), using a .5cc or 1cc insulin syringe with a 30 ga, 5/16 inch needle. Injection technique is the same as you would use for Trimix. Since you haven't tried it before, I'd start with a low dose and work myself up. Maybe inject .05cc/ml (5 on the barrel) the first time and see what happens. Slowly move up by 5's until you find your spot. Have some real Suafed pills available- not the generic or non-epe. stuff, to help reduce the erection if it goes over the 4 hour limit.

I'm curious- if you had done Trimix before, it must have been from a different doctor? I can't see why your current one would object to Trimix. There's really no statistical way to prove his point in the literature, that I am aware of. Maybe it's something he read or heard sometime in the past.

Make sure the druggist gives you the bacteriostatic water to go with the pwoder (If you indeed do get a powder in a vial) and some info on how much to add to reconstitute the vial, if powder. If it is already liquid, keep refrirgerated, not frozen. Shelf life says 3 months, but mine went 6 months or more. As long as you practice sterile drawing technique and the liquid doesn't turn milky it should he fine.

Some people say they take an over the counter pain reliever, such as ibuprufen or such. I don't know if it has much effect on it.

In another thread you said:
Thanks for a very nice and informative group. I am a 44 year old man who have had a persistent ED problem for a while -- i think it is psychological -- since I do get nocturnal erections (early morning wood) quiet often. I have used Trimix in the past and it worked. But since it finished, I have tried Viagra and Cialis, and they do work, but then the erection doesn't last for long...sometimes, I have to take about 50-100 mgs to have any effect. Thus, I am willing to try Trimix again.

Thus, I am wondering if anyone know of a good urologist around Philly area -- I need to see one, and would appreciate some leads, especially one that is sympathetic to and knowledgeable about Trimix, and willing to prescribe one.

It appears that you haven't had Prostate Cancer or any of its treatments hence you are not suffering any of the known side effects of the treatments on erectile dysfunction. Your case may be quite different, due to the nature of your problem.

In your post you say you have had PCa. When was your prostate treatment and what course did you take? Are you a zero now?

OK. understood now..Make sure you come back and let us know your experience with the prostgladin and the Trimix, if you do go to that later.

Well, just an update:

I picked up the prostaglandin medication this morning from Wedgwood pharmacy in Swedesboro, NJ.

It is a 20mcg strength in a 5ml bottle. I have ordered the B-D Autoinjector (http://www.bddiabetes.com/us/main.aspx?cat=2&id=421), hence opted for the 1cc, 31ga, 5/16 BD Insulin needle and syringes. I will pick up the autoinjector later this afternoon from Medicineshoppe pharmacy, and then experiment later this evening. I left a message for my doctor to suggest a dose. If I don't hear back from him, I will start low: probably between .20 and .30 on the insulin syringe and see what happens.

Thanks and will welcome other thoughts ..

rgds, LisaMarie

James,

thanks for all your useful and encouraging advice. I agree - gendered name is a bit disconcerting. I have made a change.

all the best -- from DannyP.

James, I called my doctor and he said that I should start with about .15ml and then adjust to my capability. So I think your advice given over here (https://www.healingwell.com/community/default.aspx?f=35&p=1&m=1022627) about beginning with lower doses and adjusting to individual tastes should be well taken.

I am yet to try it....maybe over the weekend. I will report back...

rgds, DannyP

Sorry you had such poor results. First, as tempting as it can be, I wouldn't recommend injecting twice in one evening. Every couple days is the usual interval. Now then, do you have a VED? (penis pump and rings?). My technique, which is used with success by a couple guys here is this: Using a pump, pump an erection that is about 30 to 40%. Just a good plump stage. While in this state, place the smallest ring you have on the penis, to hold the blood in. Do your regular injection- maybe .2cc ?, and very gently massage the sides of the penis with the ring on, to spread the drug throughout the cavernous cavity and into the tissue of the penis. Keep the ring on for 3 to 4 minutes, then remove and continue. a gentle stimulation until full erection may be required. The reason this is sometimes needed is the veinous valves in the penis, which holds the blood in and creates the erection, is weak or even non-working in your case, for a variety of possible reasons. This condition lets the drug out of the penis before it can be adsorbed. The partial erection opens up tissue to better adsorb the drug, and the ring holds it in long enough to adsorb it. Injecting in the 9 or 3 o'clock position in the area from 1 inch or so from the body, up to and inch or so behind the head of the penis will get the best results. Alternate sides with each injection.

Also, injecting and expecting an instant erection doesn't work that often. Gentle stimulation and mentally getting into the mood for lovemaking will keep it going and sustain it, especially until the drugs kick in good.

Hi,

Well, Jim, I took all the advice given, and was able to finally obtain a fairly usable wood by injecting about .65ml (and could even go up to .70) of prostaglandin. Even then, the erection lasted for just about an hour, and the pain was manageable. I'm wondering why this is the case since most people tend to do well with between .20 and .50 -- I want to notify my doctor since I am injecting right and massaging the sites and penis properly, unless 20mg is not strong enough for me...

thanks - Danny

James, I did follow with the pump and the ring. Ok...so my experience is not unique, and my tissues would need more relaxing before getting the right dosage. Whewww... did you also start with Prostaglandin alone or Trimix right away? Thanks - Danny