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Posted 8/5/2013 3:05 PM (GMT 0)

Here's a Trimix issue I haven't seen posted yet.

My urologist put me on trimix therapy for ED in March.  The optimal dosage for me leveled out at .3 ml, and I couldn't have been happier, as that translated to more than 16 doses from the 5cc prescription.  Trouble is, the vial was empty after 3.5cc.  When I called the pharmacy for a renewal, I pointed out the shortage, which they were at a loss to explain.  I thought maybe they wouldn't do this again when they realized I was logging my doses. Wrong.

The second prescription also ran out after 3.5cc, but by then the pharmacy (A) was closed down after a state inspection and the prescription was transferred to another pharmacy(B).  After that, the .3 doses failed to work, and I spent the next vial in a frustrated and nervous search for a working dose, which turned out to be .5, minimum.  This vial from pharmacy B ran out after 4cc of the prescribed 5cc.  I have a 2nd vial from pharmacy B, but I'm looking for a better result from pharmacy C, if I can find it.

My urologist pretty much told me I'm on my own with this problem.  If anyone has a suggestion, it will be appreciated.  Thanks for letting me rant.

Posted 8/5/2013 3:53 PM (GMT 0)
My husband is under the care of Dr. John Mulhall, who is one of the top ED doctors in the country. My husband gets his trimix from a pharmacy that Dr. Mulhall recommends and uses - they are trimix experts. They ship all over the country. The amount of trimix you receive will be accurate and it will be properly compounded. The pharmacy is called Pharmagen Laboratories in Stamford, CT. 800-798-7279.
Posted 8/5/2013 3:54 PM (GMT 0)

Welcome to HW. Seems you have gotten along pretty well so far.

You did not mention the area you live in, which may limit suggestions from members as to the pharmacies they use. I have two near me, but I don't know if they ship trimix.

As to quantity, the regulation of pharmacies is pretty strict, so I would hope that 5 is 5. My uro does 10ml prescriptions, and the pharmacy suggested doing it as 2 5ml vials for a number of good reasons.

Now, back to how many shots you get from a vial, I can see all sorts of opportunities to lose some of the liquid. My doc has me pull just a bit more than I need, then clear the air out of the needle after I change from the draw needle to the injection needle. With the tiny bit I use, that could be half the dose.

Posted 8/5/2013 4:40 PM (GMT 0)
Bluebird, thanks! I happen to live in CT, so that may be an option since trimix has to be shipped cold overnight in an insulated container.

142, I use a disposable 1cc needle for both draw and inject - the amount of loss can't be more than what's left in the needle shaft, less than a drop, couldn't account for 70% of a vial. I'm very suspicious of competitive businesses in a down economy, and several pharmacies in my area have been fined for various violations. Shorting injectable prescriptions probably happens all the time. Thanks for the welcome and your input.
Posted 8/5/2013 4:57 PM (GMT 0)
I live in Austin Tx and use "Peoples Pharmacy". I have been using them for over 3 years and have been satisfied with their product. As far as to why you had to increase the amount from .3 to .5 I suspect that may be the the drug combination may have changed.
Posted 8/5/2013 5:09 PM (GMT 0)
My syringes are also disposable. They come with a mounted 27 ga needle that I use to load the syringe, then I change it for a 30 ga to inject. So I always lose a visible amount. I am not much for being coordinated, so actually completeing the entire process at all is quite an accomplishment for me.

I guess I am very trusting of my pharmacy, but lining up some bottles that I had not used from the fridge that I keep for "show & tell" with new injection guys at my support group, they are all near identical (they make 10 ml then divide it into the two 5ml vials, so some variance would be expected). My guy there says they do ship, but for CT it would be a $60 - $75 charge because it must be kept cold. The prescription cost varies noticeably every month, as the material costs change.

Posted 8/5/2013 6:13 PM (GMT 0)
I'm sure most pharmacies are honest, and it seems you are fortunate. If we were talking about a half cc, I wouldn't mention it, but 1.5 is a bit much. Thanks for checking on the shipping. Within Ct it's about $20 for UPS overnight, including the insulated packing box & cold pack, so I think that's reasonable.

I think Ed has a point about the drug combination, and I'll ask the new pharmacy to confirm the prescription when he calls my dr.'s office.
Posted 8/5/2013 7:39 PM (GMT 0)
I have been to Pharmagen Laboratories because I live nearby. I am one of the few customers who picks up trimix in person - almost all of their trimix is shipped. I have become friendly with the pharmacist there, who knows everything that there is to know about trimix. This lab is totally professional. They do a huge volume of trimix and bimix business. The pharmacist showed me a huge bag from one of their freezers of hundreds of bottles of premixed trimix that they purchase, probably in a standard formula (I'm making an assumption here). I'm sure that they could compound any formula though. Once they purchase this bag (all the small bottles in it are the same lot number) they send out one bottle of trimix to be evaluated for accuracy, before they sell it. This bag then sells out within a few days. They keep records of everything.

Dr. Mulhall is a very famous ED doctor at Sloan Kettering in NY. His patients around the country get their trimix from this lab. If this lab was not completely accurate they would not be recommended by Dr. Mulhall.
I know that the lab is used by other urologists also. If you have any concerns ask to speak to the pharmacist there. He has been compounding trimix for many years and can answer any question you may have. I learned a lot from him.
Posted 8/5/2013 9:19 PM (GMT 0)
Bluebird, I'll give them a call. Thanks for being so helpful.
Posted 8/6/2013 2:15 PM (GMT 0)
Sam,

Welcome to our forum. It was questions about the use of Trimix that first brought me to HW 2 years ago last month, as it appears that is what also brought you here. My URO is a big believer in Dr Mulhall and follows his protocols for treating post RP ED. I use a very good compounding pharmacy here in Birmingham, AL and to my knowledge I have always gotten the full 5ml vial, but I have to admit I have not kept the kind of record you have. I use a double strength version of Trimix and not the standard dosage most use here. I have a serious venous leak issue that requires a larger amount for injection. Good luck going forward.

Terry

Posted 8/6/2013 2:53 PM (GMT 0)
Do hospital pharmacies compound or do they order from a Lab ? You might want to call a hospital by you.
Posted 8/6/2013 3:08 PM (GMT 0)
Donald,

From what I have been told some hospitals can do compounding but not for injectables like Trimix. Most major cities have at least one true compounding pharmacy and many can ship frozen overnight.

Terry

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