Prescription for: ____________________________,
Rx: Intraurethral Trimix in syringe-catheter. Store at freezer temperatures.
Forty microliters (four small marks) comprises a 40 mg dose when used as described below and
contains the following:
Alprostadil, g Prazosin, g Papaverine, g
1000 200 400
Inactive ingredients: Lippogel, lidocaine
Indications for use: For the induction of erection
Contraindications: This product should not be used by those with known allergy or sensitivity
to its components. This product should not be used by men who have low blood pressure, or are
taking newly prescribed heart or blood pressure medication. The physician who prescribed the
heart or blood pressure medication should be consulted before using this product. This product
should not be used by men with urinary tract infections, any other cause of urethritis or urethral
stricture, or by men with a history of priapism in response to similar products.
Warnings: see package inserts or the Physicians Desk Register entries for the above
pharmaceuticals for complete warnings and side effect profiles and read the following:
1. May cause low blood pressure and fainting. Prior to use, make sure you are hydrated by
drinking plenty of water and eating some food. Do not operate a car or other dangerous
equipment within an hour of use. If you feel lightheaded, lie down immediately. Do not use in
combination with alcohol or any new prescription for the heart or blood pressure.
2. May cause urethral irritation. Do not use if you have a urinary tract infection or any other
cause of urethritis. If the degree of urethral irritation at the lowest dose is more than mildly
uncomfortable for you, do not go on to a higher dose.
3. This product is likely to cause some aching of the penis. If the degree of penile aching at the
lowest dose is more than mildly uncomfortable for you, do not go on to a higher dose.
4. If this product induces erection that lasts more than 4 hours without subsiding at all, go to the
nearest emergency room with this prescription to show the physician. Failure to seek treatment
for persistent erection may cause permanent penile damage and impotence.
Instructions for use: 1. Keep the product in the freezer in its wrapper until use. The product is
a creme at freezer and room temperature, but in a hot car, or in an airplane luggage compartment,
it may spill out.
2. The product is supplied in a 1 cc syringe with a round-tip catheter. Remove the applicator
from the pack and inspect it. Do not touch the tip with your fingers. The tip of the applicator
should contain a cloudy white creme. If some of the creme gets on your fingers, wash it off with
soap to prevent getting the creme in your eyes, nose or mouth which could be irritated by it. If
the creme is not visible within the tip, gently push the plunger until the catheter fills with the
crème all the way to the end. If the creme is discolored or has melted onto the wrapper, discard
immediately. The tip should be firmly attached to the syringe.
3. To check your sensitivity to this product, first urinate so the urethra is slightly wet. Gently
push on the syringe plunger until a small amount of the crème is extruded from the catheter and
still clinging to it. Open the tip of the penis by gently squeezing it top-to-bottom. Insert the tip
of the applicator at least half-an-inch and remove. Wait for a few minutes to see if the product
causes undue irritation. If not, proceed:
4. To use the Intraurethral Tri-Mix, first urinate to provide some moisture in the urethra. Then,
put on any venous constriction device such as Actis at this time so it is gently snug around the
base of the penis. Read the Warnings above. Open the tip of the penis by gently squeezing it
top-to-bottom. Insert the tip of the applicator at least half-an-inch and depress the plunger of the
syringe the desired distance--no more than four of the smallest markings (0.04 cc)
5. If so instructed, start with the lowest dose, equivalent to 250 micrograms of alprostadil or one
small mark on the syringe barrel. If there is little or no effect after 10 minutes, that dose may be
repeated or the next higher dose of 500 micrograms (2 marks) may be tried. Note the total
effective dose and if no unpleasant side effects occur, the total dose may be used on the next
occasion, after 12-24 hours. Do not exceed a dose of 1000 micrograms alprostadil on any
occasion.
6. Remove the applicator from the penis. Immediately hold closed the tip of the penis and
massage the medicine down the length of the shaft. Hold the tip of the penis closed for 30
seconds or so to ensure adequate absorption. If the dosage is correct, erection should begin
within 5-10 minutes and persist for 30-60 minutes. Wipe the end of the catheter with an alcohol
pad and return the syringe to the freezer.
7. If you get an erection that lasts more than 4 hours without subsiding at all, go to the nearest
emergency room with this prescription to show the physician. Failure to seek treatment for
persistent erection may cause permanent penile damage and impotence.
I understand that this product contains pharmaceuticals in a form and for a use not
endorsed by the Food and Drug Administration (off-label use of approved drugs), and that
these medications are being dispensed in non-standard packaging.
Signature of Patient: ________________________________________ Date _____________
Signature of prescribing physician____________________________________________
James D. Shoemaker MD PhD Office telephone: 314-977-9230, Pager: 460-9111
Office Address: St. Louis University Health Sciences Center, 1402 S. Grand, St. Louis, 63104
U.S. Law prohibits dispensing of this product without a physician’s prescription.