Erectile Injections Reviewed
If you’ve tried other easier forms of erectile treatment – like drugs or herbal supplements like Herbal Ignite – and have found they are not suited to your needs, the next best way to get your sex life up and running is to consider erectile injections.
Erectile dysfunction injections are based on alprostadil, an ED drug that was approved long before sildenafil (Viagra) and are one of the most effective erectile dysfunction treatments, but have never enjoyed the popularity of oral capsules because of “needle fear.”
But some men who find Viagra or other erection drugs work for them still prefer injections because “they only work in a localised area, and don’t affect the whole body.” (Comment on Caverject User Reviews site)
There are several different brands of erectile injections available and we review the different types Australian men may be offered below.
Pros and Cons of Different Erectile Injections
Made by Pfizer, contains Prostaglandin E-1 in a synthetic form (alprostadil)
The Caverject Impulse is supplied as a needle and syringe that contains both the powder medicine and the sterile liquid. The dose is automatically mixed when you turn a dial on the end of the syringe.
The unit is a disposable, single-dose, dual chamber syringe system consisting of a glass cartridge which contains sterile, freeze-dried alprostadil in the front chamber and sterile bacteriostatic water for injection in the rear chamber. The alprostadil is reconstituted with the sterile bacteriostatic water just before injection.
Caverject Impulse: Pros
- Popular in Australia, named as one of the best by sexual health expert Dr Michael Lowy at Sydney Mens Health
- Easier to use than the Caverject, with a fine needle which minimises pain.
Caverject Impulse: Cons
- Alprostadil on its own is not effective for some men who may need a combination mix
- Alprostadil can cause a dull mild to medium ache in the groin – once again leading men to bypass it for other combination mixes.
- The very fine needle may be more prone to breaking off than the larger gauge one. There is an unconfirmed web report of a man allegedly suing Pharmacia Upjohn because he the needle snapped in his penis had to be surgically removed.
- The delivery system has been criticised as cumbersome, even for health professionals with experience in using syringes.
Also made by Pfizer, contains Alprostadil (synthetic version of Prostaglandin E1) like the Caverject Impulse, but with a different syringe delivery system.
- Many men who would not otherwise get an erection finds it works very satisfactorily for them
- The unit is portable and does not require refrigeration until you mix the ingredients.
- It’s expensive compared to other injection products
- The needle is larger than the fine 29 – 30 gauge ones typically used by diabetics
- Some men mix the powder and liquid using the large needle supplied and then change to a smaller needle for the injection – but this is less convenient.
- Has the same drawbacks as the Caverject Impulse in terms of using Alprostadil – it doesn’t work for some men and causes groin pain for some.
Made by Schwarz Pharma, and like the Caverject and Caverject Impulse contains the drug alprostadil (synthetic Prostaglandin E1)
- Safe and effective treatment
- Complaints it is expensive compared to compound pharmacy products
- Edex User Reviews complain the needle is too large and hurts like hell
- Aprostadil can cause groin pain
The Swedish injection Invicorp which is recommended by some Australian specialists contains a mixture of phentolamine and the drug avaptadil (also known as a vasoactive intestinal polypeptide (VIP).
Invicorp is approved for sale in Europe but not in the US, and is one of the leading erectile injections used in Australia, according to the Virtual Medical Centre which claims to be “Australia's leading medical information website.”
- Shown in clinical trials to be as effective or more effective than similar products
- Virtually pain free in comparison to its competitors
- Needle is finer than that of some of its competitors
- Negligible risk of getting erections lasting too long (more than three hours)
- Information not as readily available for lay people (no website)
- Same general disadvantages as all injection therapies – needle fear and lack of spontaneity
Specially Compounded Injections
Most doctors will start by recommending alprostadil in Caverject, Caverject Impulse or Edex formulations.
If this does not work or causes unpleasant side effects, your doctor can prescribe a mix prepared by a compounding pharmacy to meet your individual needs.
Ask about Bi-Mix or Tri-Mix (also known as Triple P, which is the next most used combination after alprostadil (Prostaglandin)
The most common compound pharmacy injectables for ED
1) Bi-Mix: Papaverine + Phentolamine
Several studies beginning in 1985 have established Bi-Mix has a success rate of of 70 - 72 per cent versus 20% with papaverine alone.
Usual prescribed strength: Papaverine 6-25mg + Phentolamine 0.05-2.0mg/ml
2) Tri-Mix or Triple P: Papaverine + Phentolamine + Alprostadil
Combination therapy was first introduced in 1991 by AH Bennett and his colleagues who demonstrated a success rate of TriMix of 92%.
Usual prescribed strength: Papaverine 18-25mg + Phentolamine 1.0-2.0mg + Prostaglandin E1 10-25mcg/ml
3) Quad-Mix: Papaverine + Phentolamine + Alprostadil + Atropine
Quad-Mix includes the addition of atropine. In a study conducted by Israilov and colleagues, 54 per cent that failed Tri-mix had a positive response to Quad-mix.
Usual prescribed strength: Papaverine 20-25mg + Phentolamine 1.5-2.0mg + Prostaglandin E1 20-25mcg + Atropine 0.02-0.08mg/ml
- Greater chance of success because they are individually formulated
- Smaller chance of groin pain associated with alprostadil
- More economical than “Big Pharma” commercial injections
- Usually reserved for men who fail alprostadil (PGE-1), fail Bi-Mix or for patients with severe penile pain from prostaglandin E1
- Injections are not commercially available and must be mixed by a compounding pharmacy
- Requires an initial greater commitment to find an injection which will work
- The risk of developing penile fibrosis is higher with Tri-Mix
- Tri-Mix carries a higher risk of priapism than Caverject/Edex.
- Because the compound medications are pre-mixed they need to be kept refrigerated.
Reach Medical in the US are now selling Vaso - ject, pre-loaded Bi-Mix and Tri-Mix syringes by prescription only in some states.