TRIMIX INSTRUCTIONS

(PAPAVERINE/REGITINE/PROSTAGLANDIN E-1)

1. Wait 3 days between injections.

2. Do not inject more than 6 times a month.

3. Keep mixture refrigerated, as effectiveness will decrease if left at higher temperatures.

4. Your initial dose is ___cc. Wait 3 days before increasing dosage. Increase by 0.05 cc until a satisfactory dose is reached. The maximum dose is 0.50 cc. Do not be discouraged by a poor result with the first few injections, as the initial dose has been kept low to avoid a prolonged and painful erection (priapism).

5. Return to the office in 1 month for an interval evaluation and bring this worksheet. This is to be sure that you are not experiencing any difficulty and to check for scarring at the injection sites.

6. If you have any questions regarding the above instructions, please do not hesitate to call.

7. If your erection lasts longer than 1½ hours, you may take Sudafed, 60 mg orally (available without a prescription), apply an ice pack, and wait another hour. If the erection is still persistent, call IMMEDIATELY (713-798-4001). You will be instructed to go to an Emergency Room (if after hours), or to the Scott Department of Urology.

8. Instructions to attending doctor for treating a prolonged erection:

Dilute 1 amp (10 mg) of Neo-Synephrine (phenylephrine) in 9 cc of normal saline (this is now 1 mg/cc). Inject 0.3-0.5 mg (cc) of Neo-Synephrine intracavernosally every 10 minutes until detumescence occurs, up to a maximum dose of 2 cc. If this is unsuccessful in decreasing the erection, irrigate the corporeal bodies with a 19 gauge butterfly needle, one in each corporeal body, with a mixture of Neo-Synephrine in normal saline as follows: 1 amp (10 mg) of Neo-Synephrine injected into 250 cc of normal saline. Use this solution to irrigate in-and-out of the corpus cavernosum.

TRIMIX SELF-INJECTION PROCEDURE

MAJOR STEPS

1. GETTING SET UP

2. PREPARE THE SYRINGE

3. SELECT AND PREPARE THE SITE FOR INJECTION

4. INJECT TRIMIX AND APPLY COMPRESSION

DETAILED PROCEDURE

1. GETTING SET UP

a. Proper hygeine is important. Wash your hands and keep the penis clean.

b. Assemble the following:

-Bottle of Trimix

-Alcohol pad

-Syringe

c. Keep the Trimix cold by returning the bottle to the refrigerator, or by placing the bottle in a cup of ice.

STEP 2: PREPARE THE SYRINGE

a. Wipe the rubber top of the vial with an alcohol pad.

b. After removing the cap of the needle, pull the plunger back to the desired dosage, filling this volume with air. Use a new needle and syringe each time.

c. Insert the needle through the rubber top and inject the air into the vial.

d. Turn the vial with needle and syringe inserted upside down. Pull back on the syringe plunger in a slow and steady motion until the desired dosage is achieved.

e. Tap the side of the syringe (1cc tuberculin syringe with a 29 gauge needle) to allow any air bubbles to float towards the needle. Avoid having these air bubbles in the syringe when self-injecting by first injecting out the collected bubbles that may form.

f. Remove the needle from the bottle and replace the protective cap on the needle.

STEP 3: SELECT AND PREPARE THE SITE FOR INJECTION

a. The proper location for injection is at the 9-11 and 1-3 o'clock positions, between the base and mid-portion of the penis.(see diagram) Avoid the midline because of potential for injury to the urethra (6 o'clock; for urinary passage) and the penile arteries and nerves (near 12 o'clock). Avoid any visible veins or arteries on the surface.

b. Grasp and pull the head of the penis toward the side of your leg with the index finger and thumb (use the left hand, if right handed). While maintaining light tension, select a site for injection.

c. Clean the site with an alcohol pad.

STEP 4: INJECT TRIMIX AND APPLY COMPRESSION

a. With a steady and continuous motion, penetrate the skin with the needle at a 90 ^o angle. The needle should then be advanced to the hub. Slight resistance is encountered as the needle passes into the proper position within the erectile tissue (corporeal body).

b. Inject the Trimix over approximately 4 seconds. Withdraw the needle from the penis and apply compression to the injection site for approximately 1 minute. Several minutes of compression may be required to avoid bleeding, especially if you are an aspirin user.

c. Replace the cap on the needle and dispose of properly.