Trimix treatment supposes using Phentolamine, Papaverine, and Alprostadil three main drugs for an injection which is made to the shaft of the penis.
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Papaverine
Papaverine is a drug that causes blood vessels to expand (vasodilator); it produces an erection by allowing for increased blood flow to the penis. Papaverine interacts with adenylate cyclase resulting in increased cyclic adenosine monophosphate (cAMP) production, ultimately resulting in increased erectile capacity by relaxation of penile smooth muscle.
This drug was one of the first effective therapies for erectile dysfunction administered by penile injection. Papaverine works by inhibiting phosphodiesterase nonspecifically, there are also multiple other mechanisms by which this drug acts to improve erectile capacity.
Papaverine’s ability to decrease resistance to venous outflow has been replicated in clinical studies.
Phentolamine
When injected into the penis, Phentolamine induces an erection by relaxing and dilating the blood vessels of the penis, as well as by elevating cardiac output.
Phentolamine is classified as an Alpha-Adrenoceptor Antagonist. Noradrenaline affects the smooth muscle tone of the penile tissues by keeping the corpora cavernosa in a contracted state. By blocking the functional noradrenaline receptors, the Alpha-Adrenoceptor, erectile response can be achieved.
The Alpha-Adrenoceptor Antagonist of phentolamine is considered to be complex. The non-selective receptor blocking action interacts with adrenergic nerves in a complex fashion.
Prostaglandin E1
A potent hormone-like substance that induces erection by relaxing the penis’s blood vessels and dilating cavernosal arteries-dilation of the cavernosal arteries is accompanied by increased arterial inflow velocity and increased venous outflow resistance allowing for more blood into the penis and less blood out.
Medications to activate alternative relaxant pathways in addition to prostaglandin E1 may be necessary for patients who fail to respond to prostaglandin E1.
The known effects of prostaglandin E1 include systemic vasodilation, prevention of platelet aggregation, and intestinal activity stimulation.
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