How to Freeze or Refrigerate Trimix? How Long Does it Last?

Erectile dysfunction (ED) affects about 150 million men worldwide and is expected to increase to over 300 million by 2025.
 
While there are various treatments for ED, including oral medications, vacuum pumps, or urethral suppositories, penis injections, like Trimix or Caverject, can provide great results when others fail.
 
Trimix is the most widely prescribed one. But this individualized combination of 3 erectile dysfunction drugs is quite unstable and requires rigorous storage and temperature conditions.
 
Understanding how to properly store your Trimix vials and syringes is essential for the success of your treatment.
 

What is Trimix?

• Alprostadil, a prostaglandin E1 analog, relaxes the muscles and widens the blood vessels in the penis to increase blood flow.
• Papaverine is a vasodilator that relaxes the blood vessels and makes it easier for blood to pass through the penis.
• Phentolamine is an alpha-blocker that blocks the action of adrenaline and prevents it from constricting blood vessels. 

When these 3 drugs are combined in the correct dosage, they can produce a more potent and longer-lasting erection than using any of these drugs alone.
 
The dosage is tailor-compounded by the pharmacy according to individual requirements and doctor’s prescription. It generally comes in small glass bottles (5 to 50 mL vials) and must be injected with disposable small-needle syringes.
 
Like similar penile injections, such as Caverject, Bimix, or Quadmix, Trimix is administered via intracavernous injection (an injection into the base of the penis). At first, most men experience anxiety or discomfort at the mere idea of injecting Trimix into their penis. However, it is painless when performed correctly with the appropriate injection technique.
 
Trimix should not be used more than 3 times a week, and patients should wait at least 24 hours between two doses. Overuse of penile erection injections can increase the risk of developing side effects such as priapism (prolonged erection), penile fibrosis (the formation of scar tissue), and others. Besides, this medication must be taken under medical supervision. Never take Trimix if it has not been prescribed to you.

Related article: A Step-By-Step Guide to Injecting Trimix Correctly!

How to Store Trimix? How Long Does it Last?

Trimix is a liquid injectable drug that comes in small vials. Unfortunately, the active ingredients are unstable, limiting how long Trimix can maintain its potency when stored at room temperature or refrigerated.
 
Different compounding pharmacies manufacture Trimix, so it may have different shelf life depending on its dosage and composition. Therefore, patients must always refer to the specific storage instructions delivered with their medication.
 
However, some general rules can be applied regarding Trimix storage conditions:

• Open in-use Trimix vials should be stored in the refrigerator.
• They can be left at room temperature for short periods of time only.
• Stocks of unopened Trimix vials must be stored in the freezer.

But let’s dig a bit deeper.

Related article: Does Insulin Need to Be Refrigerated?

How long does Trimix last in the freezer?

According to Olympia Pharmaceuticals, unopened vials of Trimix should be stored in the freezer and kept frozen at 0°F - 31°F (-18°C - 0°). When frozen, it can last for 6 months and up to one year.

How long does Trimix last in the refrigerator?

Once you’ve unfrozen, opened, or started to use a vial of Trimix, it can't be put back in the freezer but must be stored in the refrigerator, ideally between 32°F – 39°F (0°C - 4°C).
 
Most domestic fridges’ inside temperature is set at 36°F - 46°F (2°C - 8°C). For optimal storage conditions, you should lower your fridge temperature to the recommended range.
 
According to the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH), Trimix lasts about one month in the refrigerator.

How long can Trimix stay at room temperature?

For user convenience, most Trimix manufacturers agree that the drug can stay at room temperature for short periods of time while in use, typically from a few hours to a day at the most. 
 
However, leaving your vials out of the fridge must remain occasional. Room temperature exposure must be avoided, and the vials must be put back in the refrigerator immediately after use.  
 
Related article: Does Testosterone Need to Be Refrigerated?

What happens if Trimix isn’t stored correctly?

If Trimix is not stored correctly, its efficacy may be compromised, and it may not work as intended, leading to inadequate erectile dysfunction treatment.
 
A study on the long-term stability of Trimix[1] found that alprostadil was the most unstable of the three active drugs in the mixture. It lost about:

• 8% potency in five days at room temperature.
• 11% potency after 2 months in the refrigerator.
• Less than 5% potency when frozen for 6 months.

Additionally, exposure to high temperatures, direct sunlight, or moisture can cause the medication to degrade quicker or become contaminated. Trimix that has not been stored correctly or has passed its expiration date should not be used. Any unused solution should be discarded.

How Long Can You Keep Trimix in a Syringe?

• Up to 6 months (sometimes a year) when frozen.
• Up to 1 month when refrigerated.
• A few hours (up to one day) when at room temperature.

Remember that these general rules may not necessarily apply to your individual Trimix composition. Always ask for your doctor's or pharmacist's advice and double-check the specific storage instructions for your vials of Trimix.
 
Related article: How to Travel with Refrigerated Medications?

FAQs About Storing Trimix

Can you refreeze Trimix?

Like any drug or product, thawing and refreezing Trimix repeatedly is not recommended. Besides the risks of bacterial growth and contamination, refreezing after it has thawed can cause the erectile injection drug to degrade, lose potency, and become ineffective quicker.
 
Once Trimix is thawed, it should be used within a specific time frame, typically 30 days if refrigerated, one day if at room temperature, or as instructed by the manufacturer.

What happens if Trimix gets warm?

Trimix can stay at room temperature for a few hours (up to a day). But that does not mean it can be exposed to heat.
 
By room temperature, pharmaceutical companies generally mean anything below 77°F (25°C). Exposure to higher temperatures can lead to very quick degradation of your medicine.  

• Never let your Trimix vials get warm.
• Always transport them in a medical-grade cooler.
• Do not place them near heat sources, stoves, fireplaces, barbecues, etc.
• Never expose Trimix to direct sunlight.
• Don't leave vials or syringes in the car.
• Do not warm Trimix to unfreeze it. 

If you suspect your Trimix has been exposed to high temperatures, it is important to check the solution's appearance before using it. If the solution appears discolored, cloudy or has particulate matter, it should be discarded and not used. When it doubts, throw it away and get a new vial from the freezer.

Can you freeze Trimix in a syringe?

Yes, you can freeze Trimix in a syringe. To preload Trimix syringes for freezing, follow these steps:

1. Clean the stopper on the vial with an alcohol swab, as you would typically do.
2. Draw up your prescribed dose of Trimix into a new disposable syringe, making sure to add a tiny bit extra.
3. Put the needle cap back on the syringe. Do not use alcohol to clean the needle; it could remove the lubricant.
4. Place your preloaded Trimix syringe in the freezer with the needle facing up so that any air bubbles would stay at the top. This ensures that if the Trimix solution expands when frozen, it will only push out air, not the medicine.

Let your frozen Trimix syringe thaw before using it. Then, push out the air and a small amount of liquid from the needle to ensure the syringe works correctly.

How long does it take for Trimix to unfreeze?

It depends on the size of the container! Generally, a vial of Trimix takes about 15-20 minutes to thaw when sitting at room temperature, while a syringe should take 5-10 minutes only.
 
If you need it faster, gently roll your Trimix vial or syringe in your palms. But never use a microwave or any heat source, as it could destroy your injection. 
 
It's essential to let the penile injection completely thaw before drawing it and injecting it to ensure no solid particles are left inside, as it could impair the injection process.

Related article: How to Ship Refrigerated Drugs?

What happens if you use expired Trimix?

Using expired Trimix may be ineffective or even unsafe, as the medication's potency may have decreased, and its composition may have degraded or become contaminated, increasing the risk of infections or other adverse effects.
 
Expired Trimix should not be used. Any unused medication should be safely disposed of according to local guidelines.
 
Trimix is an odorless, colorless, and slightly yellow liquid. Cloudiness or the presence of particles may indicate it has gone bad.

How to travel with Trimix?

Because of its rigorous storage conditions, traveling with Trimix injections can be challenging. But you’re in luck, as 4AllFamily designs medical-grade portable travel coolers that guarantee your vials and syringes stay refrigerated while traveling! 
 
Related article: Essential Tips for Traveling with Trimix Injections!
 
What about you? Have you been prescribed Trimix injections? How do you store your vials and syringes at home?

References:

[1] Trissel LA, Zhang Y. Long-term stability of Trimix: a three-drug injection used to treat erectile dysfunction. Int J Pharm Compd. 2004 May-Jun;8(3):231-5. PMID: 23924676. https://pubmed.ncbi.nlm.nih.gov/23924676/